Day-to-day cover

Benefits guide - English
Benefits guide - Afrikaans

Select plan

  • Day-to-day limit

    Member without dependants: R6 780
    Member with dependants: R9 270

    Benefit 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 year

    100%

    at Transmed rate

  • 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

  • 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

  • Specialist consultations

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

    Paid at the Transmed rate

    100%

    at Transmed rate

  • 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 310 per family per year, with a maximum of R250 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

  • 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

  • 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

  • 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 R730, including refraction, glaucoma screening, visual field screening and artificial intelligence screening for the detection of diabetic retinopathy

    Frames/Spectacles/Lenses
    R1 000 towards frame and/or lens enhancements together with 1 pair of clear, single-vision lenses to the value of R210 or clear, bifocal lenses to the value of R445 or clear, multifocal lenses to the value of R820

    OR

    Contact lenses
    Limited to R1 380

    NON-NETWORK BENEFIT
    Services out of the network will have a co-payment for member's own account

    Examination
    Limited to 1 consultation to the value of R350

    Frames/Spectacles/Lenses
    R800 towards frame and/or lens enhancements, together with 1 pair of clear, single-vision lenses to the value of R210 or clear, bifocal lenses to the value of R445 or clear, multifocal lenses to the value of R820

    OR

    Contact lenses
    Limited to R1 380

    Please call PPN on 0861 103 529

    100%

    at Transmed rate

  • 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

  • Specialised dentistry

    Benefit provided through DENIS

    Subject to protocols and limitations

    Limited to R4 770 per family per year

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

    Paid at the Transmed rate

    Pre-authorisation required for all specialised procedures

    Please call 0860 104 941

    100%

    at Transmed rate

  • Orthodontics

    Benefit provided through DENIS

    Subject to protocols and limitations

      Limited R9 480 per beneficiary younger than 18, once in a lifetime

      Paid at the Transmed rate

    Pre-authorisation required
    Please call 0860 104 941

    100%

    at Transmed rate

  • Dentures

    Benefit provided through DENIS

    Subject to protocols and limitations

      Subject to availability of funds in the specialised dentistry limit of R4 770 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 104 941

    100%

    at Transmed rate

  • 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

  • Traditional healers

    No benefit