For all consultations (doctor, nurse, allied healthcare provider and specialist), including maternity consultations, members of the Value Care Plan will need to use Prime Cure facilities and the practitioner network.
Consultations at a Prime Cure Network pharmacy clinic with a nurse for minor illnesses
Limited to R640 per family per year, up to a maximum of R320 per visit.
Unlimited visits to any Prime Cure Network GP. Pre-authorisation is needed from the Prime Cure Call Centre on 0861 665 665 before the 7th visit. If no pre-authorisation is obtained, there will be a 30% co-payment for Prescribed Minimum Benefit conditions Non-Prescribed Minimum Benefit conditions will not be covered.
You will have 1 (one) visit per beneficiary or 2 (two) visits per family per annum to a non-Prime Cure Network GP or registered emergency medical facility, limited to a total cost of R1 215 per visit, including any medicine or additional services, such as radiology and pathology tests.
Authorisation is needed within 72 hours of the visit. You will be required to pay the claim and thereafter submit a claim to Prime Cure for reimbursement.
You can visit a Dis-Chem Pharmacy Clinic for unlimited virtual GP consultations. A registered nurse will do a clinical assessment and facilitate a virtual consultation with a GP if clinically required.
Three (3) consultations per beneficiary and up to five (5) consultations per family per year for non-Prescribed Minimum Benefit conditions. You need a referral from a Prime Cure facility or network doctor for a specialist visit as well as pre-authorisation from the Prime Cure Call Centre by phoning 0861 665 665. Specialist consultations are limited to R4 000 per family, 5 consultations per family and a maximum of 3 consultations per beneficiary per year. Subject to authorisation and referral by a network practitioner.
You will have to pay 30% of the consultation if you voluntarily visit a non-Prime Cure specialist and do not get pre-authorisation. Services are paid up to the Prime Cure agreed rate only. Medication prescribed and obtained at a Prime Cure network pharmacy is included in this limit.
PMB conditions: You must register your chronic condition with Prime Cure and obtain authorisation before the specialist visit.
Emergencies: Authorisation must be obtained the next working day after the event.
Services are paid up to the Prime Cure agreed rate only.
These include services like audiology, dietetics, occupational therapy, podiatry, physiotherapy, psychology, social services and speech therapy. Authorisation and referral are required.
A co-payment of 30% of Prime Cure negotiated/agreed rate applies if you self-refer to any practitioner. Allied healthcare services are limited to R3 000 per family with a maximum of R 2000 per beneficiary per year.