General Practitioner Services, Medication and Statutory Prescribed Minimum Benefits. All benefits are subject to pre-authorisation and include:

– Unlimited primary health care from your chosen general practitioner

– Medication as per formulary – acute and chronic

– Basic pathology and radiology as authorised (Radiology: CXR – suspected fractures of extremities and two obstetric sonars per pregnancy) (Pathology: PAP smear single slide, Glucose, Hb, WCC, Platelets RPR, Blood Group)

– Ambulance services for medical emergencies. Lifemed ambulance 0861086911

– Optometry and Primary Care Dentistry benefits are provided by accredited providers, subject to authorisation and limits

Statutory Prescribed Minimum Benefits as authorised, in respect of the relevant health services as described in terms of section 67(1)(g) of the Act Accessed in State Hospitals.

Experienced risk managers review all hospital admissions to optimise care and expenditure.

Optometry

Spectacles must be obtained from an accredited optometrist, as authorised via the call centre 0860 00 24 00, necessary for correcting significant visual impairment problems.

Limitations:

Lenses: One set of lenses per beneficiary every 24 months
Frames: One frame per beneficiary every 24 months

The cost of single lenses is fully covered subject to the following conditions:

– The refraction error must be equal to, or more than 0.5 dioptre

– The total cost including testing and spectacle is limited to R580.00 per beneficiary per 24 months

The scheme is not liable for the following:

– Multi focal lenses are not covered

– Contact lenses are not covered

– Replacement of lost spectacles is not covered

Dentistry

All dentistry must be provided by an accredited dentist or dental therapist, after the dentist has obtained authorisation via: Dental Information Systems (Pty) Ltd, call no. at 0860 033 647

The following conservative dentistry is fully covered within managed care protocols:

– Consultations

– Fillings: pre-authorisation applies

– Extractions: pre-authorisation applies

– Prevention: pre-authorisation applies

IN CASE OF AN EMERGENCY, contact Enablemed National Call Line as soon as possible at 0860 00 24 00.