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Optimal 20192019-02-22T13:57:19+00:00

Monthly Premium

R285 per family for under 65yrs

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R405 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 Subject to the Overall Annual Limit
Sub-limit Cover R20 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 (R100 000 excess)
Biological Cancer Drug Cover Provides cover for Biological Cancer Drugs when the Medical Scheme imposes a sub-limit. Subject to the formulary (see pg 10) and the Overall Annual Limit

Out-of hospital benefits

Co-payments for MRI, CT and PET scans Subject to the Overall Annual Limit
Casualty Benefit (Accidents only) R8 000 per event per insured. Subject to the Overall Annual Limit

Added benefits

Medical Scheme Contribution Waiver Up to R6 000 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 12 months; in the event of death or permanent and total disability as a result of an accident, of the contribution payer
Personal Accident Benefit R10 000 per insured on the Policy, in the event of accidental death or permanent and total disability
Critical Illness Benefit R7 500 per insured on the Policy in the event of death due to a critical illness
International Travel Cover R5 000 000 per insured

Overall Annual Limit (OAL) – R157 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 Optimal.

Specific Cancer Categories
List of Drugs

Waiting Periods, Exceptions and more

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

Waiting Periods
Childbirth Limits
Exceptions