Managed Care Plan
Overview
Managed Care Plan offers the following comprehensive benefits:
- Unlimited hospital cover paid at 100% of the Scheme Reimbursement Rate (SRR)
- The Top-Up rate pays up to a maximum of 230% of the SRR for specialist services in hospital, excluding pathology, radiology, allied healthcare services and GPs performing specialist services (230% = 100% SRR + additional 130% of SRR)
- A Medical Savings Account for out of hospital services and discretionary spend
- Unlimited Radiology and Pathology
- Frail care where clinically required
- Extensive chronic medication
- Voluntary use of a GP network (no co-payments)
- Reimbursement for specialist consultations and procedures out of hospital up to 125% of SRR
Contributions are split as follows:
- 21% allocated to savings, for discretionary spend.
- 79% allocated to limited/unlimited benefits
This category of benefit provides cover for procedures over which members have little or no control and includes benefits such as:- Prescribed Minimum Benefits (PMBs)
- Non-PMB Chronic medicine subject to authorisation
- Cancer, diabetes and kidney treatment, subject to registration on the disease management programmes.
Contributions (excluding savings) | ||
---|---|---|
Member | Adult dependant | Child dependant |
R4 650 | R4 650 | R1075 |
Savings | ||
---|---|---|
Member | Adult dependant | Child dependant |
R1 235 | R1 235 | R285 |
Total contribution (including savings) | ||
---|---|---|
Member | Adult dependant | Child dependant |
R5 885 | R5 885 | R1 360 |
*2023 benefits and contributions are subjected to the approval of the Council for Medical Schemes.