Day-to-day cover
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 R4 800
M+ R8 430100%
at the Transmed rate
- GP and specialist consultations
-
General practioner (GP) consultations
Paid at the Transmed rate
Subject to the availability of funds in the general day-to-day limit
100%
at the Transmed rate
-
Specialist consultations
Paid at the Transmed rate
Subject to the availability of funds in the general day-to-day limit
100%
at the 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 the 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 the 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 the Transmed rate
-
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 retinopathy
Frames/Spectacles/Lenses
R1 045 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 R810OR
Contact lenses
Limited to R1 435NON-NETWORK BENEFIT
Members will be liable for a co-payment for out-of-network servicesExamination
Limited to 1 consultation to the value of R380Frames/Spectacles/Lenses
R836 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 R810OR
Contact lenses
Limited to R1 435Please call PPN on 0861 103 529
100%
at the Transmed rate
-
Basic dentistry
Provided through DENIS
Subject to protocols and limitations
No annual limit but only stated codes are coveredPaid at the Transmed rate
Root canal
Limited to 1 per family per yearPlease call DENIS on 0860 104 941
100%
at the Transmed rate
-
Specialised dentistry
Benefit provided through DENIS
Subject to protocols and limitations
Limited to R4 620 per family per yearPaid at the Transmed rate
Crowns
Limited to 1 per family every 2 years for beneficiaries 16 years and olderDentures
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 olderPre-authorisation required
Please call DENIS on 0860 104 941100%
at the Transmed rate
-
Orthodontics
No Benefit
-
Dentures
R1 170 stand-alone benefit per family for beneficiaries older than 21
Accounts in excess of this limit is payable from the specialised dentistry limit of R4 620 per family per yearPaid at the Transmed rate
Pre-authorisation required
Please call DENIS on 0860 104 941100%
at the Transmed rate