Issue link: https://www.hub.camaf.co.za/i/1530521
2025 MEMBER GUIDE - NETWORK CHOICE 12 What is the time limitation for a referral? There is no time limitation on referrals for chronic conditions (CDL or additional chronic conditions). You must have an initial referral from your nominated GP to your treating Specialist. For acute conditions, referrals from your nominated GP should not be older than 12 months per condition. What if my treatment extends to the next benefit year? A nominated network GP referral can be carried over from one benefit year to the next, if the same condition requires extended treatment with repeat or follow-up visits. Please check that your nominated network GP is still on the network for the new year. What if I visit the same specialist for a new condition? You must obtain a new referral from your nominated GP for other visits to the same specialist for treatment of a new condition. How often do I need to obtain a referral to a gynaecologist when I'm pregnant? You only need to obtain a referral to see a gynaecologist for the first visit. For any subsequent follow-up visits to the same gynaecologist relating to that pregnancy, the claim must simply reflect the initial referral GP name and practice number. What if I decide to change my gynaecologist during my pregnancy? Your claim for your new gynaecologist must have your nominated GP referral. What happens if the specialist prescribes medication? Medication prescribed by a specialist for treatment is subject to the medicines benefit of R4 118. How is this account paid? If you have paid the specialist then post the account to the Claims Department at CAMAF, PO Box 2964, Randburg, 2125 or scan the account and send to claims@camaf.co.za. Please ensure that your medical aid number appears on the account as well as the referring Network doctor's details. Radiology and Pathology What happens if the specialist refers me for x rays? Basic Radiology referred by a nominated network GP or a specialist is covered at 100% CBT but the costs are subject to the radiology benefit of R5 565. What is the difference between basic and advanced radiology? Basic Radiology - black and white x-rays and soft tissue ultrasound. Advanced Radiology - CT, MRI and PET Scans. The benefit for such radiology is R47 586 (combined limit for in and out hospital) per family. Such claims require authorisation and are paid at 100% CBT. Contact 0860 100 544 for authorisation. You are entitled to have 3 ante-natal scans per pregnancy per annum and these scans are paid at 80% CBT and are subject to the advanced Radiology benefit of R47 586 (limit per family combined for in and out of hospital). Am I covered for a Mammogram? Yes - this is covered under your preventive wellness benefit for all females from 25 years of age. What happens if the specialist refers me for tests e.g., pathology? Basic Pathology tests requested by the specialist are covered at 100% CBT but the costs are subject to the Pathology benefit of R8 880 per beneficiary and the same protocols as those for a GP. BACK TO CONTENTS PAGE