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Equilibrium Option

Equilibrium is the peace-of-mind-and-body medical cover for those looking for stability with extra security.

With well-balanced benefits at a highly competitive rate, this option offers an unlimited private hospital plan, specified day-to-day cover and benefits for 29 chronic medical conditions, as well as dental cover and a savings plan.

It strikes the perfect balance in everyday cover.

Our perfect balance of medical cover and savings in one.

Equilibrium
2023 Monthly Contributions

Principal Member

– Monthly Contribution: R2 348
– Monthly Savings: R184
– Total Monthly Contribution: R2 532

Adult Dependant

– Monthly Contribution: R1 450
– Monthly Savings: R114
– Total Monthly Contribution: R1 564

Child Dependant

– Monthly Contribution: R722
– Monthly Savings: R56
– Total Monthly Contribution: R778

*Note: Contributions charged up to a maximum of 3 child dependants

Medical Benefits

  • Hospital

  • Accidents

  • Specialists

  • Oncology

  • MRI & ICT Scans

  • Optical

  • Dental

  • Chronic Medication

  • Ambulance

  • Medical Appliances

  • Scopes

  • PMB's

Click on the tabs below to see a full description of the option benefits.

Major medical expenses cover

All costs related to treatment at any Life Healthcare and Netcare hospitals nationally and Mediclinic hospitals in the Western Cape, Bloemfontein, and Polokwane and other selected hospitals (DSP hospital network), will be paid in full. There is no restriction on the number of admissions to the hospital, but all in-hospital procedures should be pre-authorised prior to admission.

*30% co-payment applicable on the hospital account if a non-DSP hospital is voluntarily used.

Benefits value: Unlimited

Injuries suffered as result of an accident

Almost all accidents are regarded as a PMB (Prescribed Minimum Benefit) and the treatment of such injuries, including the hospitalisation, will therefore be covered in full by the Scheme, as per the rules and clinical protocols.

Benefit value: Unlimited

Specialist services in-hospital

The services provided by any Specialist whilst the member is in hospital are covered by the Scheme.

Benefit value: Unlimited
*Conditions apply

Oncology

The diagnosis and treatment of cancer related conditions.

Benefit value: R180 000 Per family per annum

MRI & CT scans

Includes scans done for diagnostic reasons both in and out of hospital.

Benefit value: R20 000 Per family per annum combined benefit in or out-of-hospital. R1 500 co-payment per scan in or out-of-hospital (except for confirmed PMBs).

*Conditions apply

Day-to-day medical expenses cover (outside of the hospital)

Medical savings account (MSA)

A portion of a member’s monthly contribution is allocated in advance at the beginning of the year to a MSA that is used to pay for day-to-day medical expenses.

The MSA can also be used to pay for expenses not covered by the Scheme (e.g. co-payments, exclusions, etc.) and is carried forward to the following year if there is a positive balance at the end of that year. This is a family benefit which means that one member of a family can use the total benefit allocation.

Benefit value: 

  • Principal Member: R2 208 Per annum
  • Adult dependant: R1 368 Per annum
  • Child dependant: R672 Per annum
Routine medical expenses

Includes day-to-day medical expenses for GP and Specialist consultations, X-rays; prescribed (acute) and over-the-counter medication, blood tests, physiotherapy, optical, etc.

This benefit is a family benefit which means that one member of a family can use the total benefit allocation.

Benefit value:

  • Principal Member: R3 290 Per annum
  • Adult dependant: R2 265 Per annum
  • Child dependant: R1 005 Per annum
Pathology

Blood tests done outside of the hospital as requested by a GP or Specialist are paid from the day-to-day benefit amount, i.e. the MSA and/or routine expenses portion.

Benefit value: Subject to amount available in MSA

Optical services

Optical services, including eye tests, frames, lenses and contact lenses, are paid from the day-to-day benefit amount, i.e. the MSA and/or routine expenses portion.

Benefit value: Subject to amount available in MSA and/or routine benefit allocation
*Conditions apply

Dentistry

Dental treatment

The provision of conservative dental treatment to members includes a consultation at the dentist, any x-rays, oral hygiene treatment, fillings, extractions and root canal treatment.

Benefit value: Unlimited
*Conditions apply

Specialised dental treatment
  • Orthodontics (non-cosmetic treatment only)

  • Only 1 beneficiary per family may commence treatment per calendar year. Limited to beneficiaries aged 9-18 years.

Benefit value: 80%
*Conditions apply

Chronic medication

Chronic medication for CDL conditions

Prescribed medication used continuously for 3 months or more for one of the 26 CDL (Chronic Disease List) illness conditions

Benefit value: Unlimited

Extra chronic medication

Prescribed medication used continuously for 3 months or more for (3 extra chronic conditions) that are not on the CDL (Chronic Disease List) illness conditions for children under the age of 21.

Benefit value: Unlimited

Supplementary services cover

Psychiatric Treatment
  • Per family per annum.
  • In-hospital benefit only.
  • Pre-authorisation compulsory.
  • Case Management applies.
  • Out-of-hospital: PMB entitlement.

Benefit value: R22 900 

Prosthesis / Prosthetics / Fixation Devices
  • Per family per annum.
  • Combined benefit.
  • Pre-authorisation compulsory.
  • Subject to case Management, reference pricing, preferred provider, and Scheme protocols.

Benefit value: R3 750 

Emergency transport by ambulance

Netcare 911 (DSP provider) provides members with emergency transport from any accident scene by road or air ambulance and medically justified inter-hospital transfers. For emergencies members may also be transferred from their homes to the hospital.

Benefit value: Unlimited

Medical appliances

The provision of medical equipment used for the treatment and cure of medical conditions or procedures, including equipment such as wheelchairs, crutches and contraceptive devices).

Benefit value: R8 400 Per family per annum
*Conditions apply

Endoscopic procedures (scopes)

All scopes are covered in full if done at a DSP hospital – any Life Healthcare and Netcare hospitals nationally and Mediclinic hospitals in the Western Cape, Bloemfontein, and Polokwane and other selected hospitals (DSP hospital network) or if done in the doctor’s rooms, subject to the use of a KeyHealth Specialist.

Benefits value: Unlimited

Prescribed Minimum Benefits (PMB)

Prescribed Minimum Benefits

Prescribed Minimum Benefits (PMBs) are a set of legislated, defined benefits to ensure that all medical scheme members are entitled to certain minimum health services, regardless of the benefit option they have selected on their scheme.

Benefit value: Unlimited

Additional Benefits

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Smart Baby

Not Included on Equilibrium - Click here
  • Hospitalisation benefits for the following procedures:
    • Varicose vein surgery
    • Reflux surgery
  • Specialised dentistry