Option C Overview
Designed for the young and healthy who want affordable basic healthcare cover.
If you hardly use your medical aid and just need it in case something happens to you.
For that odd doctor’s visit and unforeseen needs, like being diagnosed with a chronic condition or being involved in a car accident.
CONTRIBUTIONS FROM 1 JANUARY 2025 | |||
Monthly income | Principal Member | Adult Dependant | Child Dependant |
R0 – R8 185 | R1 707 | R1 470 | R453 |
R8 186 – R11 140 | R1 878 | R1 653 | R561 |
R11 141 – R14 985 | R2 055 | R1 812 | R615 |
R14 986+ | R2 121 | R1 854 | R630 |
Please note
- Adult dependants include spouses/partners, registered children age 21 and older (except children who are younger than 25 years of age and who are full-time students registered at a recognised tertiary institution), parents and siblings dependant on the member;
- Your portion of the contribution will depend on your subsidy;
- If you are unsure of your subsidy, please check with your Human Resources Department.
Prescribed Minimum Benefit (PMB)
Chronic disease list – This is a list of the PMB conditions covered by the Scheme in terms of legislation governing all medical schemes
- Addison’s disease
- Asthma
- Bipolar mood disorder
- Bronchiectasis
- Cardiac failure
- Cardiomyopathy disease
- Chronic renal disease
- Chronic obstructive pulmonary disease (emphysema)
- Coronary artery disease (angina pectoris and ischaemic heart disease)
- Crohn’s disease
- Diabetes insipidus
- Diabetes mellitus type I and II
- Dysrythmias
- Epilepsy
- Glaucoma
- Haemophilia
- Hiv/aids
- Hyperlipidaemia
- Hypertension (high blood pressure)
- Hypothyroidism
- Multiple sclerosis
- Parkinson’s disease
- Rheumatoid arthritis
- Schizophrenia
- Systemic lupus erythematosus
- Ulcerative colitis
Option C: Day-to-day benefits
The following table reflects the overall annual day-to-day benefits with sub-limits on Option C
Service | Benefit limit |
OVERALL DAY-TO-DAY LIMITS | |
This benefit limit depends on the family size; All sub-limits are subject to the overall annual day-to-day limit | Maximum annual limits: R3 240 per member R3 240 per adult dependant R840 per child dependant |
Acute medication | |
Prescribed (acute) medication | Subject to the overall day-to-day limit; 100% of medicine price and limited to: Member: R1 940 Adult dependant: R1 940 Child dependant: R520 |
Pharmacist-advised therapy (PAT) Medication will be subject to generic and/ or formulary reference pricing; If a member chooses to purchase a medication that is not on the Scheme`s formulary, the member will be required to pay the difference between the cost of the medication as a co-payment at the point of service | 100% of medicine price and limited to R990 per family per year Members are encouraged to make use of the Scheme’s pharmacy network to minimise possible co-payments |
General practitioners (GPs) | |
Visits, consultations and outpatient visits | Subject to the overall day-to-day limit |
Network GP | 100% of negotiated rate |
Non-Network GP (non-DSP) | 80% of cost or MSR, whichever is less Members are encouraged to make use of the GP network to minimise possible co-payments |
Specialists | |
Visits, consultations and outpatient visits | Subject to the overall day-to-day limit Benefits are only covered if: • a member was referred by a GP • AND Pre-authorisation was obtained from the Scheme for the first consultation at a given Specialist |
Preferred specialist | Paid at 100% of cost or 110% MSR, whichever is less. Members are encouraged to make use of a preferred specialist provider to minimise possible short payments or co-payments. |
Non-preferred specialist | Paid at 100% of cost or MSR, whichever is less |
Auxiliary services | |
Occupational therapy, speech therapy, physiotherapy, psychology, social workers, audiometry, chiropractors, dieticians | Paid at 100% of cost or MSR, whichever is less and limited to R1 090 per family per year; Subject to the overall day-to-day limit (Service must be obtained by an approved and registered paramedical and auxiliary service provider) |
No benefit for: Biokineticist, chiropody, orthoptists, orthotic consultations, remedial therapy, reflexology, homeopaths, naturopaths, acupuncturists, osteopaths, phytotherapists, ayuverdic practitioners,aromatherapists, therapeutic massage therapists and Chinese medicine | |
OVERALL OPTICAL BENEFITS | |
Overall optical benefits every two years Includes frames, all prescription lenses/add- ons, clear single vision, clear Aquity, flat-top bifocal, clear Aquity multifocal lenses, contact lenses and eye tests | Subject to R1 480 per beneficiary every two years, including a frame sub-limit of R500 |
OVERALL DENTISTRY BENEFITS | |
Basic dentistry Includes routine prophylaxis (prevention and treatment), scaling and polishing (cleaning), fluoride application, fillings, non-surgical tooth extraction and root canal treatment All dentistry benefits are subject to the Scheme`s managed care protocols and benefits; In-hospital dentistry is subject to prior approval and pre-authorisation; Refer to Annexure E for details of dentistry benefits and exclusions that are applicable | 100% of cost or MSR, whichever is less; Subject to a maximum limit of R3 800 per family per year |
Advanced dentistry | Paid at 100% of cost or MSR, whichever is less; Subject to the overall annual day-to-day limit All specialised/advanced dentistry procedures (including orthodontic services) are subject to prior approval No benefit for dental implants |
PRIMARY CARE BENEFIT (PCB) (Out of hospital) | |
Radiology | Limited to R1 070 per family per year Subject to MME |
Pathology | Limited to R980 per beneficiary per year Subject to MME |
Contact Us
Client Services
Tel: 0860 100 078
Fax: 086 566 1372
Email: enquiries@medipos.co.za
Managed Care Services (including hospital
pre-authorisation & ICON)
0860 100 078
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Tel: 0800 112 811
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Walk-in Centres
POPIA
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DISCLAIMER : The material and other information provided on this website is for educational, communication and informational purposes only and does not by any means supersede the rules of the Scheme. Please note that the scope of the Scheme and all terms and conditions are set out in detail in the rules of the Scheme. In the event of any discrepancy between this website and the rules of the Scheme, the rules of the Schemes always take precedence.