Members on the Value Care Plan must obtain authorisation for hospitalisation and must use Prime Cure private hospitals or public hospital facilities. A Prime Cure doctor referral and authorisation is necessary for all planned hospital admissions as well as for admissions following a casualty visit. Hospitalisation for non-Prescribed Minimum Benefits admissions have an Annual Family Hospital Limit of R157 500 and a sublimit of R68 250 for private hospitals per year.
For hospitalisation relating to non-Prescribed Minimum Benefit conditions, members need to call the Prime Cure Call Centre on 0861 665 665 to authorise the hospital event and confirm the benefits available. If you do not get a referral from a Prime Cure doctor and authorisation from Prime Cure, a R2 000 co-payment will apply or the cost of the entire account. We pay for all hospitalisation cases at 100% of the Prime Cure Rate in a Prime Cure private or state hospital.
Hospital services include GP and specialist consultations in hospital, day cases and 7-day supply of to-take-out medication.
Allied healthcare services in hospital
Dietetics, occupational and speech therapy, physiotherapy, podiatry and social services have a sublimit of R 7 560 per year, subject to the Family Hospital Limit.
Blood transfusions are subject to a sublimit of R15 500 per year for non-PMB conditions and the Family Hospital Limit.
Psychiatric services are limited to 5 days per admission, with a maximum of R7 560 per family per year, subject to the Family Hospital Limit. PMB psychiatric services are limited to 21 days.