Prescribed minimum benefits (PMBs)
Guardian plan
-
Treatment plan services
Paid at cost
Subject to the approved treatment plan services
Supplier of own choice may be used for PMB CDL conditions
100%
paid at cost
-
Hospitalisation
100% cover at a State hospital, subject to the UPFS
If a State hospital is not accessible in terms of the set criteria, authorisation can be obtained for admission to a hospital on the Transmed private hospital network as the secondary DSP and payable at the Transmed rate
The co-payment for the voluntary use of a non-DSP will be the amount equal to the difference between the total cost incurred in respect of the hospital services, including all related medical services, and the cost that would have been payable to the State hospital (DSP)
If the PMB service was not accessible in a State hospital,but available at a Transmed private hospital network hospital, and the member voluntarily uses a non-network private hospital, the co-payment will be the amount equal to the difference between the total cost incurred in respect of the hospital services, including all related medical services, and the cost that would have been payable to State hospital (DSP)
100%
at UPFS rate
-
Chronic medication
The Transmed pharmacy network consists of:
- Clicks pharmacy group
- Dis-Chem pharmacies
- MediRite pharmacy group (pharmacies in Shoprite/Checkers stores)
- Contracted independent pharmacies
Members may be liable for a co-payment if a pharmacy outside the Transmed pharmacy network is used
100%
at the Transmed rate