Day-to-day cover

Benefits guide - English
Benefits guide - Afrikaans

Link plan

  • All other day-to-day benefits

    Only PMB conditions
    Obtain from the Universal Healthcare network
           Paid at the Transmed rate
           Please call 0861 686 278

    100%

    at Transmed rate

  • General practitioner (GP) consultations

    Network providers
    Number of consultations per year:
    Member without dependants: 8
    Member with 1 dependant: 12
    Member with 2 dependants: 14
    Member with 3 dependants: 15

    Non-network providers
    1 consultation at a non-network provider per beneficiary per year, up to a maximum of 2 consultations per family per year

    Limited to R1 140 per event

    Paid at the Transmed rate

    100%

    at Transmed rate

  • Specialist consultations

    3 specialist consultations per beneficiary per year, up to a maximum of 5 consultations per family per year, limited to a maximum amount of R3 420 for 1 beneficiary or R5 000 per family

    Pregnant beneficiaries are entitled to 2 additional specialist consultations per year

    Specialist consultations are subject to pre-authorisation and referral by a network GP

    A 30% co-payment applies for voluntary consultations at specialists and consultations without pre-authorisation according to the agreed referral process

    Paid at the Transmed rate

    Pre-authorisation required
    Please call 0861 686 278

    100%

    at Transmed rate

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

    Acute medicine benefit

    Unlimited if according to the Universal medicine formulary and obtained from accredited Universal pharmacies

    No benefit for medicine dispensed or prescribed by a specialist if the referral process was not adhered to, unless a specialist consultation was as a result of an involuntary PMB consultation

    Paid at the Transmed rate

    Formulary reference pricing applies

    Over-the-counter (OTC) medicine benefit
    R270 per family per year, with a maximum of R110 per event
    Medication must be dispensed by a Universal network pharmacy or accredited service provider

    100%

    at Transmed rate

  • Basic pathology (out of hospital)

    Unlimited, subject to Universal network codes

    Subject to referral by Universal network GP or accredited service provider

    No benefit for pathology requested by specialist if the specialist referral process was not adhered to, unless specialist consultation was as a result of an involuntary PMB consultation

    Paid at the Transmed rate

    100%

    at Transmed rate

  • Out-of-hospital radiology

    Unlimited, subject to Universal network codes

    Subject to referral by Universal network GP or accredited service provider

    No benefit for radiology requested by specialist if the specialist referral process was not adhered to, unless specialist consultation was as a result of involuntary PMB consultation

    Paid at the Transmed rate

    100%

    at Transmed rate

  • Optical benefits

    Obtained from the Universal Healthcare network

    Examination
    Limited to 1 examination per beneficiary per year

    Frames/Spectacles/Lenses
    1 pair of single-vision or bifocal lenses and specified frame per beneficiary per year every 24 months, according to Universal Healthcare network criteria

    OR

    Contact lenses
    Limited to R780 per beneficiary per cycle

    Please call 0861 686 278

    100%

    at Transmed rate

  • Basic dentistry

    1 consultation, preventative treatment and general examination per year through a Universal Healthcare network DSP

    Fillings, extractions and dental X-rays are subject to Universal protocols and applicable Universal dental codes

    Paid at the Transmed rate

            Please call 0861 686 278

    100%

    at Transmed rate

  • Specialised dentistry

    No benefit

  • Orthodontics

    No benefit

  • Dentures

    1 set of acrylic or plastic dentures per family, every 2 years

    Limited to R4 000 per partial or full set of dentures

    Paid at the Transmed rate

    Please call 0861 686 278

    100%

    at Transmed rate

  • Auxiliary services (physiotherapy, occupational and remedial therapy and audiology)

    Obtained from the Universal Healthcare network

    Only PMB conditions

    Paid at the Transmed rate

    Please call 0861 686 278

    100%

    at Transmed rate

  • Traditional healers

    R1 530 per family per year, limited to R760 per event

    Applicable to healers registered with the Traditional Healer Council

    Members are liable for the upfront payment of the practitioners; claim forms can be obtained from
    0861 686 278 and submitted with receipts for refunds

    Paid at the Transmed rate

    100%

    at Transmed rate