{"id":3199,"date":"2013-01-23T15:40:42","date_gmt":"2013-01-23T15:40:42","guid":{"rendered":"http:\/\/profconsure.co.za\/?page_id=3199"},"modified":"2013-01-23T15:50:20","modified_gmt":"2013-01-23T15:50:20","slug":"primary-option","status":"publish","type":"page","link":"http:\/\/profconsure.co.za\/?page_id=3199","title":{"rendered":"Primary Option"},"content":{"rendered":"
\n

General Practitioner Services, Medication and Statutory Prescribed Minimum Benefits. All benefits are subject to pre-authorisation and include:<\/p>\n

– Unlimited primary health care from your chosen general practitioner<\/p>\n

– Medication as per formulary \u2013 acute and chronic<\/p>\n

– Basic pathology and radiology as authorised (Radiology: CXR \u2013 suspected fractures of extremities and two obstetric sonars per pregnancy) (Pathology: PAP smear single slide, Glucose, Hb, WCC, Platelets RPR, Blood Group)<\/p>\n

– Ambulance services for medical emergencies. Lifemed ambulance 0861086911<\/p>\n

– Optometry and Primary Care Dentistry benefits are provided by accredited providers, subject to authorisation and limits<\/p>\n

 <\/p>\n

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.<\/p>\n

Experienced risk managers review all hospital admissions to optimise care and expenditure.<\/p>\n

<\/h2>\n

Optometry<\/h2>\n

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.<\/p>\n

Limitations<\/strong>:<\/p>\n

Lenses: One set of lenses per beneficiary every 24 months
\nFrames: One frame per beneficiary every 24 months<\/p>\n

 <\/p>\n

The cost of single lenses is fully covered subject to the following conditions:<\/p>\n

– The refraction error must be equal to, or more than 0.5 dioptre<\/p>\n

– The total cost including testing and spectacle is limited to R580.00 per beneficiary per 24 months<\/p>\n

 <\/p>\n

The scheme is not liable for the following:<\/p>\n

– Multi focal lenses are not covered<\/p>\n

– Contact lenses are not covered<\/p>\n

– Replacement of lost spectacles is not covered<\/p>\n

<\/h2>\n

Dentistry<\/h2>\n

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 <\/strong><\/p>\n

The following conservative dentistry is fully covered within managed care protocols:<\/p>\n

– Consultations<\/p>\n

– Fillings: pre-authorisation applies<\/p>\n

– Extractions: pre-authorisation applies<\/p>\n

– Prevention: pre-authorisation applies<\/p>\n

 <\/p>\n

IN CASE OF AN EMERGENCY<\/strong>, contact Enablemed National Call Line as soon as possible at 0860 00 24 00<\/strong>.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

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 \u2013 acute and chronic – Basic pathology and radiology as authorised (Radiology: CXR \u2013 suspected fractures of extremities and two obstetric sonars per […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":3197,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/pages\/3199"}],"collection":[{"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/profconsure.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3199"}],"version-history":[{"count":3,"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/pages\/3199\/revisions"}],"predecessor-version":[{"id":3208,"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/pages\/3199\/revisions\/3208"}],"up":[{"embeddable":true,"href":"http:\/\/profconsure.co.za\/index.php?rest_route=\/wp\/v2\/pages\/3197"}],"wp:attachment":[{"href":"http:\/\/profconsure.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3199"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}