Comprehensive medical aid option

Dimension Elite 2012

Dimension Elite is the top option in the Dimension range and offers ample benefits for families and individuals who prefer to provide for their extensive day-to-day healthcare needs by means of insured benefits. The option also offers comprehensive cover for medical emergencies and hospitalisation. Add to that the preventative care benefits of the health and benefit booster and you can rest assured that your family's health is in good hands.

what makes the Dimension Elite benefit option unique?

Day-to-day benefits - ample seperately insured benefits
Major medical benefits - unlimited treatment (medical and surgical services, anaesthesia as well as material and medicines used during the rendering of a service) by GPs and specialists
Dentistry benefits
Optometry benefits
Dependent children under 26 pay subscriptions for child dependants
Preventative care - health and benefit booster

monthly contribution

Member	Subscription
Principal member	R2,394
Adult dependant	R2,238
Child dependant younger than 26 years	R648

major medical benefits
No overall annual limits for:

Private hospitalisation (in the hospital of your choice)
The diagnosis, treatment and care costs of 270 PMB and 26 chronic conditions (CDL)
Trauma recovery benefits

emergency medical services

Unlimited emergency medical services are provided by Netcare 911 to residents within the borders of South Africa, Lesotho, Swaziland, Mozambique and Namibia
24-hour helpline and Rape Crisis Centre (Netcare 911)

day-to-day benefits

Ample insured benefits, which include separate insured benefits for radiology and pathology, dentistry and optical services as well as benefits for chronic medication

preventative care
Health and benefit booster

Benefits are provided for a selection of medical services that will contribute to protecting your good health and augmenting your insured day-to-day benefits

preventative care

health and benefit booster

*Benefits are provided at 100% of the contracted/scheme tariff and do not include the consultation fee, which will be paid from the available day-to-day benefits where applicable.

major medical benefits

Description	Benefit
HOSPITALISATION (government and private hospitals and day clinics) Subject to pre-registration, pre-authorisation, protocols and case management Intensive and high care wards Ward accommodation Theatre fees Visits, treatment and ward medicine Surgery and anaesthesia	100% of the contracted/ scheme tariff/medicine price R600 co-payment per admission where no other co-payments are applicable (non-PMB cases) Unlimited 20% co-payment in case of no pre-authorisation
ORGAN TRANSPLANT
CONFINEMENT
HYSTERECTOMY
ENDOSCOPIC PROCEDURES During hospitalisation	100% of the contracted /scheme tariff R2,000 co-payment per admission
In the doctor’s rooms	100% of the scheme tariff Unlimited
ONCOLOGY (SAOC NETWORK – ONCOELITE PROTOCOL) Subject to pre-authorisation Surgery and hospitalisation Chemotherapy and radiotherapy (PMB cases)	100% of the scheme tariff/cost Unlimited
Chemotherapy and radiotherapy (non-PMB cases) During and not during hospitalisation	100% of the scheme tariff/medicine price R18,940 per beneficiary per year
DENTAL PROCEDURES UNDER GENERAL ANAESTHESIA Subject to Denis protocols and pre-authorisation Hospitalisation General anaesthesia	100% of the Medihelp Dental Tariff R600 co-payment per admission 20% co-payment in case of no pre-authorisation
GENERAL RADIOLOGY AND PATHOLOGY During hospitalisation	100% of the scheme tariff Unlimited
PHYSIOTHERAPY, OCCUPATIONAL AND SPEECH THERAPY, DIETICIAN SERVICES, AUDIOMETRY, PODIATRY, MASSAGE, ORTHOPTIC, CHIROPRACTIC, HOMEOPATHIC, HERBAL AND NATUROPATHIC, OSTEOPATHIC AND BIOKINETIC SERVICES During hospitalisation	100% of the scheme tariff/cost Unlimited
OXYGEN During hospitalisation	100% of the scheme tariff/cost Unlimited
DIALYSIS During and not during hospitalisation Subject to pre-authorisation	100% of the scheme tariff Unlimited
TECHNOLOGIST SERVICES During and not during hospitalisation	100% of the scheme tariff Unlimited
APPLICABLE PRESCRIPTION MEDICINE DISPENSED AND CHARGED BY THE HOSPITAL ON DISCHARGE FROM THE HOSPITAL (TTO) Excluding chronic medicine	100% of the medicine price R260 per admission
NECK AND BACK FUSIONS (non-PMB cases) Subject to protocols and pre-authorisation	100% of the contracted/scheme tariff Unlimited R6,230 co-payment per admission
CIRCUMCISION OR HYMENECTOMY	100% of the contracted/scheme tariff Unlimited R1,130 co-payment per admission
INTERNALLY IMPLANTED PROSTHESES (non-PMB cases) EVARS prosthesis Subject to pre-authorisation	100% of the scheme tariff/cost R83,140 per beneficiary per year
Vascular/cardiac prosthesis	100% of the scheme tariff/cost R35,600 per beneficiary per year
Health-essential functional prosthesis Subject to pre-authorisation Intra-ocular lenses	100% of the scheme tariff/cost R39,470 per beneficiary per year Sub-limit: 100% of the scheme tariff/cost 2 lenses per beneficiary per year R2,760 per lens
Hip, knee and shoulder replacements Hospitalisation and prosthesis component Subject to pre-authorisation	100% of the scheme tariff/cost R12,580 per admission
Prosthesis with reconstructive or restorative surgery Subject to pre-authorisation During and not during hospitalisation	100% of the scheme tariff/cost R6,230 per family per year
SPECIALISED RADIOLOGY Services rendered during and not during hospitalisation MRI and CT scanning Subject to pre-authorisation Angiogram	100% of the scheme tariff R20,860 per family per year
PSYCHIATRIC TREATMENT OF A MENTAL HEALTH CONDITION Subject to pre-authorisation Professional psychiatric services rendered during and not during hospitalisation by a psychiatrist General ward accommodation Electroconvulsive therapy Medicine supplied during the period of treatment in the institution	100% of the contracted/ scheme tariff/medicine price R600 co-payment per admission (non-PMB cases) R22,680 per beneficiary per year (maximum R31,380 per family per year) 20% co-payment in case of no pre-authorisation
PRIVATE NURSING Subject to pre-authorisation and as an alternative to hospitalisation	100% of the contracted/ scheme tariff/medicine price Unlimited
HOSPICE SERVICES AND SUB-ACUTE CARE FACILITIES Subject to pre-authorisation and as an alternative to hospitalisation	100% of the contracted/ scheme tariff/medicine price Unlimited 20% co-payment in case of no pre-authorisation

major medical benefits - trauma recovery (PMB cases)

Description

Benefit

BENEFITS FOR TRAUMA THAT NECESSITATES HOSPITALISATION IN THE CASE OF:

Motor vehicle accidents
Stab wounds
Gunshot wounds
Head trauma
Burns
Near drowning

Subject to pre-authorisation and case management

100% of the cost

Unlimited - in accordance with PMB regulations

POST-EXPOSURE PROPHYLAXIS (Optipharm)

major medical benefits - prescribed minimum benefits (PMB)

Description	Benefit
DIAGNOSIS, TREATMENT AND CARE COSTS OF 270 PMB AND 26 CHRONIC CONDITIONS ON THE CDL, INCLUDING OUTPATIENT TREATMENT Subject to protocols, pre-authorisation and preferred providers (where applicable)	100% of the cost Unlimited - in accordance with PMB regulations Co-payments may apply

emergency medical services

Description	Benefit
EMERGENCY TRANSPORT SERVICES (NETCARE 911) Transport by road or air within the borders of the RSA, Lesotho, Swaziland, Mozambique and Namibia (residents of these countries)	100% of the contracted tariff Unlimited
Outside these borders: Transport by road	100% of the cost R1,360 per case
Transport by air	100% of the cost R8,840 per case
BLOOD TRANSFUSION SERVICES AND THE TRANSPORT OF BLOOD AND BLOOD PRODUCTS	100% of the cost Unlimited
24-HOUR HELPLINE AND RAPE CRISIS CENTRE (NETCARE 911)	Phone 082 911 for advice in a medical emergency

day-to-day benefits

Description	Benefit
GENERAL MEDICAL PRACTITIONERS, MEDICAL SPECIALISTS AND EMERGENCY UNITS Treatment (medical and surgical services, anaesthesia as well as material and medicines used during the rendering of a service)	100% of the scheme tariff/ medicine price Unlimited
Consultations and follow-up	100% of the scheme tariff/cost R1,850 per single member per year R3,550 per family per year
CLINICAL PSYCHOLOGISTS AND PSYCHIATRIC NURSES Services rendered during and not during hospitalisation
PHYSIOTHERAPISTS Treatment and material
OCCUPATIONAL AND SPEECH THERAPY, DIETICIAN SERVICES, AUDIOMETRY, PODIATRY, MASSAGE, ORTHOPTIC, CHIROPRACTIC, HOMEOPATHIC, HERBAL AND NATUROPATHIC, OSTEOPATHIC AND BIOKINETIC SERVICES
MEDICINE Medicine dispensed by the Medihelp Preferred Pharmacy Network Acute medicine (including medicine dispensed at an emergency unit and self-medication, oral contraceptives, intra-uterine devices and homeopathic, herbal, naturopathic and osteopathic medicine)	80% of the medicine price R2,800 per single member per year R5,300 per family per year
Authorised chronic medicine	80% of the medicine price R2,720 per single member per year R4,240 per family per year
Authorised chronic PMB medicine	100% of the medicine price Unlimited Co-payments may apply
OPTOMETRY Benefits are subject to pre-authorisation by PPN and services should be obtained from a PPN provider Optometric examinations	Benefits are available per 24-month cycle per beneficiary: 1 comprehensive consultation, including refraction test, tonometry and visual fields test
Spectacles and contact lenses Benefits are limited to either spectables or contact lenses: Spectacles: Frame and/or lens enhancements	R700
Lenses One pair of standard high-quality clear lenses	Clear single vision lenses or Clear Aquity bifocal lenses or Clear Aquity multifocal lenses
Contact lenses	R1,510
DENTAL SERVICES All benefits are subject to clinical protocols determined by Denis Routine check-ups	100% of the Medihelp Dental Tariff 2 per beneficiary per year
Oral hygiene Fluoride treatments for children only	100% of the Medihelp Dental Tariff 2 scale and polish treatments per beneficiary per year
Fillings Treatment plan and X-rays may be required for multiple fillings	100% of the Medihelp Dental Tariff 1 filling per tooth per 365-day cycle
Tooth extractions and root canal treatment in the dentist’s chair	100% of the Medihelp Dental Tariff
Laughing gas (in the dentist’s chair)	100% of the Medihelp Dental Tariff
Dental procedures under conscious sedation in the dentist's chair (sedation cost) Subject to pre-authorisation and protocols	100% of the Medihelp Dental Tariff Extensive dental treatments only
Plastic dentures	100% of the Medihelp Dental Tariff 1 set (upper and lower jaw) per beneficiary in a 4-year cycle
Specialised dental services All specialised dentistry should be pre-authorised Partial metal frame dentures	100% of the Medihelp Dental Tariff 2 partial frames (upper and lower jaw) per beneficiary in a 5-year cycle
Maxillofacial surgery and oral pathology Surgery in the dentist's chair Benefits for temporomandibular joint (TMJ) therapy are limited to non-surgical interventions/treatments	100% of the Medihelp Dental Tariff
Crowns and bridges	100% of the Medihelp Dental Tariff 2 crowns per family per year, once per tooth in a 5-year cycle
Implants	For member's account
Orthodontic treatment Fixed braces – only one beneficiary per family may begin orthodontic treatment per calendar year	100% of the Medihelp Dental Tariff R8,000 per beneficiary younger than 18 years per lifetime
Periodontal treatment Subject to registration on the Perio Programme Conservative, non-surgical therapy only	100% of the Medihelp Dental Tariff
X-rays Intra-oral X-rays	100% of the Medihelp Dental Tariff
Extra-oral X-rays	1 per beneficiary in a 3-year cycle
PATHOLOGY Excluding services requested by naturopaths, herbalists and homeopaths	100% of the scheme tariff R1,900 per family per year
GENERAL RADIOLOGY	100% of the scheme tariff R1,900 per family per year
MEDICAL, SURGICAL AND ORTHOPAEDIC APPLIANCES Services rendered during and not during hospitalisation: Artificial eyes, speech and hearing aids	100% of the scheme tariff/cost R5,350 per beneficiary per 3-year cycle
Artificial limbs and wheelchairs	100% of the scheme tariff/cost R4,280 per beneficiary per 3-year cycle
Other appliances, including hyperbaric oxygen treatment	100% of the scheme tariff/cost R410 per beneficiary per year
Stoma components and urine bags	100% of the scheme tariff/cost Unlimited
OXYGEN Subject to pre-authorisation	100% of the scheme tariff/cost 20% co-payment in case of no pre-authorisation

Dimension Elite benefit exclusions

This is a summary of the available benefits. In the event of a dispute the registered Rules of Medihelp wil apply, subject to approval by the Registrar of Medical Schemes. If a beneficiary joins during the course of a financial year, the benefits (limits) are calculated pro rata according to the remaining number of months per year.

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