Maternity Programme

PLATCOMPREHENSIVE OPTION

REGISTRATION ON THE MATERNITY PROGRAMME IS REQUIRED FOR MEMBERS TO ENJOY FULL BENEFITS

Only 1 pregnancy per beneficiary is covered under the PlatCap Option.

Antenatal consultations

Referral letter from GP/Specialist required to see Gynaecologist.
Authorisation required from Case Management prior to each visit.
Motivational letter from Gynaecologist required for more visits than the prescribed 8 visits.

Pregnancy scans

3 sonars per event/pregnancy.
Authorisation required from Case Management prior to scans.
Motivation letter from Obstetrician required for high-risk pregnancies.
Ultrasound scans are performed three times: at 12 and 22 weeks, and between 23 and 40 weeks.
Other sonars will be for the member’s own account, if no complication is registered.

Amniocentesis

100% of Scheme Tariff.

Blood tests

Lancet/Pathcare to be used.

Antenatal classes

Not covered.

Supplements

As per Option formulary.

Normal vaginal deliveries

A stay of 2 days at DSP hospital.
Authorisation required from Case Management prior to hospital admission.

Caesarean section

A stay of 3 days at DSP hospital.
Authorisation required from Case Management prior to hospital admission.

Circumcision

100% of Scheme Tariff.

Childhood Immunisation

100% of scheme tariff.
Limited to PH Child Immunisation Programme (excludes consultation cost).

PLATCAP
OPTION

REGISTRATION ON THE MATERNITY PROGRAMME IS REQUIRED FOR MEMBERS TO ENJOY FULL BENEFITS

Only 1 pregnancy per beneficiary is covered under the PlatCap Option.

Antenatal consultations

Subject to Specialist consultations benefit limit: 3 visits or R4 378 PB, up to 5 visits or R6 350 per family at DSP specialists.
Authorisation required from Case Managed for each visit.

Pregnancy scans

3 sonars per event/pregnancy.
Authorisation required from Case Management prior to scan.
Motivational letter from Obstetrician required for high-risk pregnancies.
Ultrasound scans are performed three times: at 12 and 22 weeks, and between 23 and 40 weeks.
Other sonars will be for the member’s own account, if no complication is registered.

Amniocentesis

1 per family for the year.
100% of Scheme Tariff.

Blood tests

Lancet/Pathcare to be used.

Antenatal classes

Not covered.

Supplements

As per Option formulary.

Normal vaginal deliveries

A stay of 2 days at DSP hospital only. No cover for non-DSP hospitals.
Authorisation required from Case Management prior to hospital admission.

Caesarean section

A stay of 3 days at DSP hospital. No cover for non-DSP hospitals.
Authorisation required from Case Management prior to hospital admission.

Circumcision

100% of Scheme Tariff.

Childhood Immunisation

100% of scheme tariff.
Limited to PH Child Immunisation Programme (excludes consultation cost).

PLATFREEDOM
OPTION

REGISTRATION ON THE MATERNITY PROGRAMME IS REQUIRED FOR MEMBERS TO ENJOY FULL BENEFITS

Only 1 pregnancy per beneficiary is covered under the PlatCap Option.

Antenatal consultations

Subject to the Maternity Benefit limit of R10 830 PMF.
No authorisation required.
Subject to Overall Annual Limit (OAL).

Pregnancy scans

Two 2D scans for the family for the year.
Subject to the Maternity Benefit limit of R10 830 PMF.
Authorisation required from Case Management prior to scan.
3D & 4D scans paid up to the rate of a 2D scan only.
Subject to Overall Annual Limit (OAL).

Amniocentesis

R10 900 PMF.
Subject to Overall Annual Limit (OAL).

Blood tests

- Limited to R12 062 PMF.
- Subject to Overall Annual Limit (OAL).

Antenatal classes

Not covered.

Supplements

As per Option formulary.
Subject to Overall Annual Limit (OAL)

Normal vaginal deliveries

A stay of 2 days at any hospital only.
Authorisation required from Case Management prior to hospital admission.
Subject to Overall Annual Limit (OAL).

Caesarean section

- A stay of 3 days at any hospital only.
- Authorisation required from Case Management prior to hospital admission.
- Subject to Overall Annual Limit (OAL).

Circumcision