Benefits
Benefits
Overview
Overview
Prescribed Minimum Benefits (PMB)
Diagnosis, treatment and care costs of 270 PMB.
Unlimited coverage
Prescribed Minimum Benefits (PMB)
Diagnosis, treatment and care costs of 270 PMB.
Unlimited coverage
Prescribed Minimum Benefits (PMB)
Diagnosis, treatment and care costs of 270 PMB.
Unlimited coverage
Chronic Illness
26 Chronic conditions on the CDL.
Add-on costs
Chronic Illness
26 Chronic conditions on the CDL.
Add-on costs
Chronic Illness
26 Chronic conditions on the CDL.
Add-on costs
Specialised Radiology
Unlimited in and out of the hospital.
Unlimited coverage
Specialised Radiology
Unlimited in and out of the hospital.
Unlimited coverage
Specialised Radiology
Unlimited in and out of the hospital.
Specialised Radiology
Unlimited in and out of the hospital.
Trauma-Related Benefits
Including post-exposure prophylaxis.
Trauma-Related Benefits
Including post-exposure prophylaxis.
Trauma-Related Benefits
Including post-exposure prophylaxis.
Unlimited coverage
Trauma-Related Benefits
Including post-exposure prophylaxis.
Unlimited coverage
Road & Air Transport
Netcare 911 and ambulance services within RS.
Fully covered
Road & Air Transport
Netcare 911 and ambulance services within RS.
Fully covered
Road & Air Transport
Netcare 911 and ambulance services within RS.
Fully covered
Day-to-day costs
Dental services, GP visits, optometry etc.
Not covered
Day-to-day costs
Dental services, GP visits, optometry etc.
Not covered
Day-to-day costs
Dental services, GP visits, optometry etc.
Not covered
Diagnoses & Conditions
Diagnoses & Conditions
Diagnoses & Conditions
270 Diagnoses
Standard hospital plans are defined by a list of 270 diagnoses and treatment pairs (DTPs) with specific codes and treatment guidelines which quality for PMB.
270 Diagnoses
Standard hospital plans are defined by a list of 270 diagnoses and treatment pairs (DTPs) with specific codes and treatment guidelines which quality for PMB.
270 Diagnoses
Standard hospital plans are defined by a list of 270 diagnoses and treatment pairs (DTPs) with specific codes and treatment guidelines which quality for PMB.
Medical emergencies
What is an emergency? An emergency is the sudden and unexpected onset of a health condition that requires an immediate medical or surgical treatment. Failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part or would place the person's life in serious jeopardy.
Medical emergencies
What is an emergency? An emergency is the sudden and unexpected onset of a health condition that requires an immediate medical or surgical treatment. Failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part or would place the person's life in serious jeopardy.
Medical emergencies
What is an emergency? An emergency is the sudden and unexpected onset of a health condition that requires an immediate medical or surgical treatment. Failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part or would place the person's life in serious jeopardy.
26 Chronic Conditions
Addison's disease
Asthma
Bipolar mood disorder
Bronchiectasis
Cardiac failure
Cardiomyopathy
Chronic obstructive pulmonary disease (COPD)
Chronic renal disease
Coronary artery disease
Crohn's disease
Diabetes insipidus
Diabetes mellitus type 1
Diabetes mellitus type 2
Dysrhythmia
Dysrhythmia
Epilepsy
Glaucoma
Haemophilia A and B
Hyperlipidaemia
Hypertension
Hypothyroidism
Multiple sclerosis
Parkinson's disease
Rheumatoid arthritis
Schizophrenia
Systemic lupus erythematosus (SLE)
Ulcarative colitis
Specialised Radiology
Unlimited in and out of the hospital.
Specialised Radiology
Unlimited in and out of the hospital.
Trauma-Related Benefits
Including post-exposure prophylaxis.
Trauma-Related Benefits
Including post-exposure prophylaxis.
Detailed coverage
Detailed coverage
Detailed coverage
Description
StokWell base cover
Average base price
R500 to R900 per month Base price is personalized to individual
Read more
Average base price
R500 to R900 per month Base price is personalized to individual
Read more
Average base price
R500 to R900 per month Base price is personalized to individual
Read more
Chronic Illness and PMB
Diagnosis, treatment and care costs of 270 PMB and 26 Chronic conditions on the CDL.
100% of the MT Chronic specific add-ons available (R200-400 p/m)
Read more
Chronic Illness and PMB
Diagnosis, treatment and care costs of 270 PMB and 26 Chronic conditions on the CDL.
100% of the MT Chronic specific add-ons available (R200-400 p/m)
Read more
Chronic Illness and PMB
Diagnosis, treatment and care costs of 270 PMB and 26 Chronic conditions on the CDL.
100% of the MT Chronic specific add-ons available (R200-400 p/m)
Read more
Trauma Benefits
Benefits for major trauma and necessitates hospitalisation in the case of: Motor vehicle accidents, stab wounds, guntshot wounds head trauma, burns and near drowning.
100% of the MT Unlimited
Trauma Benefits
Benefits for major trauma and necessitates hospitalisation in the case of: Motor vehicle accidents, stab wounds, guntshot wounds head trauma, burns and near drowning.
100% of the MT Unlimited
Trauma Benefits
Benefits for major trauma and necessitates hospitalisation in the case of: Motor vehicle accidents, stab wounds, guntshot wounds head trauma, burns and near drowning.
100% of the MT Unlimited
Post-Exposure Prophylaxis (for HIV/Aids)
100% of the MT Unlimited
Post-Exposure Prophylaxis (for HIV/Aids)
100% of the MT Unlimited
Post-Exposure Prophylaxis (for HIV/Aids)
100% of the MT Unlimited
Emergency Transport Services
Netcare 911
100% of the MT Unlimited
Emergency Transport Services
Netcare 911
100% of the MT Unlimited
Emergency Transport Services
Netcare 911
100% of the MT Unlimited
Hospitalisation
(State and private hospitals and day clinics) Intensive and high care wards, theatre fees, treatment and ward medication, consultations, surgery and anaesthesia.
100% of the MT Unlimited
Hospitalisation
(State and private hospitals and day clinics) Intensive and high care wards, theatre fees, treatment and ward medication, consultations, surgery and anaesthesia.
100% of the MT Unlimited
Hospitalisation
(State and private hospitals and day clinics) Intensive and high care wards, theatre fees, treatment and ward medication, consultations, surgery and anaesthesia.
100% of the MT Unlimited
Confinement (childbirth)
Subject to pre-authorization, protocols and case management.
Maternity Add-on (R150 p/m)
Read more
Confinement (childbirth)
Subject to pre-authorization, protocols and case management.
Maternity Add-on (R150 p/m)
Read more
Confinement (childbirth)
Subject to pre-authorization, protocols and case management.
Maternity Add-on (R150 p/m)
Read more
Home Delivery
Home Delivery Subject to pre-authorization: professional nursing fees, equipment, material and medicine.
Maternity Add-on (R150 p/m)
Read more
Home Delivery
Home Delivery Subject to pre-authorization: professional nursing fees, equipment, material and medicine.
Maternity Add-on (R150 p/m)
Read more
Home Delivery
Home Delivery Subject to pre-authorization: professional nursing fees, equipment, material and medicine.
Maternity Add-on (R150 p/m)
Read more
Standard Radiology, Pathology and Medical Technologist Services
Standard Radiology, Pathology and Medical Technologist Services In hospital - subject to clinical protocols.
100% of the MT Unlimited
Standard Radiology, Pathology and Medical Technologist Services
Standard Radiology, Pathology and Medical Technologist Services In hospital - subject to clinical protocols.
100% of the MT Unlimited
Standard Radiology, Pathology and Medical Technologist Services
Standard Radiology, Pathology and Medical Technologist Services In hospital - subject to clinical protocols.
100% of the MT Unlimited
Specialised Radiology
In hospital - On request of a specialist and subject to clinical protocols: MRI, CT imaging, angiography.
100% of the MT Unlimited after initial R1,600
Specialised Radiology
In hospital - On request of a specialist and subject to clinical protocols: MRI, CT imaging, angiography.
100% of the MT Unlimited after initial R1,600
Specialised Radiology
In hospital - On request of a specialist and subject to clinical protocols: MRI, CT imaging, angiography.
100% of the MT Unlimited after initial R1,600
Organ Transplants
Subject to pre-authorization and clinical protocols, Cornea implants limited to R34 200 per year.
100% of the cost Unlimited
Organ Transplants
Subject to pre-authorization and clinical protocols, Cornea implants limited to R34 200 per year.
100% of the cost Unlimited
Organ Transplants
Subject to pre-authorization and clinical protocols, Cornea implants limited to R34 200 per year.
100% of the cost Unlimited
Post-Hospital Care
Post-Hospital Care Professional services relating to a hospital admission, required for up to 30 days after discharge: speech therapy, occupational therapy, physiotherapy.
100% of the MT R2,200 per member
Post-Hospital Care
Post-Hospital Care Professional services relating to a hospital admission, required for up to 30 days after discharge: speech therapy, occupational therapy, physiotherapy.
100% of the MT R2,200 per member
Post-Hospital Care
Post-Hospital Care Professional services relating to a hospital admission, required for up to 30 days after discharge: speech therapy, occupational therapy, physiotherapy.
100% of the MT R2,200 per member
Supplementary Health Services
In hospital: Occupational and speech therapy, audiometry, podiatry, massage, orthoptic, chiropractic, homeopathic, herbal and naturopathic, osteopathic and biokinetic services In addition: Physiotherapy and dietician services on referral by the attending medical doctor.
100% of the MT Unlimited
Supplementary Health Services
In hospital: Occupational and speech therapy, audiometry, podiatry, massage, orthoptic, chiropractic, homeopathic, herbal and naturopathic, osteopathic and biokinetic services In addition: Physiotherapy and dietician services on referral by the attending medical doctor.
100% of the MT Unlimited
Supplementary Health Services
In hospital: Occupational and speech therapy, audiometry, podiatry, massage, orthoptic, chiropractic, homeopathic, herbal and naturopathic, osteopathic and biokinetic services In addition: Physiotherapy and dietician services on referral by the attending medical doctor.
100% of the MT Unlimited
Oxygen
Oxygen In hospital
100% of the MT Unlimited
Oxygen
Oxygen In hospital
100% of the MT Unlimited
Oxygen
Oxygen In hospital
100% of the MT Unlimited
Neurostimulators
Neurostimulators Subject to pre-authorisation and clinical protocols: device and components.
100% of the MT R106 200 per member
Neurostimulators
Neurostimulators Subject to pre-authorisation and clinical protocols: device and components.
100% of the MT R106 200 per member
Neurostimulators
Neurostimulators Subject to pre-authorisation and clinical protocols: device and components.
100% of the MT R106 200 per member
Renal Dialysis
Renal Dialysis In and out of hospital.
100% of the MT Unlimited
Renal Dialysis
Renal Dialysis In and out of hospital.
100% of the MT Unlimited
Renal Dialysis
Renal Dialysis In and out of hospital.
100% of the MT Unlimited
Psychiatric treatment of a mental health condition
Subject to pre-authorisation, protocols and services rendered in an approved facility: professional services rendered in and out of hospital by a psychiatrist, general ward accommodation, medicine supplied during the period of treatment and outpatient consultations.
100% of the MT R23 200 per member
Psychiatric treatment of a mental health condition
Subject to pre-authorisation, protocols and services rendered in an approved facility: professional services rendered in and out of hospital by a psychiatrist, general ward accommodation, medicine supplied during the period of treatment and outpatient consultations.
100% of the MT R23 200 per member
Psychiatric treatment of a mental health condition
Subject to pre-authorisation, protocols and services rendered in an approved facility: professional services rendered in and out of hospital by a psychiatrist, general ward accommodation, medicine supplied during the period of treatment and outpatient consultations.
100% of the MT R23 200 per member
Oncology
PMB cases and non-PMB cases: hospital and related cancer treatments and services, including bone marrow/stem cell transplants .
100% of the MT Non-PMB limited to R250,000
Oncology
PMB cases and non-PMB cases: hospital and related cancer treatments and services, including bone marrow/stem cell transplants .
100% of the MT Non-PMB limited to R250,000
Oncology
PMB cases and non-PMB cases: hospital and related cancer treatments and services, including bone marrow/stem cell transplants .
100% of the MT Non-PMB limited to R250,000
Hospice services, private nursing and sub-acute care facilities
Subject to pre-authorisation; Services rendered in an approved facility and prescribed by a medical doctor.
100% of the MT Unlimited
Hospice services, private nursing and sub-acute care facilities
Subject to pre-authorisation; Services rendered in an approved facility and prescribed by a medical doctor.
100% of the MT Unlimited
Hospice services, private nursing and sub-acute care facilities
Subject to pre-authorisation; Services rendered in an approved facility and prescribed by a medical doctor.
100% of the MT Unlimited
Appendectomy
Subject to pre-authorisation - Conventional or laparoscopic procedure.
100% of the MT Unlimited
Appendectomy
Subject to pre-authorisation - Conventional or laparoscopic procedure.
100% of the MT Unlimited
Appendectomy
Subject to pre-authorisation - Conventional or laparoscopic procedure.
100% of the MT Unlimited
Prostatectomy
Subject to pre-authorisation - Conventional or robot assisted laparoscopic procedure
100% of the MT R105 400 per member
Prostatectomy
Subject to pre-authorisation - Conventional or robot assisted laparoscopic procedure
100% of the MT R105 400 per member
Prostatectomy
Subject to pre-authorisation - Conventional or robot assisted laparoscopic procedure
100% of the MT R105 400 per member
Internally implanted prostheses
EVARS, Vascular/cardiac, health-essential functional, implantable hearing devices, external breast prostheses- Conventional or robot assisted laparoscopic procedure
100% of the MT Subject to limits based on prostheses
Internally implanted prostheses
EVARS, Vascular/cardiac, health-essential functional, implantable hearing devices, external breast prostheses- Conventional or robot assisted laparoscopic procedure
100% of the MT Subject to limits based on prostheses
Internally implanted prostheses
EVARS, Vascular/cardiac, health-essential functional, implantable hearing devices, external breast prostheses- Conventional or robot assisted laparoscopic procedure
100% of the MT Subject to limits based on prostheses
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