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 incomePrincipal MemberAdult DependantChild Dependant
R0 – R8 185R1 707R1 470R453
R8 186 – R11 140R1 878R1 653R561
R11 141 – R14 985R2 055R1 812R615
R14 986+R2 121R1 854R630

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

ServiceBenefit 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 limitMaximum annual limits: R3 240 per member
R3 240 per adult dependant R840 per child dependant
Acute medication
Prescribed (acute) medicationSubject 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 visitsSubject to the overall day-to-day limit
Network GP100% 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 visitsSubject 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 specialistPaid 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 specialistPaid at 100% of cost or MSR, whichever is less
Auxiliary services
Occupational therapy, speech therapy, physiotherapy, psychology, social workers, audiometry, chiropractors, dieticiansPaid 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 testsSubject 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 dentistryPaid 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)
RadiologyLimited to R1 070 per family per year Subject to MME
PathologyLimited 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

MEDiPOS Anti-fraud Hotline
Tel: 0800 112 811

24 Hour Pre-Auth Guide

Walk-in Centres

POPIA

Resolving Problems & Queries

COVID-19 Documents

Self Help Kit

Click here for the South Africa’s official Coronavirus (Covid-19) online news and information portal. In association with The Department of Health and the NHI.

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.