Savings

An option to keep you and your family covered

An option created to provide your family with the most essential medical cover. Set the foundation for your family healthcare plan.

What's Covered

Pre-authorisation (PAR) is required in respect of hospitalisation and the associated clinical procedures before treatment starts or, in case of an emergency, within the next two business days, otherwise no benefits are allowed.

Click here for help understanding our terminology.

Access the Topmed Formulary for this plan here.

Click here to download the 2019 Savings Benefit Guide.

Hospitalisation
  • Hospital CoverUnlimited Private Hospital Cover. 100% of Agreed Tariff
  • Casualty Cover (Treatment delivered on day of injury – Trauma only) 100% of Topmed Tariff . 100% of Agreed Tariff for facility fee
  • Neo-natal confinement Unlimited
  • Elective Caesarean 100% of Topmed Tariff
  • Home Birth / Water Birth Subject to a registered service provider assisting with the birth
  • Ambulance Services 100% of Agreed Tariff at preferred provider. 100% of Topmed Tariff limited to R2 328 per family per annum for non-preferred provider
  • Specialised Surgery (New technology) No benefit
  • Psychiatric admissions Case Managed and limited to 21 days per beneficiary per annum
  • Immunocompromise and Opportunistic Infections 100% of Topmed Tariff . Limited to R46 872 per family per annum
  • TTO Medication (Received on discharge) 100% of Agreed Tariff. Max 7 days supply (Topmed Reference Price and formulary applies)
  • Medical Practitioners and Specialists 100% of Topmed Tariff . Prescribed Minimum Benefits Designated Service Provider applies
  • Secondary Facilities (Step-down nursing, hospice and rehabilitation) Case Managed and limited to R139 200 per beneficiary per annum
  • Dentistry Subject to day to day benefits
  • Maxillo-Facial Surgery 100% of Topmed Tariff subject to clinical criteria and limited to jaw fractures, congenital deformaties and pathological conditions
  • Impacted Wisdom Teeth Subject to day to day benefits
  • Orthognathic Surgery No benefit
  • Scopes (Gastroscopies and Colonoscopies) (Pre-authorisation required) 100% of Topmed Tariff subject to a R2 600 co-payment per scope. If performed in a day clinic/doctors rooms no co-payment applies
Radiology and Pathology during hospitalisation
  • Radiology and Pathology 100% of Topmed Tariff
  • MRI scans, CT scans, radioisotope studies (Pre-authorisation required) 100% of Topmed Tariff subject to a R2 600 co-payment per scan
Auxillary Services during hospitalisation
  • Blood transfusions 100% of Cost
  • Physiotherapy, speech therapy, occupational therapy, social workers and dieticians 100% of Topmed Tariff
  • Clinical and medical technologists 100% of Topmed Tariff
  • Internal medical and surgical accessories (additional Pre-authorisation required) 100% of Cost subject to sub-limits as applied per clinical protocols.

Members are allocated a 16% Medical Savings Account for Day-to-day claims.

Day to Day Benefits – Out of Hospital
  • Casualty Cover (Non Trauma) 100% of Cost from Savings
  • Medical Practitioners and Specialists – Including clinical procedures, visits (Prescribed Minimum Benefits - Designated Service Provider applies), material and injection material (excluding medicine) administered in a Doctor’s consulting room 100% of Cost from Savings
  • Prescribed Acute Medication 100% of Cost from Savings
  • Reproductive Health – Oral, injectable and IUD contraceptives 100% of Cost from Savings
  • Vitamins and Minerals 100% of Cost from Savings
  • OTC Medication 100% of Cost from Savings
  • Optical 100% of Cost from Savings
  • Dentistry (Conservative and Specialised) 100% of Cost from Savings
  • Clinical Psychology and Psychiatric Treatment 100% of Cost from Savings
Radiology and Pathology – Out of Hospital
  • Basic radiology 100% of Cost from Savings
  • MRI scans, CT scans, radioisotope studies (Pre-authorisation required) 100% of Topmed Tariff subject to a R2 600 co-payment per scan
  • Basic pathology 100% of Cost from Savings
Auxillary Services – Out of Hospital
  • Physiotherapy, speech therapy, occupational therapy, social workers, dieticians, podiatry,orthoptic treatment, audiometry, hearing aid acoustics, biokinetics, chiropractors, osteopaths, homeopaths, naturopaths and herbalists 100% of Cost from Savings
  • Clinical and Medical Technologists 100% of Cost from Savings
  • External medical and surgical appliances (Pre-authorisation required) 100% of Cost from Savings
Chronic Medication (Registration required)
  • Unlimited Chronic Conditions 100% of Agreed Tariff – Designated Service Provider applies. Click here for the Topmed Formulary.
  • Prescribed Minimum Benefits / Non-Formulary / Non-Designated Service Providers 70% of Agreed Tariff
Disease Management Programmes (Registration required)
  • HIV / AIDS Case Managed and limited to Prescribed Minimum Benefits
  • Organ Transplant Case Managed and limited to Prescribed Minimum Benefits
  • Kidney Dialysis Case Managed and limited to Prescribed Minimum Benefits
  • Oncology Case Managed and limited to R298 320 pb per 12 month cycle
  • Oncology Speciality Medicines and Biologicals No benefit
  • Stomatherapy Limited to R19 980 per family per annum. Thereafter Case Managed
TopBaby Maternity Programme (Registration required)
  • Antenatal Consultations (Tariff code 0190 / 0192) 100% of Topmed Tariff limited to 12 consultations
  • Antenatal Classes (Tariff code 88407) 100% of Topmed Tariff limited to 12 classes
  • Antenatal Scans (3D and 4D scans paid at 2D rate) Limited to 2 2D scans per beneficiary per pregnancy
  • Paediatrician Consultations Limited to 2 newborn visits
  • Prenatal Vitamins Formulary applies
  • Baby Bag Yes
  • Baby Immunisations (Subject to Department of Health Protocols) 100% of Topmed Tariff
Wellness Benefits
  • Screening Benefits (Health Assessment)
  • Immunisation Programme
  • Early Detection Tests
Extended Benefits (Pre-authorisation required)
  • Post total hip replacement 8 Physiotherapy sessions within 3 months post-op
  • Post total knee replacement 8 Physiotherapy sessions within 3 months post-op
  • Post crime trauma Combined total of 12 consultations within 6 months post-event with a Psychologist, Psychiatrist or Social Worker
  • Heart Attack Case Managed. Treatment must be prescribed by the treating Cardiologist/Physician
  • Stroke Case Managed. Comprehensive rehabilitation programme including therapy from a multi-disciplinary team 3 months post-event (acute) with a Physiotherapist, Occupational Therapist and Speech Therapist
Deductibles and Co-Payments
  • Kindly refer to Benefit Guide for specific deductibles and co-payments. Scheme policies and protocols apply
Prosthesis Benefits
  • Kindly refer to Benefit Guide for specific internal medical/surgical prostheses and appliance limits. Scheme policies and protocols apply
International Business and Leisure Travel Insurance
  • Foreign claims are limited to medical expenses only as provided by the Schemes’s policy, limited to R10 million per family per year, subject to authorisation and applicable conditions. Maximum of 90 days cover, travel must be declared before departure
Savings Principal member Adult dependant Student / minor dependant
Contribution R2 119 R1 692 R638
Savings Level R404 R323 R122
Total R2 523 R2 015 R760

The Scheme only charges for a maximum of 3 children on this option. The savings levels listed are compulsory and will be added to the contributions.



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