Issue link: https://www.hub.camaf.co.za/i/1541115
MEMBER GUIDE - ALLIANCE PLUS & ALLIANCE NETWORK 12 Day-to-day Benefits Day-to-day benefits limited to an overall collective limit - paid at 80% CBT rate. The difference can be paid from Medical Savings Account. Benefits below are subject to the overall annual limit Annual Overall Limits Adult R46 160 Child R28 750 GPs and Dentists Dental x-rays performed by dentists, consultations and procedures performed by these practitioners; basic dentistry 80% CBT Nominated Network GP for Alliance Network Specialists Consultations, procedures and radiology performed by these practitioners 80% CBT (on referral from a nominated network GP for Alliance Network) Acute Medication Including injections and materials 80% SEP plus dispensing fee, subject to MMAP, co-payment from MSA (on referral from a nominated network GP for Alliance Network) Non-DSP Visits to doctor's rooms One visit per beneficiary 80% CBT for Alliance Network for non-network or non-nominated GP Casualty and Out Patient Treatment at a Hospital 80% CBT Nurse Visits 80% CBT up to 21 days Supplementary Health Audiology, Chiropractors, Dieticians, Homeopaths, Occupational Therapy, Physiotherapists, Biokineticists, Podiatry and Speech Therapy 80% CBT (on referral from a nominated network GP or from a specialist for Alliance Network) Advanced Dentistry Crowns, Bridges, Orthodontics, Dentures 80% CBT limited to: M0 R23 535 M1 R35 175 M2+ R42 420 Dental Implants R68 250 per beneficiary for the case as a whole (facility fee and provider accounts) Health Check Boost Day-to-day top up benefit (allocated once all 3 required screenings are completed in the same benefit year). The benefit is non-transferable, does not roll over, and is applied per beneficiary per benefit year. R500 per beneficiary Not available for pharmacy benefits. Over the Counter Medication 80% SEP plus a dispensing fee, subject to MMAP, co- payment from MSA, limited to R5 810 per beneficiary Laser K/Excimer Laser Benefit not available if spectacles or contact lenses claimed in the previous 12 months. If Laser K benefit is utilised, no spectacle and contact lense benefit for 24 months. 80% CBT limited to R17 825 per beneficiary per eye