Issue link: https://www.hub.camaf.co.za/i/1541117
2026 11 Out of Hospital Benefit and Extent of Cover Choice The DSP for audiology consultations and obtaining Hearing Aids is HearConnect for both Vital Plus and Vital Network. The benefit is subject to pre-authorisation and reimbursed at DSP rates. Co-payments will apply if the DSP is not used. Preventative Wellness Cover Preventative programme accessible to all beneficiaries. One consultation per beneficiary per annum with a GP, specified Specialists, dietician, dentist - for a general checkup only and optometrist for an eye test - paid at CBT rate, and one health risk assessment (to be done at network pharmacy). Additionally, screening benefits (melanoma, PSA, pap smear, mammogram) and certain vaccines are covered under this benefit. Post-hospital Cover Post-hospital cover for a period of 90 days. Benefits other than Day-to- day benefits Subject to an Overall Annual Limit of R21 000 per Beneficiary (please consult your benefits brochure for details of monetary limits). Limit before PMB/CDL applies. *CBT (CAMAF Base tariff) - the maximum tariff paid to providers of health care services. For full details consult the Rules - Schedule 1. Day-to-day benefits Vital Plus and Vital Network are hospital plans with no day-to-day benefits. Do I need to have my medical or surgical appliance prescribed by a medical practitioner or can I just purchase it? You may not just purchase the appliance - it must be prescribed by a medical practitioner, whether you purchase the appliance from a pharmacy, Orthotist or Prosthetist. For details of monetary limits consult the Benefit Brochure. What happens to unused benefits at year end? Benefits run from January to December of each year. Any unused "risk" benefits are forfeited at year end and new benefits are allocated on 1 January each year. If I have not incurred any claims is there a possibility of a "no claims bonus" or any kind of refund? No - unlike the short term insurance industry, where this practice is common, medical schemes are governed by the Medical Schemes Act which does not allow this practice. As all medical schemes are "not for profit" organisations, all money in excess of the annual budget remains in the reserves of the scheme and is used for the benefits of members in paying claims. 11