Co-payments | POLMED

Overview of Plans

BENEFITS	MARINE	AQUARIUM	CO-PAYMENTS AND COMMENTS
In-Hospital Benefits
PMB Hospital cover	Unlimited	Unlimited	Subject to Polmed DSP R15 000 co-payment for admission in a non-DSP hospital Negotiated DSP tariff Subject to pre-authorisation Subject to R5 000 penalty where pre-authorisation was not obtained Subject to managed care protocols and guidelines
Non-PMB Hospital cover	Unlimited	R200 000	R15 000 co-payment for admission in a non-DSP hospital Negotiated DSP tariff Subject to pre-authorisation Subject to R5 000 penalty where pre-authorisation was not obtained Subject to managed care protocols and guidelines
Elective Caesarean Sections	Yes	Yes	Subject to pre-authorisations Considered in line with managed care and funding protocols A co-payment of R10 000 will apply for voluntary Caesarean sections

BENEFIT CATEGORY	APPLICABLE NETWORK AND/OR REQUIREMENT	APPLICABLE CO-PAYMENTS AND/OR PENALTIES	REMARKS
General Practitioners (GP)	GP Network	Funded at Non-Network tariff rate	Allows 2 out of network consultations per beneficiary per annum
Specialists	Specialist Network	Polmed rate applies, any shortfall will be for the account of the member.	PMB Rate applies
Hospital	Hospital DSP	R15 000 co-payment for admission in a non-DSP Hospital R5 000 penalty for unauthorised admissions	Polmed Hospital DSPs: Mediclinic Life Health NHN Clinix JMH Limited Netcare
Pharmacy	Pharmacy Network	20% of costs for using a non-Network Pharmacy 20% co-payment for voluntarily using a non-formulary product	Open Pharmacy Network with 90% of Pharmacies
Renal Dialysis	Renal Dialysis Network	30% of cost when using a non-DSP	Renal Dialysis Network Refer to the website for more details
Oncology (Cancer)	Oncology Network	Funded at Network tariff rate	Preferred Providers: Independent Clinical Oncology Network (ICON)
Emergency Medical Services	Netcare 911	40% of cost for using unauthorised service provider

BENEFIT CATEGORY	APPLICABLE NETWORK AND/OR REQUIREMENT	APPLICABLE CO-PAYMENTS AND/OR PENALTIES	REMARKS
General Practitioners (GP)	GP Network	Funded at Non-Network tariff rate	Allows 2 out of network consultations per beneficiary per annum
Specialists	Specialist Network / DSP	Polmed rate applies, any shortfall will be for the account of the member.	PMB Rate applies
Hospital	Hospital DSP	R15 000 co-payment for admission in a Non-DSP Hospital R5 000 penalty for unauthorised admissions	Polmed Hospital DSPs: Mediclinic Life Health NHN Clinix Limited Netcare
Pharmacy	Pharmacy Network	20% of costs for using a non-Network Pharmacy 20% co-payment for voluntarily using a non-formulary product	Open Pharmacy Network with over 2 200 Pharmacies
Renal Dialysis	Renal Dialysis Network	30% of price for using non DSP	Renal Dialysis Network Refer to the website for more details
Oncology (Cancer)	Oncology Network	Funded at Network tariff rate	Preferred Providers: Independent Clinical Oncology Network (ICON)
Emergency Medical Services	Netcare 911	40% of cost for using unauthorised service provider