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Optimal2018-10-05T14:38:50+00:00

Monthly Premium

R258.24 per family for under 65yrs

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R347.01 per family for 65yrs+

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Benefits

In-hospital benefits

Medical Expense Shortfall Cover Increases the medical aid rate up to 500%. (e.g. Specialists, GPs, Anaesthetists, Radiology, Pathology, etc). Subject to the Overall Annual Limit
Co-payment Cover R55 000 per admission per insured. Subject to the Overall Annual Limit
Sub-limit Cover R15 000 per admission per insured. Limited to R50 000 per family per annum. Subject to the Overall Annual Limit

In-hospital and out-of hospital Benefits

Traditional Cancer Cover Co-payment cover for traditional cancer treatment limited to 20% per admission. Subject to the Overall Annual Limit (R200 000 excess)
Biological Cancer Drug Cover Provides cover for Biological Cancer Drugs when the medical aid imposes a sub-limit. Subject to the Overall Annual Limit and Formulary

Out-of hospital benefits

Co-payments for MRI, CT and PET scans R55 000 per admission per insured. Subject to the Overall Annual Limit
Casualty Benefit (Accidents only) R7 000 per event per insured. Subject to the Overall Annual Limit

Added benefits

 

Medical Scheme Contribution Waiver Up to R5 500 per month for 6 months; in the event of death or permanent and total disability as a result of an accident, of the medical scheme contribution payer
Gap Premium Waiver Pays the premium for your Optimal policy for 6 months; in the event of death or permanent and total disability as a result of an accident, of the contribution payer
International Travel Cover R5 000 000 per insured

Overall Annual Limit (OAL) – R150 000 per insured per annum

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Additional Information

Biological Cancer Drugs

Click the respective button to reveal the cancer types that may require treatment through the use of a biological cancer drug covered under Premier.

Specific Cancer Categories
List of Drugs

Waiting Periods

Click the button to review the waiting periods and expections associated with the Optimal Plan.

Waiting Periods
Exceptions
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