Liberty Hospital Select Hospital Plan

    The Liberty Hospital Select Hospital Plan offers an affordable solution for emergency or planned hospitalisation by using one of the partner hospitals on the Select Hospital Network. Therefore, you can also select your hospital for an R 8 500 voluntary co-payment.

    Liberty Hospital Select hospital plan monthly contribution

    The plan will cost R 1246 for the main member, R 1050 for an additional adult and R 474 per child, up to a maximum of three children.

    Fortunately, there is no OAL or Overall Annual Limit however certain sub-limits are applicable.

    Liberty Hospital Select hospital plan – IN HOSPITAL PROCEDURES:

    1. Payout Rate for Specialists:

    100%  of scheme rate (prescribed rate plan pays out for specific services. Any costs exceeding this rate will be for the patient’s account)

     

    1. Hospital Choice:

    Select Hospital Network partners. Non-network hospitals can be used, but a voluntary co-payment of R8,500 will apply.

     

    1. Specialised Radiology:

    Annual limit of R25,700 per family

    Bone density scans: one per member each year, in or out of hospital

    Liberty Hospital Select hospital plan

    1. Supplementary Services: The following are paid at 100% of scheme rate: Dietician, Physiotherapist, Occupational Therapist, Audiologist, Speech Therapist, Clinical Technologist

     

    1. Transplants:

    Excluding PMBs: Organ donor procedure will only be covered provided the donor, sub acuteas well as recipient, are both Scheme members. Procedure paid at 200% scheme rate.

    PMB bone marrow transplants or solid organ transplants: 100% scheme rate at DSP

    Imported corneas: R30,000

     

    1. Co-payments:

    Provided the procedures done in public hospitals, doctor’s rooms or day clinics there is no co-payment.

    Diagnostic cystoscopy, sigmoidoscopy, colonoscopy, proctoscopy, gastroscopy R1,700

    Wisdom teeth removal, conservative spinal treatment, needle aspiration of joint, bursa or ganglion: R1,700

    Hysteroscopy, arthroscopy, laparoscopy, and endometrial ablation: R4,100

    Hysterectomy (non-cancer related), functional nasal procedures: R4,100

    Reflux surgery: R7,750

    Spinal surgery: R7,750

     

    1. Hospital alternatives:

    Private nursing, physical rehabilitation assub-acute: R19,100

    From Overall Annual Limit (OAL)

     

    Liberty Hospital Select hospital plan – OUT OF HOSPITAL BENEFITS:

     

    The following have no benefit on this plan:

     

    1. GP consultations:
    2. Specialists consultations:
    3. Pathology:
    4. General radiology:
    5. Supplementary Services: (Physio, etc.)

     

    1. Specialised radiology:

    If a CT or MRI scan is conducted out of hospital and leads to an admission, the cost is covered by the in-hospital benefit

    Two CT/MRI scans and one radioisotope scan per family, if requested by a specialist

    From Overall Annual Limit (OAL)

     

    Liberty Hospital Select hospital plan – MATERNITY BENEFITS:

    1. Scans and consultations: No benefit
    2. Hospital stay: 100% scheme rate

    Liberty Hospital Select hospital plan – CANCER (ONCOLOGY):

     

    1. Total coverage (in and out of hospital): R234 000 per person

    Subject to approved treatment plan

    From Overall Annual Limit (OAL)

     

    Note: Preferred providers, scheme rules and protocols apply. Oncology benefits will be assessed on a case-by-case basis.

     

    Out-of-hospital treatment such as chemotherapy will also be covered under the benefit.

     

    Liberty Hospital Select hospital plan – DENTISTRY:

     

    1. Dentistry: No benefit
    2. Maxillo Facial Surgery: 100% Scheme Rate
    3. Orthodontics: Members under the age of 21 only. Pre-authorisation required.

     

    Liberty Hospital Select hospital plan – MEDICATION:

     

    1. Chronic: Only PMBs from Overall Annual Limit (OAL)
    2. Prescribed and over-the counter medication: No benefit
    3. Birth Control: No benefit
    4. Hospital Discharge: Limited to R2100, 7 days supply

    From Overall Annual Limit (OAL)

     

    OPTOMETRY:

     

    1. Optometry: No benefit

     

    MENTAL HEALTH:

     

    1. Out-of-hospital: No benefit
    2. In-hospital: Maximum R19,100 per family

    100% scheme rate

    For psychiatric admissions physiotherapy is excluded

    Maximum 3 days per GP admission

     

    OTHER BENEFITS:

    1. Dialysis: R154,500 per person
    2. General Appliances, hearing aids, wheelchairs: No benefit

    WELLNESS/PREVENTATIVE BENEFITS:

    1. HIV Test: Covered
    2. Flu vaccination: Covered
    3. Pneumonia vaccines: Covered for 65years upwards as well as at-risk members
    4. Biometric Screening: Basic tests covered
    5. Child Immunisation: Up to age 6
    6. Pap Smear: Ages 18-60 years covered, alternatively a liquid-based pap smear every 3 years
    7. Mammogram: For ages 40 and upwards, every 2 years
    8. PAS Test: Men 45 years and upwards, every 3 years

     

    PROSTHESIS:

    1. Overal Limit:

    Internal: 100% Scheme Tariff.  Subject to sub-limits listed below as well as a limit of R29,900 for unlisted internal prostheses and per person limit of R50,000

    PMB joint replacements subject to R7,750 co-payment

    External: If not specified in sub-limits, costs paid from Day-to-Day limits to a maximum of R12,000 per family

     

    1. Sub-limits: Internal:

    Elbow, Knee, Hip, Shoulder replacement: PMBs only

    Stents: R40,300

    Valves: R37,200

    Pacemaker: R47,000

    Aorta stent grafts: R47,000

    Cartoid stents: R17,800

    Detachable platinum coils: R44,600

    Embolic protection devices: R20,100

    Intracranial replacement: R22,200

    Perpheral arterial stent grafts: R33,200

    Spinal plates and screws: R39,500

    Approved spinal implantable devices and inter-vertebral discs: R39,500

    Intraocular lens: R2,410 (per eye)

    Neuro-stimulation/ablation devices for Parkinson’s: R44,600

    Vagal stimulator for intractable epilepsy: R37,200

     

    Note:

    All benefits are paid are paid at 100% scheme rate except where otherwise specified

    Pre-authorise all benefits

    Protocols authorisation and sub-limits still apply to “Unlimited” benefits

    PMBs are not subjected to limits or co-payments however scheme rules and protocols do apply.

     

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