Guardian plan

• General day-to-day limit

  Paid at the Transmed rate

  Includes:

  • GP and specialist consultations
    
  • Acute and over-the-counter (OTC) medication
    
  • Routine pathology and radiology

  All other day-to-day benefits not specifically mentioned above
  M0 R5 240
  M+ R9 200

  100%

  at Transmed rate

• General practioner (GP) consultations

  Paid at the Transmed rate

  Subject to the availability of funds in the general day-to-day limit

  100%

  at Transmed rate

• Specialist consultations

  Paid at the Transmed rate

  Subject to the availability of funds in the general day-to-day limit

  100%

  at Transmed rate

• Acute and over-the-counter (OTC) medication

  Paid at the Transmed rate

  Subject to the availability of funds in the general day-to-day limit

  Acute and OTC formularies apply

  Fund exclusions apply

  100%

  at Transmed rate

• Out-of-hospital pathology

  Paid at the Transmed rate

  Subject to the availability of funds in the general day-to-day limit

  100%

  at Transmed rate

• Out-of-hospital radiology

  Paid at the Transmed rate
  
  Basic radiology (X-rays)
  Subject to the availability of funds in the general day-to-day limit
  

  100%

  at Transmed rate

• Optical benefits

  Benefit provided through PPN protocols

  NETWORK BENEFIT
  Optical benefits are subject to authorisation by PPN and clinical protocols/prescribed rules apply

  Beneficiaries can claim every 24 months
  
  Examination
  Limited to 1 consultation to the value of R956, including refraction, glaucoma screening, visual field screening and artificial intelligence screening for the detection of diabetic retinopathy
  
  Frames/Spectacles/Lenses
  R1 265 towards frame and/or lens enhancements together with 1 pair of clear, single- vision lenses to the value of R225 or clear, bifocal lenses to the value of R485 or clear, multifocal lenses to the value of R850

  OR

  Contact lenses
  Limited to R1 580

  NON-NETWORK BENEFIT
  Members will be liable for a co-payment for out-of-network services

  Examination
  Limited to 1 consultation to the value of R420

  Frames/Spectacles/Lenses
  R1 012 towards frame and/or lens enhancements, together with 1 pair of clear, single-vision lenses to the value of R225 or clear, bifocal lenses to the value of R485 or clear, multifocal lenses to the value of R850

  OR
  
  Contact lenses
  Limited to R1 580

  Please call PPN on 0861 103 529

  100%

  at Transmed rate

• Basic dentistry

  Provided through DENIS
  Subject to protocols and limitations
  No annual limit but only stated codes are covered

  Paid at the Transmed rate

  Root canal
  Limited to 1 per family per year

  Please call DENIS on 0860 104 941

  100%

  at Transmed rate

• Specialised dentistry

  Benefit provided through DENIS
  Subject to protocols and limitations
  Limited to R5 090 per family per year

  Paid at the Transmed rate

  Crowns
  Limited to 1 per family every 2 years for beneficiaries 16 years and older

  Dentures
  Limited to 1 set per jaw every 4 years for beneficiaries older than 21
  Limited to 1 set chrome cobalt-frame dentures every 5 years for beneficiaries 21 years and older

  Pre-authorisation required
  Please call DENIS on 0860 104 941

  100%

  at Transmed rate

• Orthodontics

  do_not_disturb_on No benefit

• Dentures

  R1 290 stand-alone benefit per family for beneficiaries older than 21
  
  Accounts in excess of this limit is payable from the specialised dentistry limit of R5 090 per family per year

  Paid at the Transmed rate

  Pre-authorisation required
  Please call DENIS on 0860 104 941

  100%

  at Transmed rate