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  • Day-to-day limit

    Member without dependants: R7 620
    Member with dependants: R10 420

    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 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

  • 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 R820, including refraction, glaucoma screening, visual field screening and artificial intelligence screening for the detection of diabetic retinopathy

    Frames/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 R860

    OR

    Contact lenses
    Limited to R1 490

    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 R380

    Frames/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 R860

    OR

    Contact lenses
    Limited to R1 490

    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 R5 360 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 to R10 650 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 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 104 941

    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