Affordable Medical Cover For Students From Only R565 Per Month*

Annual Flexi Benefit (AFB)

R3 900 per beneficiary per year

R5 800 per family per year

• Specialist consultations – Subject to referral from a Universal Care Network GP. Limited to 2 visits per beneficiary and 3 visits PMF per year. Subject to the AFB. Once benefit is depleted, PMB rules apply
• Basic dentistry – limited to one consultation per beneficiary including preventative care, infection control, fillings, extractions and dental X-rays at a Universal Network dentist – R2 000 per beneficiary up to R3 440 per family, subject to the AFB
• Optometry – limited to one test per beneficiary every 24 months. Benefit for glasses with frame or contact lenses every 24 months. Clear plastic lenses for single vision or contact lenses and frames limited to R1 150 per beneficiary. Bi-focals and frames limited to R1 800 per beneficiary at a Universal Network optometrist, subject to the AFB
• Out of hospital physiotherapy – limited to R3 100 PMF (paid from risk). Limit is a combined limit for in and out of hospital. The limit is a combined limit which applies to in and out of hospital services, and forms part of the overall auxiliary benefit limit of R3 100.

• GPs and specialists
• Ward fees – general, ICU and high care
• Theatre fees
• Medication while in hospital
• Blood transfusions
• Oncology
• Surgical prostheses (PMB only)
• Clinical technologists limited to R12 000 per family
• Radiology – MRI, CT and PET scans
• Pathology
• Confinements
• Psychiatric treatment – subject to pre-authorisation and protocols (Unlimited for PMBs)
• Organ and bone marrow transplants, plasmapheresis and renal dialysis (Unlimited for PMBs)
• Cover for injuries sustained whilst participating in professional sports
• Emergency medical treatment for injuries resulting from accidents or trauma
• Physiotherapy – limited to R3 100 per member family. Combined auxiliary services limit in and out of hospital. A separate pre-authorisation is required for all auxiliary services in hospital (per provider)
• Alcoholism, drug dependence and narcotism

Unlimited – subject to pre-authorisation and scheme protocols

• Not Subject to The Annual Flexi Benefit (AFB)
• Services Subject to the use of the Universal Provider Network.
• GPs
  • In-Network – Unlimited for clinically necessary services subject to network rules and guidelines
  • Unlimited face-to-face consultations within the Universal Network. Pre-authorisation may be required from the 4th visit. Virtual consultations unlimited at participating providers
  • Out-of-Network – 2 visits PB. Limited to R2 000 per event including medicines, pathology, radiology (all related costs). A 20% co-payment applies. Member to pay at point of service and claim back from the Scheme
• Acute medication – unlimited if prescribed by a Universal Network GP, or by a specialist provided member referred by a Universal Network GP. Subject to formulary. No cover for non-formulary medicines unless otherwise pre-authorised. No cover in case of voluntary use of non-Universal providers, or voluntary use of specialist without referral by a Universal Network GP
• X-rays for Visa purposes – one chest X-ray paid from risk
• Basic radiology – Unlimited subject to Universal Care approved codes. Referral from a Network GP required
• Basic pathology – Unlimited subject to Universal Care approved codes and managed care protocols. Referral from a Network GP required