Benefits
RUMed offers comprehensive medical cover, ensuring that in-hospital benefits are covered at 100% of the scheme tariff, providing peace of mind during hospital stays. For day-to-day medical expenses, the scheme operates on a co-payment basis, allowing members to contribute a portion of the costs while still receiving essential healthcare benefits. This balanced approach ensures affordability while maintaining access to quality medical care.
Day to Day benefits
| Benefits | Description | Scheme rate | |
|---|---|---|---|
MEDICATIONSubject to reference price list and exclusions |
Acute | The first R2 200 per beneficiary paid at 100%thereafter at 80% to a max of R4 400 per beneficiary with a maximum of R10 000 per family | |
| Contraceptives | Sublimit of R3500. Oral contraceptives limited to R220 per script. IUDs and implants limited to once every 5 years | 100% of RUMed Tariff | |
| Chronic | 26 CDL (Chronic Disease List) Conditions (in accordance with the PMB regulations) |
100% of RUMed Tariff | |
| Extended Chronic List (Pre-authorisation required) |
No limit | 90% of RUMed Tariff, to a maximum of R100per item | |
| To Take Out (TTO) | Limited to R500 per admission | From hospital limit, thereafter from the Acute Medication limiT |
|
| Over The Counter (OTC) | Subject to a maximum of R250 per script with a limit of R2 500 per family per year, included in the Acute Medication limit | 100% of RUMed Tariff | |
| DENTISTRY | Conservative Dentistry | The first R1 500 paid at 100% thereafter at 80% Unlimited |
|
| Specialised Dentistry | R7 000 per beneficiary at 80% of RUMed Tariff. The specialised dentistry benefit can be utilised up to the family limit of R14 000 at 70% of RUMed Tarif | ||
| In-Hospital Dental Procedures (Pre-authorisation required) |
R14 000 per beneficiary (includes doctors’ cost and hospitalisation) |
100% of RUMed Tariff | |
| GP’S AND SPECIALISTS | In-Hospital Consultations | No Limit | 100% of RUMed Tariff |
| Out-of-Hospital Consultations | The first R2 700 per beneficiary paid at 100%thereafter at 80% to a max of R5 400 per beneficiary with a maximum limit of R11 000 per family. | ||
| OPTOMETRY | Eye Examination - One per beneficiary per year Lenses SingIe Vision - Up to R670 per beneficiary Bi-focal - Up to R1 500 per beneficiary Multi-focal - Up to R2 670 per beneficiary Frames – Up to R1 110 per beneficiary Should the frame benefit not be fully utilised, tints, hardening and non-reflective coatings can be claimed from this benefit Contact Lenses (annually) – Up to R1 990 per beneficiary |
||
| AUXILIARY SERVICES | R4 000 per beneficiary, with a maximum of R10 000 per family. The psychology benefit can be utilised up to the family limit of R10 000 |
80% of RUMed Tariff | |
|
PHYSIOTHERAPY Subject to reference price list and exclusions |
In-Hospital | R4 000 PMF Combined limit with In-Hospital Auxiliary Services. | 100% of RUMed Tariff |
| Out-of-Hospital | Included in Auxiliary Service limit | 80% of RUMed Tariff | |
| RADIOLOGY | In-Hospital | No limit | 100% of RUMed Tariff |
| Out-of-Hospital | No limit | 80% of RUMed Tariff | |
| Specialised Radiology (Pre-authorisation required) |
No limit | 100% of RUMed Tariff | |
| PATHOLOGY | In-Hospital | No limit | 100% of RUMed Tariff |
| Out-of-Hospital | No limit | 80% of RUMed Tariff | |
|
MEDICAL APPLIANCES (Pre-authorisation required) |
Combined limit of R5 000 per family plus an additional R18 000 for hearing aids paid at 90% of RUMed Tariff per ear per 4-year period. |
80% of RUMed Tariff | |
|
PREVENTATIVE CARE/HEALTH MAINTENANCE |
Cholesterol Blood Test, Blood Glucose Test, HIV Test, Glaucoma Test | R2 000 per beneficiary with a maximum of R4 000 per family. |
100% of RUMed Tariff |
| Immunisations | An additional R2 000 for child immunisation which does not accumulate to the family limit of R4 000 and is not pro-rated during a calendar year. |
100% of RUMed Tariff | |
| Oxygen | R10 000 per family | 100% of RUMed Tariff | |
| Compassionate Care Benefit | An additional R2 000 for child immunisation which does not accumulate to the family limit of R4 000 and is not pro-rated during a calendar year. |
100% of RUMed Tariff | |
| Maternity Benefit (Subject to registration on the maternity program) |
4 Visits GP/Gynaecologist Confinement fee Antenatal vitamins Home Delivery Benefit – Successful home delivery covered up to R12 000 else R1 200 if hospitalised. 2 2D scans 1 Paediatrician Visit Maternity Bag |
200% of RUMed Tariff R100 / for 9 months (from acute benefit) Limit R3 000 |
In-Hospital Benefits
|
HOSPITALISATION (PRIVATE AND PUBLIC) Pre-authorisation required |
Accommodation in a general ward, HCW and ICU Theatre fees Medication and equipment Annual Limit |
100% of RUMed Tariff | |
|---|---|---|---|
| Ambulance | No limit if authorised through ER24 | ||
| In-Hospital Benefits | R10 000 per beneficiary | 100% of RUMed Tariff | |
| Internal Surgical Implants | R44 000 per beneficiary | 100% of RUMed Tariff | |
| External Prosthesis | R6 000 per beneficiary | ||
| In-Hospital Auxiliary Services | R4 000 per family | 100% of RUMed Tariff | |
| Psychiatric Hospitalisation | R12 000 per family (Includes psychiatric visits in hospital |
100% of RUMed Tariff |
Major Medical Expenses
|
MAJOR MEDICAL EXPENSES Pre-authorisation required |
Organ Transplant | R100 000 per family unless in accordance with the Prescribed Minimum Benefit |
100% of RUMed Tariff |
|---|---|---|---|
| Kidney Dialysis | Unlimited per family | subject to protocols | 100% of RUMed Tariff | |
| Oncology | R350 000 per family, including cancer screening. Cancer Screening: Breast Cancer Screening - Mammogram Cervical Cancer Screening - PAP Smear Prostate Cancer Screening - PSA Colo-Rectal Cancer Screening - Fecal Occult Blood Test. |
100% of RUMed Tariff | |
| HIV/AIDS | Unlimited Subject to managed care protocols |
100% of RUMed Tariff |
Information
