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    Compcare-Student Brochure 2023

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    sithandazilem30
    This document summarizes a medical insurance plan called the CompCare Networx Option for 2023. It provides unlimited hospital coverage at network hospitals and covers services like doctors visits, surgery, and chronic medication. It also provides benefits for day-to-day services like GP and specialist visits, basic dental, and optometry, subject to an annual flexi benefit limit.

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    Download as PDF, TXT or read online from Scribd

    Compcare-Student Brochure 2023

    Uploaded by

    sithandazilem30
    8 views2 pages
    This document summarizes a medical insurance plan called the CompCare Networx Option for 2023. It provides unlimited hospital coverage at network hospitals and covers services like doctors visits, surgery, and chronic medication. It also provides benefits for day-to-day services like GP and specialist visits, basic dental, and optometry, subject to an annual flexi benefit limit.

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    This document summarizes a medical insurance plan called the CompCare Networx Option for 2023. It provides unlimited hospital coverage at network hospitals and covers services like doctors visits, surgery, and chronic medication. It also provides benefits for day-to-day services like GP and specialist visits, basic dental, and optometry, subject to an annual flexi benefit limit.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    8 views2 pages

    Compcare-Student Brochure 2023

    Uploaded by

    sithandazilem30
    This document summarizes a medical insurance plan called the CompCare Networx Option for 2023. It provides unlimited hospital coverage at network hospitals and covers services like doctors visits, surgery, and chronic medication. It also provides benefits for day-to-day services like GP and specialist visits, basic dental, and optometry, subject to an annual flexi benefit limit.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    (2023 rates)

    UNLIMITED UNLIMITED Excellent


    hospitalisation doctor visits OUT-OF-HOSPITAL
    benefits

    EMERGENCY PLAYING REPATRIATION


    ASSISTANCE, SPORT? COVER
    including airlifts We’ve got via Universal 360°
    you covered

    SMS ‘youth’ to 32673 if


    you’re keen to find out more

    Complete Cover. Committed Care. CompCare.

    0861 222 777 Administered by

    [email protected]
    CompCare Medical Scheme is administered by
    Universal Healthcare Administrators (Pty) Ltd.
    COMPCARE NETWORX OPTION | 2023
    In-hospital benefits • Unlimited – subject to scheme protocols
    Overall Annual Limit (OAL)

    Services covered in • GPs and specialists


    • Ward fees – general, ICU and high care
    hospital • Theatre fees
    100% of the agreed tariff (AT), subject • Medication while in hospital
    to pre-authorisation and Network DSP • Blood transfusions
    hospitals. All treatment in hospital • Oncology
    is subject to case management and • Surgical prostheses (PMB only)
    scheme protocols • Clinical technologists limited to R12 000 per family
    • Radiology – MRI, CT and PET scans
    • Pathology
    • Confinements
    • Psychiatric treatment – subject to pre-authorisation and protocols (PMB only)
    • Organ and bone marrow transplants, plasmapheresis and renal dialysis (PMB only)
    • Cover for injuries sustained whilst participating in professional sports
    • Emergency medical treatment for injuries resulting from accidents or trauma
    • Physiotherapy – limited to R2 700 per family. Combined auxiliary services limit in and out of hospital
    • Alcoholism, drug dependence and narcotism

    Cover for chronic


    conditions • Chronic medication is unlimited, subject to medicine formulary and if prescribed by a Universal Network Provider
    27 chronic conditions covered and dispensed within a Universal Network pharmacy or by a dispensing Universal Network GP. Any voluntary use of
    Chronic medication is subject to the chronic medicine prescribed by an out-of-network provider and any non-formulary medicines are for the member’s
    Core Formulary list of medicines and own account, unless pre-authorised by the medical advisor. (PMB rules apply)
    a Formulary reference price (FRP). • Subject to formulary reference pricing
    Members are required to register for all
    chronic conditions

    Unlimited day-to-day • GP visits – unlimited at a Universal Network GP, subject to clinical necessity. Clinical motivation may be required
    to authorise more than three GP visits per beneficiary per year
    services • Two out-of-network visits per beneficiary per year. A 20% co-payment applies. Members are required to pay
    Not subject to the Annual Flexi Benefit at point of service and claim back from the scheme. Benefits per event (including medicines, pathology and
    (AFB) radiology) and excluding facility fees are limited to R1 320 per event
    • Acute medication – unlimited if prescribed by a Universal Network GP, or by a specialist provided member referred
    Services subject to the use of the by a Universal Network GP. Subject to formulary. A 25% co-payment will apply if medicine is not on the formulary.
    Universal Provider Network No cover for non-formulary medicines unless otherwise pre-authorised. No cover in case of voluntary use of non-
    Universal providers, or voluntary use of specialist without referral by a Universal Network GP
    • Basic radiology – unlimited, subject to specific codes- referral by a Universal Network GP required
    • Basic pathology – unlimited, subject to specific codes- referral by a Universal Network GP required

    Day-to-day services paid • Specialist consultations – limited to two per beneficiary, maximum of three per family, subject to referral by a
    Universal Network GP, pre-authorisation required. Referrals limited to specialists in DSP Network hospitals only
    from the Annual Flexi • Basic dentistry – limited to one consultation per beneficiary including preventative care, infection control, fillings, extractions
    Benefit (AFB) at 100% of and dental X-rays at a Universal Network dentist – R1 870 per beneficiary up to R3 120 per family, subject to AFB
    the agreed tariff • Optometry – limited to one test per beneficiary every 24 months, including lenses – clear plastic lenses for single
    vision and frames limited to R1 053 per beneficiary. Bi-focals and frames limited to R1 680 per beneficiary at a
    AFB – R3 600 per beneficiary per year
    Universal Network optometrist, subject to AFB
    R5 400 per family per year
    • Out of hospital physiotherapy
    • Hospital emergency room/casualty emergency visits for non-emergency consultations

    Wellness: Lifestyle and • Blood pressure, blood sugar, cholesterol, BMI and waist circumference - one measurement per beneficiary over the
    age of 18 years. Limited to R250 per event
    preventative care • Flu vaccinations – one vaccination per beneficiary
    Paid from risk • Unlimited telephonic counselling sessions through the Universal Wellness Care Centre, with an option for referral
    to one-on-one sessions with qualified psychologists, social workers or registered counsellors to a maximum of 3
    referral sessions PB per year
    • Oral contraceptives limited to R160 per beneficiary per month. Subject to medication formulary

    Want to know more?


    Gauteng Eastern Cape Western Cape
    Tel: 0861 222 777 Tel: 083 565 2876 Tel: 079 382 8812
    Email: [email protected] Email: [email protected] Email: [email protected]

    KwaZulu-Natal Mbombela Walk-in office JHB


    Tel: 084 589 2790 Tel: 076 572 2084 JCCI House
    Email: [email protected] Email: [email protected] 27 Owl Street
    Cnr Empire Road, Milpark
    Website Tel: 011 208 1005
    www.studentplan.co.za

    This summary is for information purposes only and does not supersede the rules of the Scheme. In the event of a discrepancy between the summary and the rules, the
    rules will prevail. On joining the scheme, all members will receive a detailed member brochure, as approved. The final registered rules of the scheme will apply.
    *Terms and conditions apply

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