Other benefits
Alcohol and Drug treatment
If you are on the Managed Care Plan and you or dependants require treatment for alcohol or drug dependency, you will need to obtain authorisation for the admission by phoning 0860 222 633. SANCA (The South African National Council for Alcoholism and Drug Dependence) or SANCA registered facilities, are the Scheme Designated Service Provider (DSP) for alcohol and drug treatment. Hospitalisation is limited to 21 days.
Out of hospital alcohol and drug treatment is limited to funds in the Medical Savings Account.
Kidney Disease
Anglo Medical Scheme manages renal (kidney) dialysis and transplants to ensure that the correct treatment protocols are adhered to and that members get the most cost-effective care.
Should kidney failure occur, members need to ensure that their specialist contacts the Scheme to authorise a treatment plan.
Once the application has been assessed and authorised, the appropriate treatment may begin.
Managed Care Plan members need to phone the Scheme on 0860 222 633.
Organ Transplant
The Scheme funds organ transplants in accordance with the organ transplant management programme. Call 0860 222 633 to register on the program and to receive authorisation. Cover includes the harvesting of the organ, post-operative care of the member and the donor and anti-rejection medicine. All costs for the organ donation for any person other than a member or registered dependant of the Scheme are excluded.
Oxygen therapy
If you have been diagnosed with chronic obstructive airways disease and require oxygen therapy, please contact the Call Centre on 0860 222 633 for more information.
Radiology
We fund all PMB radiology at 100% of the Scheme Reimbursement Rate (SRR) according to Scheme protocols. You are entitled to 100% of the SRR for radiology services and costs of materials. These include specialised radiology (i.e. MRI and CT scans, Isotope therapy, mammogram and one bone densitometry scan).
Bone densitometry scans are limited to one per beneficiary per year.
Call 0860 222 633 for authorisation.
Pathology
We fund all PMB pathology at 100% of the Scheme Reimbursement Rate (SRR) according to Scheme protocols.
The Scheme will not pay for DNA testing and investigations, including genetic testing for familial cancers and paternal testing.
Hospice
Managed Care Plan funds hospice services instead of hospitalisation (in-patient care facility and out-patient home care). To obtain an authorisation call 0860 222 633. Subject to Scheme protocols.
Cancer screening tests
A male beneficiary is entitled to one Prostate Specific Antigen (PSA) screening test annually at age 50 and above and a female beneficiary to one Pap smear (cervical cancer screening) from age 21 - 65, unless motivated by your doctor.