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Gold Option

Gold is the superior medical cover for individuals and families who demand both substantial cover and security from their plans.

With a premium rate and loaded value, this option offers an unlimited hospital plan, superior day-to-day cover and benefits for 44 chronic medical conditions, as well as dental cover, increased savings, and out-of-hospital mental health cover.

It sets the new standard in gold medical cover.

Our superior medical cover that sets the new gold standard.

Gold
2023 Monthly Contributions

Principal Member

– Monthly Contribution: R5 762
– Monthly Savings: R640
– Total Monthly Contribution: R6 402

Adult Dependant

– Monthly Contribution: R3 897
– Monthly Savings: R432
– Total Monthly Contribution: R4 329

Child Dependant

– Monthly Contribution: R1 132
– Monthly Savings: R125
– Total Monthly Contribution: R1 257

Medical Benefits

  • Hospital

  • Accidents

  • Specialists

  • Oncology

  • MRI & ICT Scans

  • Rehab / Wound Care

  • Savings

  • Routine Expenses

  • Pathology

  • Optical

  • Dental

  • Chronic Medication

  • Prosthesis

  • Ambulance

  • Medical Appliances

  • Hearing Aids

  • 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: R461 500 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

Sub-acute facilities and Wound care

Provides for both in- and out-of-hospital services rendered after an operation or procedure at a rehab or step down facility and private nursing to assist with patient recovery.

  • Wound care is included in this benefit

  • Benefit value: R46 400 Per family per annum, Wound care is included in this benefit, up to an amount of R15 200. Combined in and out-of-hospital benefit

*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: R7 680 per annum
  • Adult dependant: R5 184 per annum
  • Child dependant: R1 500 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 exhausted and is also a family benefit which means that one member of a family can use the total benefit allocation.

Benefit value:

  • Principal Member: R5 730 per annum
  • Adult dependant: R4 270 per annum
  • Child dependant: R1 370 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
*Conditions apply

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: R3 600 Per family every 2 years
*Conditions apply

Dentistry

Dental treatment

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

Benefit value: Unlimited
*Conditions apply

Specialised dental treatment

The provision of specialised dental treatment to members which include crowns and bridges, partial metal dentures, orthodontics and periodontics.

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 conditions

Prescribed medication used continuously for 3 months or more for 18 extra chronic conditions that are not CDL (Chronic Disease List) illness conditions.

Benefit value: R9 800 Per family per annum
*Conditions apply

Supplementary services cover

Psychiatric Treatment
  • Per family per annum.Pre-authorisation compulsory.
  • Combined benefit: in and out-of-hospital.
  • Out-of-hospital treatment is limited to R19 000.

Benefit value: R46 400 

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: R53 800
*Conditions apply

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: R10 300 Per family per annum
*Conditions apply

Hearing aids

The provision of a hearing aid device and the maintenance thereof.

Benefit value:

  • R18 350 Per family per 5 year annum, with a maximum of R9 200 per ear
  • Hearing aid maintenance (including batteries) R1 115 Per beneficiary 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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