OPTIMA SERIES

  • Medicall Healthcare’s Optima Series is designed specifically for employees
  • All benefits do not incur a registration period
  • Certain benefits incur waiting periods
  • All hospital benefits are subject to pre-authorisation
  • Our call center can be contacted on 0860 077 722
  • We offer 24 hour service

OPTIMA BENEFITS

GP VISITS Members can choose from any Medicall Healthcare Network GP only. Benefits include unlimited medically necessary consultations, specified minor trauma treatment from the Network GP. Referral by Network GP to state facility if required.
MATERNITY GP Pre and post-natal care, supervision of an uncomplicated pregnancy up to week 20 including one 2D sonar scan per pregnancy. Referral by Network GP to a state facility if required.
BASIC PATHOLOGY Basic blood tests as requested by Medicall Healthcare provider; subject to Medicall protocols and approved list of codes.
BASIC RADIOLOGY Basic Black and White X-Rays as requested by Medicall Healthcare provider, subject to Medicall protocols and approved list of codes.
ACUTE MEDICATION As dispensed by a Medicall Healthcare Network GP or via prescription through a Network Pharmacy according to the Medicall Healthcare medicine formulary.
HIV BENEFIT Included in cost of day to day benefits. HIV Elisa blood test, Symptomatic treatment due to HIV Infection. Referral by Network GP to state facility if required.
CHRONIC MEDICATION

(Waiting Periods Apply)

26 Chronic Conditions covered. Subject to registration and approval from Medicall Clinical Department and issued according to the Medicall Healthcare medicine formulary. 6 Month Waiting Period.
HIV CHRONIC MEDICATION

(Waiting Periods Apply)

Subject to quote request by employer.
ONSITE NURSING Chronic disease management, primary health and wellness management. Subject to group size. Refer to On Site Nursing in Brochure
BASIC DENTISTRY

(Waiting Periods Apply)

Members can choose from any Medicall Healthcare Network Dentist. Benefits include consultations, fillings, extractions, infection control, cleaning and polishing of teeth. Subject to a list of approved dental codes.
6 Month Waiting Period.
BASIC OPTOMETRY

(Waiting Periods Apply)

Members can choose from any Medicall Healthcare Network Optometrist. Benefits include one optical test, standard basic frame, one set of clear mono, bi-focal or multi-focal lenses or contact lenses (to the value of R395) per 24 months. Co-payment by member if lenses exceed R290 per lens.
6 Month Waiting Period.
HOSPITAL TRAUMA

(Stabilisation following emergency)

An Emergency Room / Trauma Room Benefit is payable in the event of a life threatening incident, as assessed and authorized by Medicall Healthcare, up to a maximum of R20,000 per member. This benefit is limited to one incident per year, per member. Subject to a 30 day waiting period.
MEDICAL EVACUATION Payable per accident for transportation and emergency medical treatment up to R100,000 per accidental event.
ACCIDENTAL DEATH R100,000 where accidental bodily injury results in the death of a member.
ACCIDENTAL DISABILITY Up to a limit of R100,000 where accidental bodily injury results in the permanent total disability of a member as defined in the policy definitions.
DAILY BENEFIT Daily cash benefit for non-medical expenses as a result of hospitalisation following accidental bodily injury up to a maximum limit of R1000 per day / 20 days per annum Requires hospital confinement of more than 24 hours. * Subject to pre-authorisation.
AMBULANCE All members enjoy the benefit of ambulance services when an ambulance service is required for an accident or life threatening emergency as assessed by the emergency call centre. Up to R35,000 per event.
FUNERAL BENEFIT PRINCIPAL Death Benefit of R10,000 for Principal member, 6 month waiting period.

MORE INFORMATION