Affordable Medical Cover For Students From Only R565 Per Month*
If you are an international student and need medical cover to register at a South African university, this is the plan for you!
The Low-down
The Best Part:
Real Benefits
When it comes to your healthcare needs, we’ve got you covered.
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Access and view your medical scheme option, benefits and claims anywhere, anytime.
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The Umbono Plus Benefits
Unlimited Day-to-day services (not subject to the Annual Flexi Benefit AFB)
Unlimited Essential Care through the Universal Network for clinically necessary services subject to Network rules and guidelines.
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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.
Services Covered in Hospital
100% of the agreed tariff (AT), unlimited, subject to pre-authorisation and scheme protocols.
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- 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
Wellness: Lifestyle and Preventative Care
When it comes to your health and wellbeing, we’ve got you covered, having taken extra care to ensure that you have the necessary benefits at your disposal when you need them most.
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Paid From Risk
- Blood pressure, blood sugar, cholesterol, BMI and waist circumference – one measurement per beneficiary over the age of 18 years. Limited to R280 per event
- Flu vaccinations – one vaccination per beneficiary
- Unlimited telephonic counselling sessions through the Universal Wellness Care Centre, with an option for referral to one-on-one sessions with qualified psychologists, social workers or registered counsellors to a maximum of 3 referral sessions PB per year.
- Oral contraceptives limited to R190 per beneficiary per month. Subject to medication formulary
- Pap smear: One per female beneficiary over the age of 18 per annum – paid from risk
- Mammogram: One per female beneficiary over the age of 35 every second year – paid from risk
- Prostate-specific antigen (PSA) blood test: Paid from risk, one test per male beneficiary over the age of 40 per annum.
In-Hospital Benefits
Overall Annual Limit (OAL)
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Unlimited – subject to pre-authorisation and scheme protocols
Unlimited Essential Care through the Universal Network for clinically necessary services subject to Network rules and guidelines
GP visits through the Universal Network of GPs, Acute medicine as prescribed by your Universal Network GP (medicine formulary applies), basic radiology and pathology as referred by your Universal Network GP (specific codes apply).
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- 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
Cover for Chronic Conditions
32 chronic conditions covered.
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Chronic medication is subject to the Core Formulary list of medicines and a Formulary Reference Price (FRP). Members are required to register for all chronic conditions.
Chronic medication is unlimited, subject to medicine formulary and if prescribed by a Universal Network Provider and dispensed within a Universal Network pharmacy or by a dispensing Universal Network GP. Any voluntary use of chronic medicine prescribed by an out-of-network provider and any non-formulary medicines are for the member’s own account, unless pre-authorised by the scheme. (PMB rules apply)
Subject to formulary reference pricing
To obtain the registered scheme rules approved by the Council of Medical Schemes, please email your request through to [email protected].
We’re all about you and your future
You are passionate about the future and we have a passion for life.
We’re all about you and your future
You are passionate about the future and we have a passion for life.
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