SelfNET 2019

SelfNET – Networked


Download Detailed Benefits:

Detailed Benefits 2019

A great medical aid option specifically designed in conjunction with our Designated Service Provider Network to cover everyday and accident events. Get the peace of mind that you and your family are covered.

  • Hospital cover – Subject to a DSP network, limited to PMB conditions.
  • 25 PMB Chronic Conditions
  • 3 Non PMB Conditions – Adenoidectomy, Tonsillectomy, Grommets
  • General Practitioners Consultations – Unlimited, 100% of Network Rate via the Network GP for all medically necessary
    consultations per beneficiary. Cover includes basic primary care services. Minor trauma treatment subject to the listed tariffs.
  • Specialist Practitioners Consultations – 100% of Network Rate via the Network Provider, subject to a combined limit of R 1,185.00 per Beneficiary per year for cost of consultation, medication, procedures and Radiology and Pathology related to the authorised out of hospital specialised visit, limited to a maximum of R 2,370.00 per family per year.
  • Spectacles and Contact Lenses – One pair of clear standard mono-focal, bi-focal or multi-focal lenses plus standard frame from a selection OR one set of approved contact lenses to the value of R 480.00 per Beneficiary per 24 months at the Network Optometrist. Frames other than the pre -selection of frames limited to R 185.00.
  • Basic dentistry – 100% of the Network Rate, subject to the Network protocol and the use of the Network Dentist.
  • Basic Radiology – 100% of Network Rate, subject to the Network protocol, formulary and referral by a Network GP.
  • Basic Pathology – 100% of Network Rate, subject to the Network protocol, formulary and referral by a Network GP.
  • MRI-, CT scans in and out of hospital – 100% of the Network Rate for MRI-, CT scans, performed in or out of hospital, subject to PMB regulation, obtaining a PAR, motivation and approval. MRI and CT scans will be covered to a maximum of R 500.00, should scan confirm non-PMB condition, subject to the General Practitioner – Out of Network/ Emergency visits limit of R 1,050.00 per annum.
  • Maternity – Subject to pre-authorisation and Network Provider referral process.
  • Outpatient treatment at hospital facility/Out of Network Consultations – Benefits as described in respect of Medical Practitioners, limited to three consultations, subject to R 1,050.00 limit. Account payable upfront by member and submitted to Network for refund in accordance with the Network protocol and benefit limit.