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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

MARINE: APPLICABLE CO-PAYMENTS AND/OR PENALTIES

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

AQUARIUM: APPLICABLE CO-PAYMENTS AND/OR PENALTIES

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

Tel: 0860 765 633 or 0860 POLMED
Email: polmed@medscheme.co.za
Fax: 0860 104 114

Polmed Client Service Centre:

Nedbank Plaza, C/o Stanza Bopape and
Steve Biko Streets, Arcadia, 0083

Postal Address:

Polmed, Private Bag X16,
Arcadia, 0007

Emergency Services:

ER24 0800 727 772 or
084 124

Council for Medical Schemes:

www.medicalschemes.com
Polmed Fraud Hotline:
0800 112 811
SMS: 33490

information@whistleblowing.co.za
fraud@medscheme.co.za

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