Comprehensive Health Plans
Schemes A, B and C are tiered to offer three levels of medical aid cover. Scheme A is the entry-level option while Scheme C is the executive health plan option.
If you are looking for a basic outpatient, affordable health option, then Scheme A Standard is for you.
| DESCRIPTION |
SCHEME A STANDARD |
SCHEME A |
SCHEME B |
SCHEME C |
| RECOMMENDED FOR: |
LOW INCOME relatively healthy employees with a limited budget. |
Low Income relatively healthy employees. |
Individual and Corporate clients |
Executives and those who travel frequently. |
| CONTRIBUTIONS & BENEFITS: |
‘day to day’ affordable health care only |
Affordable and Comprehensive |
Affordable, Competitive and Comprehensive |
International Medical Travel Extension through a strategic partner CHARTIS. |
| COVER: |
Comprehensive Care to keep member healthy. |
Comprehensive |
Comprehensive |
Comprehensive & Executive |
| OVERALL ANNUAL LIMITS: |
SINGLE:
FAMILY:
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SINGLE: P274,145.00
FAMILY: P290,772.00
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SINGLE: P866,532.00
FAMILY: P1009,686.00
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SINGLE: P1,351,121.00
FAMILY: P1,785,000.00
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| PENSIONER MEMBERSHIP: |
30-50% Discounted subscriptions at pensioner membership. |
30-50% Discounted subscriptions at pensioner membership. |
30-50% discounted subscriptions at pensioner membership. |
30-50% Discounted subscriptions defaulted to Scheme B benefits. |
| EMERGENCY MEDICAL SERVICES (Air & Ground Ambulance Cover): |
FULL COVER : South Africa, Zimbabwe, Namibia, Lesotho & Swaziland. |
FULL COVER : South Africa, Zimbabwe, Namibia, Lesotho & Swaziland. |
FULL COVER: South Africa, Zimbabwe, Namibia, Lesotho & Swaziland. |
FULL REGIONAL AND INTERNATIONAL COVER THROUGH CHARTIS an International Insurance. |
|
SCHEME A STANDARD |
SCHEME A |
SCHEME B |
SCHEME C |
| 10% co-payment |
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| VAT |
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| Outpatient |
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| Hospital Cover |
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| Managed Care |
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| Chronic medication |
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| Safe Male circumcision |
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| Screening & Prevention |
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| Waiver of Premiums |
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| MRI Cover |
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| Funeral Cover |
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| BOMbaby Programme |
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| Alternative treatment |
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| P1 million travel insurance |
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| Annual Executive Med Exam |
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| Delivery of chronic conditions |
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SCHEME A |
SCHEME B |
SCHEME C |
| BENEFIT CATEGORY |
SINGLE |
FAMILY |
SINGLE |
FAMILY |
SINGLE |
FAMILY |
| Overall Scheme Benefit |
P274,145 |
P290,772 |
P866,532 |
P1,009,686 |
P1,351,121 |
P1,785,000 |
| In-Patient Dread Disease Cover |
In-Patient Dread Disease Cover |
240,000 |
P813,225 |
P931,350 |
P1,249,500 |
P1,,485,750 |
| Hospitalization |
P85,000 |
P100,000 |
P374,500 |
P487,000 |
P724,500 |
P960,750 |
| Maternity Cover |
P85,000 |
P100,000 |
P374,500 |
P487,000 |
P724,500 |
P960,750 |
| Out-patient Cover (Unlimited Consult; Invest; Drugs) |
P16,790 |
P16,790 |
P30,255 |
P43,545 |
P43,798 |
P60,638 |
| Chronic Medication (excl. HIV Benefit) |
P10,500 |
P12,600 |
P37,800 |
P44,100 |
P50,400 |
P67,200 |
| ARV DRUGS & Monitoring per person @ P1,000 per month |
12,600 |
P12,600 |
P12,600 |
P12,600 |
P12,600 |
P12,600 |
| Dental Cover |
P3,842 |
P4,672 |
P4,672 |
P10,163 |
P8,256 |
P14,175 |
| Optical/Ophthalmic(Inclusive of appliance limit) |
AS PER BENEFIT SCHEDULE |
AS PER BENEFIT SCHEDULE |
AS PER BENEFIT SCHEDULE |
AS PER BENEFIT SCHEDULE |
AS PER BENEFIT SCHEDULE |
AS PER BENEFIT SCHEDULE |
| Appliances |
P5,250 |
P6,195 |
P9,450 |
P11,340 |
P11,340 |
P13,650 |
| Allied health services(rehab & alternative |
P2,909 |
P4,541 |
P7,881 |
P11,294 |
P10.924 |
P17,174 |
| Severe Illness Benefit (PM & Spouse |
P20,000 |
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P20,000 |
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P20,000 |
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| Child Dependant |
P4,000 |
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P4,000 |
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P4,000 |
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| Funeral (PM ,Spouse & child dep.(14-21) |
P10,000 |
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P10,000 |
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P10,000 |
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| Child(6-13years) |
P5,000 |
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P5,000 |
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P5,000 |
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| Child (1-5 years) |
P2,500 |
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P2,500 |
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P2,500 |
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| Under 1 year |
P1,500 |
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P1,500 |
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P1,500 |
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Compare Scheme A, B & C benefits (2.98 MB)
Prime Health Pharmacy (665.88 KB)
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