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 280 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 850 for 1 beneficiary or R5 620 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
  R310 per family per year, with a maximum of R130 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

  Pregnant beneficiaries are entitled to 2 pregnancy scans

  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 R880 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 490 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 720 per family per year, limited to R860 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