Saver 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) 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 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 Member R5 844 Member + adult R11 616 Adult dependant R5 772 Member + child R7 632 Child dependant R1 788 Member + adult + child R13 404 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 0800 765 432 for referral to a network specialist and authorisation for the visit.
| Benefits | Description | |
|---|---|---|
| Professional services benefit | No benefit | |
| General practitioners (GPs) | Paid at the WHFT from your MSA | |
| Specialists |
Paid at the WHFT from your MSA PMBs paid at the WHFT at network specialists Call 0800 765 432 for specialist referral and authorisation |
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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 |
| Associated health services - chiropractors, homeopaths, naturopaths and dieticians | Paid at the WHFT from your MSA | |
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Auxiliary services out of hospital:
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Paid at the WHFT from your MSA No benefit for social workers, vocational guidance, childguidance, marriage guidance, school therapy or attendance at remedial education schools or clinics |
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| Registered private nurse practitioners | Paid at the WHFT from your MSA | |
| Emergency visits / outpatients |
Paid at the WHFT from your MSA |