Prosthesis Benefit

Vascular Prostheses and Appliances

 

Comprehensive Executive Family Savings Active Saver Essential Network
 

Stents (Cardiac Peripheral and Aortic)

 

100% of Cost up to R66 600 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol

 

100% of Cost up to R66 600 per beneficiary per year
unless
obtained at
a Scheme
DSP or in
accordance
with PMB
Protocol

100% of Cost up to R66 600 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol  

100% of Cost up to R60 000 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol

 

100% of Cost up to R60 000 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol

 

100% of Cost up to R60 000 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol

 

 

 

 

PMB Only

Joint Prostheses (Subject to failed conservative treatment and Risk Management)

Comprehensive Executive Family Savings Active Saver Essential Network
Hip, Knee, Shoulder or Elbow only (maximum of one per beneficiary per year) Up to
R56 580 per
beneficiary per
year
Up to
R56 580 per
beneficiary
per year
Up to
R56 580 per
beneficiary
per year
Up to
R56 580 per
beneficiary
per year
 

PMB Only

Up to R56 580 per
beneficiary
per year.
 

PMB Only

Orthopaedic Prostheses and Appliances (Subject to failed conservative treatment and Risk Management)

 

Comprehensive Executive Family Savings Active Saver Essential Network
Spinal fixation devices (max 2 levels unless motivated) 100% of Scheme Negotiated price up to R66 600 per beneficiary per year unless obtained at a scheme DSP or in accordance with PMB Protocol 100% of Scheme Negotiated price up to R66 600 per beneficiary per year unless obtained at a scheme DSP or in accordance with PMB Protocol 100% of Scheme Negotiated price up to R66 600 per beneficiary per year unless obtained at a scheme DSP or in accordance with PMB Protocol 100% of Scheme Negotiated price up to R60 000 per beneficiary per year unless obtained at a scheme DSP or in accordance with PMB Protocol 100% of Scheme Negotiated price up to R60 000 per beneficiary per year unless obtained at a scheme DSP or in accordance with PMB Protocoll 100% of Scheme Negotiated price up to R60 000 per beneficiary per year unless obtained at a scheme DSP or in accordance with PMB Protocol  

 

 

 

 

PMB Only

 

Fixation devices – non spinal

 

 

Bone Lengthening devices

 

Implantable devices, disc
prosthesis, Kyphoplasty

Combined with above limit Combined with above limit Combined with above limit Combined with above limit  

PMB Only

Combined with above limit
 

Neuro Stimulators and Deep Brain Stimulators

Up to R39 960 per beneficiary per year Up to R39 960 per beneficiary per year Up to R39 960 per beneficiary per year Up to R37 380 per beneficiary per year  

PMB Only

Up to R37 380 per beneficiary per year  

PMB Only

 

Internal Sphincters and
stimulators

Up to R64 020 per beneficiary per year Up to R64 020 per beneficiary per year Up to R64 020 per beneficiary per year Up to R60 000 per beneficiary per year  

PMB Only

Up to R60 000 per beneficiary per year  

PMB Only

 

Unspecified/Unlisted above

Up to R17 100 per procedure per year Up to R17 100 per procedure per year Up to R17 100 per procedure per year Up to R17 100 per procedure per year Up to R17 100 per procedure per year Up to R17 100 per procedure per year  

PMB Only