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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
2022 monthly contributions

Principal Member

– Monthly contribution: R2 196
– Monthly savings: R172
– Total monthly contribution: R2 368

Adult Dependant

– Monthly contribution: R1 357
– Monthly savings: R106
– Total monthly contribution: R1 463

Child Dependant

– Monthly contribution: R674
– Monthly savings: R53
– Total monthly contribution: R72

*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 Netcare, Life Healthcare hospitals (countrywide) and Mediclinic (Western Cape, Polokwane, Bloemfontein) – hospitals that are part of our Designated Service Provider (DSP) network – will be paid in full. A list of hospitals in areas where DSP hospitals are not present is available on request. There is no restriction on the number of hospital admissions, but all in-hospital procedures must be pre-authorised prior to admission.

*If a non-DSP hospital is voluntarily used, a 30% co-payment will be applicable on the hospital account.

Benefits value
Unlimited

Injuries suffered as result of an accident

Treatment for almost all accidents is regarded as a Prescribed Minimum Benefit (PMB). Treatment of such injuries, including hospitalisation, is therefore covered in full by the Scheme, subject to Scheme rules and clinical protocols.

Benefit value
Unlimited

Specialist services in-hospital

The services provided by specialists while the member is in hospital are covered by the Scheme.

Any service falling within the Scheme rules and rendered by the Scheme’s Specialist Network (DSP) or preferred provider for PMB conditions will be covered in full.

Benefit value
Unlimited*
*Conditions apply

Oncology

The diagnosis and treatment of cancer-related conditions.

Benefit value
R169 000
Per family per annum

MRI & CT scans

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

Benefit value
R17 800
Per family per annum
*Conditions apply

Day-to-day medical expenses cover (out of 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 medical savings account (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 064 per annum
  • Adult dependant: R1 272 per annum
  • Child dependant: R636 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 additional day-to-day benefit becomes available once the MSA is depleted and is a family benefit, which means that one member of a family can use the total benefit allocation.

Benefit value:

  • Principal Member: R3 090 per annum
  • Adult dependant: R2 125 per annum
  • Child dependant: R945 per annum
Pathology

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

Benefit value
Subject to amount available in MSA and / or routine benefit allocation

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 the dentist consultation, X-rays, oral hygiene treatment, fillings, extractions and root canal treatment.

Orthodontics (non-cosmetic treatment only), DENIS pre-authorisation compulsory.
Limited to beneficiaries aged 9-18 years.

Benefit value
Unlimited*
*Conditions apply

Chronic medication

Chronic medication for CDL conditions

Prescribed medication used continuously for 3 months or more for one of the 26 PMB CDL conditions

Benefit value
Unlimited

Additional chronic conditions

Prescribed medication used continuously for 3 months or more for 3 additional chronic conditions that are not on the PMB Chronic Disease List (CDL) for Child Dependants under the age of 21.

Benefit value
Unlimited

Supplementary services cover

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

Benefit value:
R21 500 per family per annum  

Prosthesis/Prosthetics

(Internal, external, fixation devices and implanted devices)

  • Pre-authorisation compulsory.
  • Subject to case Management, reference pricing, preferred provider, and Scheme protocols.

Benefit value
R3 500 per family per annum

Emergency transport by ambulance

Netcare 911 (DSP) provides members with emergency transport from any accident scene by road or air ambulance and medically justified inter-hospital transfers. 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
R7 600 per family per annum*
*Conditions apply

Endoscopic procedures (scopes)

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

Benefit 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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Health Booster

Smart Baby

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