Prosthesis Benefit

Vascular Prostheses and Appliances

 

Comprehensive Executive Family Savings Active Saver Essential Network Limited
 

Stents (Cardiac Peripheral and Aortic)

 

100% of Cost up to R63 168 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol

 

100% of Cost up to R63 168 per beneficiary per year
unless
obtained at
a Scheme
DSP or in
accordance
with PMB
Protocol

100% of Cost up to R63 168 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol  

100% of Cost up to R56 952 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol

 

100% of Cost up to R56 952 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol

 

100% of Cost up to R56 952 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol

 

 

 

 

PMB Only

 

 

 

Refer to Benefit Summary

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

Comprehensive Executive Family Savings Active Saver Essential Network Limited
Hip, Knee, Shoulder or Elbow only (maximum of one per beneficiary per year) Up to
R53 700 per
beneficiary per
year
Up to
R53 700 per
beneficiary
per year
Up to
R53 700 per
beneficiary
per year
Up to
R50 100 per
beneficiary
per year
 

PMB Only

Up to
R50 100 per
beneficiary
per year.
 

PMB Only

 

Refer to Benefit Summary

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

 

Comprehensive Executive Family Savings Active Saver Essential Network Limited
Spinal fixation devices (max 2 levels unless motivated) 100% of Cost up to R63 168 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol 100% of Cost up to R63 168 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol 100% of Cost up to R63 168 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol 100% of Cost up to R56 952 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol 100% of Cost up to R56 952 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol 100% of Cost up to R56 952 per beneficiary per year unless obtained at a Scheme DSP or in accordance with PMB Protocol  

 

 

 

 

PMB Only

 

 

 

 

Refer to Benefit Summary

 

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
R37 920 per
beneficiary
per year
Up to
R37 920 per
beneficiary
per year
Up to
R37 920 per
beneficiary
per year
Up to
R35 460 per
beneficiary
per year
 

PMB Only

Up to
R35 460 per
beneficiary
per year
 

PMB Only

 

Refer to Benefit Summary

 

Internal Sphincters and
stimulators

Up to
R60 720 per
beneficiary per
year
Up to
R60 720 per
beneficiary
per year
Up to
R60 720 per
beneficiary
per year
Up to
R56 916 per
beneficiary
per year
 

PMB Only

Up to
R56 916 per
beneficiary
per year
 

PMB Only

 

Refer to Benefit Summary

 

Unspecified/Unlisted above

Up to
R16 200 per
procedure per
year
Up to
R16 200 per
procedure
per year
Up to
R16 200 per
procedure
per year
Up to
R16 200 per
procedure
per year
Up to
R16 200 per
procedure
per year
Up to
R16 200 per
procedure
per year
 

PMB Only

 

Refer to Benefit Summary