Platinum Option
It brings new meaning to comprehensive benefits.
Platinum is the top tier of medical benefit for people who want it all taken care of, now and in the future.
With a prime rate and top-drawer value, this option offers an unlimited hospital plan, superlative day-to-day cover, self-funding gap and threshold, plus benefits for 55 chronic medical conditions, as well as increased dental cover, out-of-hospital mental health cover, unlimited oncology and prosthesis benefits, and more.
Platinum 2024 Monthly Contributions
- Principal Member: R11 308
- Adult Dependant: R7 929
- Child Dependant: R2 388
Medical Benefits
-
Hospital
-
Accidents
-
Specialists
-
Oncology
-
MRI & CT Scans
-
Rehab / Wound Care
-
Dialysis
-
Organ Transplants
-
Routine Expenses
-
Self Payment Gap
-
Threshold Zone
-
Optical
-
Pathology
-
Dental
-
Special Dental
-
Chronic Medication
-
Extra Chronic
-
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 Netcare or Life Healthcare hospital (DSP hospital network) will be paid in full. There is no restriction on the number of admissions to hospital, but all in-hospital procedures should be pre-authorised prior to admission.
*30% co-payment applicable on hospital account if non-DSP hospital is voluntarily used.
Benefit value: Unlimited
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
The services provided by any Specialist whilst the member is in hospital are covered by the Scheme.
Benefit value: Unlimited
*Conditions apply
The diagnosis and treatment of cancer related conditions.
Benefit value: Unlimited
Includes scans done for diagnostic reasons both in- and out-of-hospital.
Benefit value: R29 800 Per family per annum
*Conditions apply
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: R59 900 Per family per annum, Wound care is included in this benefit, up to an amount of R20 700. Combined in and out-of-hospital benefit.
*Conditions apply
The services provided for the treatment of kidney failure.
Benefit value: Unlimited
*Conditions apply
The transplant of a donor organ to a recipient, including the provision of immunosuppressant drugs to prevent rejection of the organ.
Benefit value: Unlimited
Day-to-day medical expenses cover (outside of the hospital)
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: R13 065 Per annum
- Adult dependant: R12 675 Per annum
- Child dependant: R3 100 Per annum
An amount payable by the member when the routine medical expenses portion is exhausted prior to entering the Threshold Zone.
Benefit value:
- Principal Member: R4 575
- Adult dependant: R4 070
- Child dependant: R1 500
Additional routine medical expenses benefits available to members once the have bridged the self-payment gap.
Benefit value:
- Acute medication
– Principal Member: R10 780
– Adult dependant: R4 870
– Child dependant: R2 400 - Physio: R17 050 Per family per annum
- Pathology: R17 050 Per family per annum
- All other expenses: Unlimited
Optical services, including eye tests, frames, lenses and contact lenses, are paid from the day-to-day benefit amount, i.e. the routine expenses portion, subject to the overall optical benefits.
Benefit value: R6 300 Per family every 2 years.
A refractive surgery benefit is also available after pre-authorisation has been obtained.
Benefit value: R24 000 Per beneficiary once per lifetime.
*Conditions apply.
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 routine expenses portion.
Benefit value: Subject to routine expenses benefits.
*Conditions apply.
Dentistry
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.
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
Prescribed medication used continuously for 3 months or more for one of the 26 CDL (Chronic Disease List) illness conditions.
Benefit value: Unlimited.
Prescribed medication used continuously for 3 months or more for 29 extra chronic conditions that are not CDL (Chronic Disease List) illness conditions.
Benefit value: R22 900 Per beneficiary per annum, with a maximum of R46 800 Per family per annum.
*Conditions apply.
Supplementary services cover
- Per family per annum.
- Pre-authorisation is compulsory.
- Combined benefit: in and out-of-hospital.
- Out-of-hospital treatment is limited to 28 000.
Benefit value: R67 300.
- Unlimited.
- Subject to pre-authorisation, case management reference pricing, preferred provider and Scheme protocols.
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.
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: R13 900 Per family per annum.
*Conditions apply.
The provision of a hearing aid device and the maintenance thereof.
Benefit value:
- R42 200 Per family per 5-year annum, with a maximum of R20 900 per ear.
- Hearing aid maintenance (including batteries) R1 605 Per beneficiary per annum.
*Conditions apply.
All scopes are covered in full if done at a DSP hospital – any Life Healthcare and Netcare hospitals nationally and selected 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 (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.
