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Silver2

Silver Option

It takes everyday benefits and loads them with a silver lining.

Silver is the step-up medical benefit for individuals and families who expect more than the usual.

With a high value-for-money rate, this option offers an unlimited hospital plan, enhanced day-to-day cover and benefits for 29 chronic medical conditions, as well as dental cover and three extra doctor’s visits for your Child Dependants.

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Silver 2024 Monthly Contributions

  • Principal Member: R4 799
  • Adult Dependant: R2 582
  • Child Dependant: R1 002
*Note: Contributions charged up to a maximum of 3 child dependants.

Medical Benefits

  • Hospital

  • Accidents

  • Specialists

  • Oncology

  • MRI & ICT Scans

  • Rehab/Wound care

  • Routine Expenses

  • Pathology

  • Optical

  • Dental

  • Chronic Medication

  • Ambulance

  • Medical Appliances

  • Scopes

  • PMB's

  • Prosthesis

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 selected 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.

Benefit value: Unlimited

Specialist services in-hospital

The services provided by any Specialist whilst the member is in hospital are covered by the Scheme, as per the rules and clinical protocols.

Benefit value: Unlimited
*Conditions apply

Oncology

The diagnosis and treatment of cancer related conditions.

Benefit value: R212 000 Per family per annum

MRI & CT scans

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

Benefit value: R21 000 Per family per annum combined benefit in or out-of-hospital. R1 580 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: R35 900 Per family per annum, Wound care is included in this benefit, up to an amount of R11 500. Combined in and out-of-hospital benefit.

*Conditions apply

Day-to-day medical expenses cover (outside of the 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 benefit is a family benefit which means that one member of a family can use the total benefit allocation.

Benefit value:

  • Principal Member: R9 300 Per annum
  • Adult dependant: R6 760 Per annum
  • Child dependant: R1 880 Per annum
Additional GP

Additional GP consultations after depletion of day-to-day benefits for child dependants up to the age of 21 (3 Per family 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. routine expenses portion.

Benefit value: Subject to routine expenses benefits
*Conditions apply

Optical services

Optical services, including eye tests, frames, lenses and contact lenses, are paid from the day-to-day benefit amount, subject to the overall optical benefits

Benefit value: R1 890 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
  • 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

Additional 4 non-PMB CDL conditions: acne and ADHD / ADD for children up to the age of 21, rhinitis, and major depression for all beneficiaries.

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: R24 000 

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: R7 700 
*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: R9 100 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 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

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