Saver & Saver Choice Option
Day-to-day Benefits
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Benefits will be allocated pro rata for members and their beneficiaries joining during the year.
Once your day-to-day benefits are exhausted, you will be required to pay the healthcare providers/services in full.
You may use any healthcare provider, and claims will be paid at the maximum rates as reflected below. PMB conditions will be paid at the designated service provider (DSP) Wooltru Healthcare Fund Tariff (WHFT) if a DSP is used.
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WHAT ARE DAY-TO-DAY MEDICAL EXPENSES?
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Day-to-day medical expenses are your everyday medical expenses such as GP consultations, dentist visits, optical visits, etc.
Day-to-day medical expenses on the Saver and Saver Choice Option are subject to your Medical Savings Account (MSA), which covers non-PMB, out-of-hospital claims such as GPs, dentists, specialists, medication, optometrists, etc. Claims are reimbursed at the agreed Wooltru Healthcare Fund Tariff (WHFT).
A portion of your monthly contribution is allocated to your MSA. The annual savings amount is calculated over a period of 12 months, or if you join the Fund during the year, the amount will be calculated on a pro rata basis. At the end of the year, any unused savings will roll over to the next year.
Your annual savings amount Saver Choice Member R5 112 Member + adult R10 224 Adult dependant R5 112 Member + child R6 672 Child dependant R1 560 Member + adult + child R11 784
Saver Member R4 656 Member + adult R9 312 Adult dependant R4 656 Member + child R6 084 Child dependant R1 428 Member + adult + child R10 740 NOTES:
Your annual savings amount is allocated upfront. If you terminate your membership of the Fund before the end of the year and you have used more than the contributions that you have paid, you will be required to pay the difference to the Fund. Once you have exhausted your MSA, you will need to pay for any additional day-to-day claims yourself. In order for your PMB specialist claims to be paid at cost, you will need to call 0802 228 922 for referral to a network specialist and authorisation for the visit.
| Benefits | Description | |
|---|---|---|
| Professional services benefit | No benefit | |
| General practitioners Out of hospital |
100% of WHFT Benefit subject to MSA 2 Virtual consultations per Family per annum will be available through Hello Doctor once MSA is depleted, subject to the Major Medical Expenses benefit |
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| Specialists Out of hospital |
Non-DSP specialist: 100% of WHFT DSP Specialist: 100% of Agreed Tariff Benefit subject to MSA |
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| Pathology, radiology and ultrasounds |
Paid at the WHFT from your MSA, unless performed as part of a hospital admission |
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| Basic dentistry - consultations, fillings, extractions, scaling and polishing |
Paid at the WHFT from your MSA |
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| Specialised dentistry - dentures, crowns, bridges and orthodontic treatment | Paid at the WHFT from your MSA | |
| Optical benefits - eye tests, lenses, frames and contact lenses |
Paid at the WHFT from your MSA |
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| OptiClear Network |
Members can receive services and materials at reduced rates from accredited OptiClear providers Click here for details of opticians on the OptiClear Network |
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| Prescribed acute medication | Paid at 100% of the Fund's reference price formulary and subject to your MSA | 100% of formulary medication |
| Over-the-counter medication |
Paid at 100% subject to the Fund's reference price formulary and subject to your MSA |
100% of formulary medication |
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Associated health and
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Paid at the WHFT from your MSA No benefit for vocational guidance, childguidance, marriage guidance, school therapy or attendance at remedial education schools or clinics |
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| Registered private nurse practitioners
The costs of consultations, and treatment in the absence of a nursing pre-authorisation, e.g. baby clinic and treatment for primary healthcare services(including the cost of vaccinations and injection material administered by the practitioner). |
100% of WHFT Benefit subject to MSA |
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| Emergency visits/outpatients |
100% of WHFT |
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| Medical and surgical appliances (including crutches, moonboots, orthotics etc) |
100% of WHFT Subject to clinical motivation and pre-authorisation Benefit subject to MSA Including appliance associated to a hospital admission |