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CC Student 1-Pager 2024

The document summarizes the benefits offered by the Umbono option of the CompCare Medical Scheme in South Africa for 2024. It provides unlimited hospital cover and doctor visits at network facilities. It also covers unlimited chronic medication subject to formulary. Out of hospital services like GP visits and basic dentistry are subject to an annual flexi benefit limit. The option also provides wellness and preventative care benefits.

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Cleopas Chigamba
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28 views2 pages

CC Student 1-Pager 2024

The document summarizes the benefits offered by the Umbono option of the CompCare Medical Scheme in South Africa for 2024. It provides unlimited hospital cover and doctor visits at network facilities. It also covers unlimited chronic medication subject to formulary. Out of hospital services like GP visits and basic dentistry are subject to an annual flexi benefit limit. The option also provides wellness and preventative care benefits.

Uploaded by

Cleopas Chigamba
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SMS ‘youth’ to
32673 if you’re keen
to find out more

(2024 rates)

UNLIMITED UNLIMITED Excellent OUT- EMERGENCY


hospitalisation doctor visits OF-HOSPITAL ASSISTANCE,
benefits including airlifts

PLAYING SPORT? RADIOLOGY, REPATRIATION


We’ve got you chest x-ray for COVER
covered visas purposes via Universal 360°

New in 2024
Prostate
NEW Pap Smear NEW Examination NEW Mammogram

0861 222 777 Administered by


student@universal.co.za
CompCare Medical Scheme is administered by
Universal Healthcare Administrators (Pty) Ltd.
CompCare Umbono Option | 2024
In-hospital benefits • The Umbono option covers unlimited cover for in hospital related services at a network of private hospitals at 100% of the
Scheme rate.
Overall Annual Limit (OAL) • Specialists are paid at 100% of the Scheme rate.

Services covered in •
•
GPs and specialists
Ward fees – general, ICU and high care
hospital • Theatre fees
100% of the agreed tariff (AT), subject • Medication while in hospital
to pre-authorisation and Network DSP • Blood transfusions
hospitals. All treatment in hospital • Oncology
is subject to case management and • Surgical prostheses (PMB only)
scheme protocols • Clinical technologists limited to R12 000 per family
• Radiology – MRI, CT and PET scans
• Pathology
• Confinements
• Psychiatric treatment – subject to pre-authorisation and protocols (PMB only)
• Organ and bone marrow transplants, plasmapheresis and renal dialysis (PMB only)
• Cover for injuries sustained whilst participating in professional sports
• Emergency medical treatment for injuries resulting from accidents or trauma
• Physiotherapy – limited to R2 970 per family. Combined auxiliary services limit in and out of hospital
• Alcoholism, drug dependence and narcotism

Cover for chronic


conditions • Chronic medication is unlimited, subject to medicine formulary and if prescribed by a Universal Network Provider and
32 chronic conditions covered dispensed within a Universal Network pharmacy or by a dispensing Universal Network GP. Any voluntary use of chronic
Chronic medication is subject to the medicine prescribed by an out-of-network provider and any non-formulary medicines are for the member’s own account,
Core Formulary list of medicines and unless pre-authorised by the medical advisor. (PMB rules apply)
a Formulary reference price (FRP). • Subject to formulary reference pricing
Members are required to register for all
chronic conditions

Unlimited day-to-day • GPs


· In-Network: Unlimited for clinically necessary services subject to network rules and guidelines
services · Unlimited face-to-face consultations within the Universal Network. The 1st 4 visits not authorised. Member to choose two
Not subject to the Annual Flexi Benefit doctors (close to home and work) from the 5th visit. Pre-authorisation required from 6th visit
(AFB) · Virtual consultations unlimited at participating providers
· Out-of-Network: 2 visits PB
Services subject to the use of the · Limited to R1 950 per event including medicines, pathology, radiology (all related costs). A 20% co-payment applies Member
Universal Provider Network 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. A 25% co-payment will apply if medicine is not on the 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
• 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

Day-to-day services paid • 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 AFB. Once benefit is depleted, PMB rules apply
from the Annual Flexi • Basic dentistry – limited to one consultation per beneficiary including preventative care, infection control, fillings, extractions and
Benefit (AFB) at 100% of dental X-rays at a Universal Network dentist – R1 950 per beneficiary up to R3 300 per family, subject to AFB
• Optometry – limited to one test per beneficiary every 24 months, including lenses – clear plastic lenses for single vision and
the agreed tariff frames limited to R1 100 per beneficiary. Bi-focals and frames limited to R1 750 per beneficiary at a Universal Network
AFB – R3 780 per beneficiary per year optometrist, subject to AFB
R5 570 per family per year • Out of hospital physiotherapy
• Hospital emergency room/casualty emergency visits for non-emergency consultations

Wellness: Lifestyle and • Blood pressure, blood sugar, cholesterol, BMI and waist circumference - one measurement per beneficiary over the age of 18
years. Limited to R275 per event
preventative care • Flu vaccinations – one vaccination per beneficiary
Paid from risk • 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 R180 per beneficiary per month. Subject to medication formulary
NEW Pap smear: One per female beneficiary over the age of 18 per year
NEW Mammogram: One per female beneficiary over the age of 35 every second year
NEW Prostate-specific antigen (PSA) blood test: One test per male beneficiary over the age of 40 per year

Want to know more?


Gauteng Eastern Cape Western Cape
Tel: 0861 222 777 Tel: 083 565 2876 Tel: 079 382 8812
Email: student@universal.co.za Email: easterncape@universal.co.za Email: westerncape@universal.co.za

KwaZulu-Natal Mbombela Walk-in office JHB


Tel: 084 589 2790 Tel: 076 572 2084 JCCI House
Email: kzn@universal.co.za Email: mpumalanga@universal.co.za 27 Owl Street
Cnr Empire Road, Milpark
Website Tel: 011 208 1005
www.studentplan.co.za

This summary is for information purposes only and does not supersede the rules of the Scheme. In the event of a discrepancy between the summary and the rules, the
rules will prevail. On joining the scheme, all members will receive a detailed member brochure, as approved. The final registered rules of the scheme will apply.
*Terms and conditions apply

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