Alcohol and drug treatment
Value Care Plan pays for an alcohol and drug treatment programme, including hospitalisation up to 21 days and medication. Designated Service Providers to be used. Subject to authorisation, referral and programme registration on 0861 665 665.
Value Care Plan members will receive treatment and management through the list of Prime Cure network providers. You need to ensure that your Prime Cure provider registers you on the Kidney Disease management programme by phoning 0861 665 665.
Treatment is subject to case management, treatment protocols and provided in a state facility.
On the Value Care Plan, organ transplants are funded in public facilities only. Call 0861 665 665 to get authorisation and to register on the organ transplant management programme. 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 donations for any person other than a member or registered dependant of the Scheme are excluded.
In hospital pathology is subject to a sublimit of R17 850 per family and the Family Hospital Limit.
Out of hospital pathology is limited to approved tests, requested by network providers only. If the pathology is for a PMB condition, register on the management programme on 0861 665 665.
Basic radiology out of hospital is limited to approved x-rays, requested by network providers only.
Basic radiology in hospital is subject to approved tests and the Family Hospital Limit (unless PMB).