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platinum
Platinum2

Platinum Option

Platinum is the top tier of medical cover 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.

It brings new meaning to comprehensive cover in every way.

Our ultimate medical cover that leaves nothing to the imagination

Platinum
2022 Monthly Contributions

Principal Member: R9 624
Adult Dependant: R6 747
Child Dependant: R2 031

Medical Benefits

  • Hospital

  • Accidents

  • Specialists

  • Oncology

  • MRI & ICT 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, 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.

Benefit value
Unlimited

Injuries suffered as result of an accident

Treatment for almost all accidents are 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
Unlimited

MRI & CT scans

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

Benefit value
R26 700 per family per annum*

Rehabilitation

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

Benefit value
R53 500 per family per annum*
*Conditions apply

Wound care

The provision of nursing services and equipment to prevent wound complications and promote wound healing.

Benefit value
R18 500 per family per annum sublimit included in the overall sub-acute facility benefits of R53 500*
*Conditions apply

Dialysis

The services provided for the treatment of kidney failure.

Benefit value
Unlimited
*Conditions apply

Organ transplants

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 (out of hospital)

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

Benefit value
Principal Member: R11 685 per annum
Adult Dependant: R11 335 per annum
Child Dependant: R2 770 per annum

Self-payment Gap

An amount payable by the member when the routine benefit allocation is depleted prior to entering the threshold zone.

Benefit value
Principal Member: R4 090
Adult Dependant: R3 640
Child Dependant: R1 345

Threshold Zone

Additional routine medical expenses benefits available to members once they have bridged the self-payment gap.

Benefit value
Acute medication:
– Principal Member: R9 640
– Adult Dependant: R4 360
– Child Dependant: R2 150
Physiotherapist: R15 250 per family per annum
Pathology: R15 250 per family per annum
All other routine benefits: Unlimited

Optical services

Optical services, including eye tests, frames, lenses and contact lenses, are paid from the day-to-day benefit amount, i.e. the routine benefit allocation.

Benefit value
R5 650 per family every 2 years*
*Conditions apply

A refractive surgery benefit is also available after pre-authorisation has been obtained.

Benefit value
R11 450 per family*
*Conditions apply

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 routine benefit allocation.

Benefit value
Subject to routine benefit allocation

Dentistry

Dental treatment

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

Benefit valu
Unlimited*
*Conditions apply

Specialised dental treatment

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

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 29 additional chronic conditions that are not on the PMB Chronic Disease List (CDL).

Benefit value
R20 500 per beneficiary per annum to a maximum of R41 900 per family per annum*
*Conditions apply

Supplementary services cover​

Psychiatric Treatment
  • Combined benefit: in and out-of-hospital.
  • Out-of-hospital treatment is limited to R25 100.
  • Pre-authorisation compulsory.
  • Case Management applies.

Benefit value:
R60 200 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
Unlimited

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
R12 450 per family per annum*
*Conditions apply

Hearing aids

The provision of hearing aid(s) and the maintenance thereof.

Benefit value:
R37 700 per family every 5 years*
+ R1 435 yearly for maintenance (including batteries) of the hearing aid(s) *
*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

Supplementary services cover​

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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