Day-to-day cover
Select plan
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Day-to-day limit
Member without dependants: R7 620
Member with dependants: R10 420Benefit limits are usually allocated in calendar-year cycles (from 1 January to 31 December) and are only applicable to the current year. Most benefits follow a one-year cycle
Benefit limits will be allocated on a pro rata basis if a member joins during a year100%
at Transmed rate
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All other day-to-day benefits
Subject to the availability of funds in the day-to-day limit
Paid at the Transmed rate
100%
at Transmed rate
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General practitioner (GP) consultations
Subject to the availability of funds in the day-to-day limit
Paid at the Transmed rate
100%
at Transmed rate
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Specialist consultations
Subject to the availability of funds in the day-to-day limit
Paid at the Transmed rate
100%
at Transmed rate
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Acute and over-the-counter (OTC) medication
Acute medicine benefit
Subject to the availability of funds in the day-to-day limit
Paid at the Transmed rate
Formulary reference pricing applies
Over-the-counter (OTC) medicine benefit of R1 430 per family per year, with a maximum of R270 per event
The OTC benefit is subject to the availability of funds in the day-to-day benefit
Medication to be obtained from the Transmed pharmacy network to avoid non-network co-payments
100%
at Transmed rate
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Basic pathology (out of hospital)
Subject to the availability of funds in the day-to-day limit
Paid at the Transmed rate
100%
at Transmed rate
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Out-of-hospital radiology
Subject to the availability of funds in the day-to-day limit
For MRI and CT scans, refer to the in-hospital radiology benefit Paid at the Transmed rate
100%
at Transmed rate
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Optical benefits
Benefit provided through PPN protocols
NETWORK BENEFIT
Optical benefits are subject to authorisation by PPN and clinical protocols/prescribed rules applyBeneficiaries can claim every 24 months
Examination
Limited to 1 consultation to the value of R820, including refraction, glaucoma screening, visual field screening and artificial intelligence screening for the detection of diabetic retinopathyFrames/Spectacles/Lenses
R1 100 towards frame and/or lens enhancements together with 1 pair of clear, single-vision lenses to the value of R215 or clear, bifocal lenses to the value of R460 or clear, multifocal lenses to the value of R860OR
Contact lenses
Limited to R1 490NON-NETWORK BENEFIT
Services out of the network will have a co-payment for member's own accountExamination
Limited to 1 consultation to the value of R380Frames/Spectacles/Lenses
R880 towards frame and/or lens enhancements, together with 1 pair of clear, single-vision lenses to the value of R215 or clear, bifocal lenses to the value of R460 or clear, multifocal lenses to the value of R860OR
Contact lenses
Limited to R1 490Please call PPN on 0861 103 529
100%
at Transmed rate
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Basic dentistry
Benefit provided through DENIS
Subject to protocols and limitations
No annual limits, but only stated codes are covered
Root canal limited to 1 per beneficiary per year
Paid at the Transmed rate
Pre-authorisation required
Please call 0860 104 941
100%
at Transmed rate
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Specialised dentistry
Benefit provided through DENIS
Subject to protocols and limitations
Limited to R5 360 per family per year
Crowns
Limited to 1 per family every 2 years for beneficiaries 16 years and olderPaid at the Transmed rate
Pre-authorisation required for all specialised procedures
Please call 0860 104 941
100%
at Transmed rate
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Orthodontics
Benefit provided through DENIS
Subject to protocols and limitations
Limited to R10 650 per beneficiary younger than 18, once in a lifetime
Paid at the Transmed rate
Pre-authorisation required
Please call 0860 104 941100%
at Transmed rate
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Dentures
Benefit provided through DENIS
Subject to protocols and limitations
Subject to availability of funds in the specialised dentistry limit of R5 360 per family per year
1 set of dentures per beneficiary older than 21, every 4 years
1 set of chrome cobalt-frame dentures per beneficiary 21 years and older, every 5 years
Paid at the Transmed rate
Pre-authorisation required
Please call 0860 104 941100%
at Transmed rate
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Auxiliary services (physiotherapy, occupational and remedial therapy and audiology)
Subject to the availability of funds in the day-to-day limit
Paid at the Transmed rate
100%
at Transmed rate
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Traditional healers
No benefit