Issue link: https://www.hub.camaf.co.za/i/1512932
2024 NETWORK CHOICE 11 OUT OF HOSPITAL Benefit and Extent of Cover Choice Members need to only use their nominated GP for GP consultations. Preventative Wellness Cover Preventative programme accessible to all beneficiaries. One consultation per beneficiary per annum with a nominated GP, specified Specialists, dentist - for a general checkup only - paid at CBT rate. Additionally, screening benefits (PSA, pap smear, mammogram) and certain vaccines are covered under this benefit up to R2 213 per beneficiary. Other benefits Not subject to an annual overall benefit limit - paid at CBT* rate, including limited external appliance benefits with specific sub-limits. Day-to-day benefits Members need to use Network service providers - sub-limits apply to some services e.g., acute medication and optical. *CBT (CAMAF Base tariff) - the maximum tariff paid to providers of health care services. For full details consult the Rules - Schedule 1. For details of monetary limits consult the Benefit Brochure. Day-to-day Cover Is there a benefit for Non-DSP and Casualty visits? Both benefits below are limited to an overall family limit of R1 675: • One non-network or non-nominated visit per beneficiary (including casualty GP), 20% co-payment AND • Casualty visits (facility fee, consumed medication and materials only). Do I have any benefit for immunisations under this option? Yes. Immunisations are covered at 100% of the SEP plus a dispensing fee, subject to MMAP and the benefit of R2 213 per beneficiary per annum. The Human Papilloma Virus (HPV) vaccine (cost of vaccine only) for female beneficiaries aged between 9 and 45 and male beneficiaries between 9 and 26 years of age is also subject to the above limit. Dentistry What is Basic Dentistry? The term Basic Dentistry means conservative and preventative dentistry, including consultations and examinations (general and specific), preventative treatment, cleaning and fluoride treatments, pain and sepsis treatment, infection control, permanent fillings and extractions, emergency treatment and basic x rays. Do I have an Advanced Dentistry benefit? The Advanced Dentistry benefit is R8 220 per beneficiary per annum, payable at 100% CBT; this includes Orthodontics. After Hours Fees Will my after-hours fee be covered if I need to consult outside of normal hours at Medicross? No. CAMAF will pay the consultation at normal rates and you will be liable for the after-hours fee. Specialists What must I do to see a specialist? You must be referred by your nominated network GP. These consultations are covered at 100% of CBT and the benefit is R12 070 per family per annum. Please ensure that your referring GP's name and practice number appear on the specialist account or your claim will be rejected. Do I need to obtain another GP referral for subsequent or follow-up visit(s) to the same specialist for the same condition? No, you only need to obtain a nominated network GP referral to see a specialist for the first visit. For any subsequent or follow-up visits relating to the same condition, the specialist claim should simply reflect the initial referral GP name and practice number. 11 BACK TO CONTENTS PAGE