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Silver2

Silver Option

Silver is the step-up medical cover 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.

It takes everyday cover and loads it with a silver lining.

Our comprehensive medical cover with a silver lining.

Silver
2022 Monthly Contributions

Principal Member: R4 084
Adult Dependant: R2 197
Child Dependant: R852

*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 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 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
R189 500 p
er 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

Rehabilitation

Provides for 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
R32 100 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
R10 300 per family per annum sublimit included in the overall sub-acute facility benefits of R32 100*
*Conditions apply

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

Benefit value:

  • Principal Member: R8 315 per annum
  • Adult Dependant: R6 045 per annum
  • Child Dependant: R1 680 per annum
Additional GP consultations

Additional GP consultations for Child Dependants up to the age of 21 after depletion of the day-to-day benefits.

Benefit value
3 consultations per family 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 routine benefit allocation.

Benefit value
Subject to amount available in 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 routine benefit allocation.

Benefit value
R1 690 per family every 2 years*
*Conditions apply

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.

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 medication

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  

Prosthetics / Prosthesis

(Internal, external, fixation devices and implanted devices)

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

Benefit value
R6 900 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
R8 200 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  – 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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Not Included on Silver - click here
  • Hospitalisation benefits for the following procedures:
    • Varicose vein surgery
    • Reflux surgery
  • Specialised dentistry