Gold Ascend

Hospital and related

• No overall annual limit (100% Scheme rate)
• Private hospitals (EDO plan network hospitals)
• Specialists cover a 100% medical aid rate
• To-Take-Out medication (TTO): seven (7) days
• Maternity cover within medical protocols (100% Scheme rate)
• Internal and external prosthesis: R32 595 per family
• Oncology: unlimited for PMB and 80% scheme rate cover above R229 320
• Specialised radiology: combined in and out of hospital, R23 786 per family per annum • Ambulance and Emergency Services – Europe Assist (0860 117 799) 24-hour access. Authorisation is required within 72 hours of an emergency event

Day-to-Day benefits include

• GP, Specialist (excluding Psychiatrists) outpatient facilities, Physiotherapy, Radiology, Pathology and Acute medication. EDO plan – access benefits from Network providers
• Benefits ranging from R7 228 to R19 755 based on family size

Dental care – Benefit managed by Dental Risk Company

• Benefit cover for conservative dentistry per beneficiary
• Two (2) consultations per beneficiary
• Oral Hygiene
• Extractions
• Fillings
• Intra and extra-oral x-rays
• Root Canal Treatment
• Plastic Dentures: One (1) set, full or partial in a four (4) year period

Optical – Benefit managed by Isoleso

• 24-month treatment cycle
• One (1) eye test per beneficiary
• Frames: R713 per beneficiary
• Lenses: single vision – R229 and up to R497 per lens for bifocal & multifocal
• Or choose contact lenses up to R1 572 Maternity benefits – Register on the Bambino programme
• Ten (10) antenatal visits per pregnancy, six (6) either with a GP or midwife and four (4) with a Specialist Obstetrician.
• Specified maternity blood tests covered
• Vitamins: R270
• Two (2) 2D Scans
• Childhood Immunisation, as per the Department of Health, is for children up to 12. 1 heart, hearing and vision screening for babies under 2 years of age

Mental health benefit – Psychiatrists and Clinical Psychologist

• R6 590 per family per annum

Medical appliances benefit (Includes nebulizer, C-Pap machine)

• R1 291 single member or R2 074 per family

Auxiliary

• R1 280 per beneficiary per annum

Wheelchair and hearing aid benefit (four [4]-year cycle)

• Wheelchair R2 389 per family
• Hearing Aids R19 091 per family per annum

Cover for 26 PMB chronic conditions, subject to registration and approval. Covered medication, bloods and GP within PMB protocols and authorisations.

• Addison’s disease
• Asthma
• Bipolar Mood Disorder
• Bronchiectasis
• Cardiac failure
• Cardiomyopathy
• Chronic obstructive pulmonary disease
• Chronic renal disease
• Coronary artery disease
• Crohn’s disease
• Diabetes insipidus
• Diabetes mellitus types 1 & 2
• Dysrhythmias
• Epilepsy
• Glaucoma
• Haemophilia
• HIV/Aids
• Hyperlipidaemia
• Hypertension
• Hypothyroidism
• Multiple sclerosis
• Parkinson’s disease
• Rheumatoid arthritis
• Schizophrenia
• Systemic Lupus Erythematosus
• Ulcerative colitis

Health screening is an essential part of preventative healthcare and is vital to maintaining overall well-being and improving outcomes by providing care at the earliest possible stage.

Wellness Consultation

• R1 870 per family per annum

Preventative Care and Screening Benefits include

• One (1) pap smear for females over 18 years per beneficiary per annum
• One (1) mammogram for females over 40 years of age per beneficiary per annum
• One (1) skin cancer screening per beneficiary above 55 years of age, annually
• One (1) PSA for males over 40 years per beneficiary per annum
• Blood sugar, cholesterol, blood pressure, Body Mass Index, HIV

Vaccinations Benefit

• Covid-19 vaccination per beneficiary
• Flu vaccination
• HPV vaccination
• Pneumococcal vaccine

Female Contraceptive Benefit

• R3 331 per family