Benefits and Services

Which one of the below health professional’s is not an allied healthcare professional

• Audiologist

• Cardiologist

• Physiotherapist

• Social worker

What is the correct referral pathway for members to have consultations paid from DEB

• VC >> Face-to-Face

• Face-to-Face >> VC >> Network pharmacy

• Network pharmacy >> Face-to-Face >> VC

• Network pharmacy >> VC >> Face-to-Face

If a member claims for Tier 7 medication from their MSA, how would we cover this claim

• The claim will pay and accumulate at 100% DHMR

• The claim will pay at 100% DHMR, but SPG will increase by 50% DHMR

• The claim will pay at 100% DHMR, but SPG will increase by 25% DHMR

• The claim will pay at 100% DHMR, but SPG will increase by 75% DHMR

An authorisation is not required for an MRI/CT scan done out-of-hospital.

• True

• False

An authorisation is not required for a scope done out-of-hospital.

• True

• False

How will we know to pay certain claims from the Maternity Benefit

• The amount claimed

• The doctor’s name on the claim

• The date on the claim

• The ICD-10 code on the claim

How are 4D maternity scans covered

• They are not covered

• Up to 100% of the DHR

• Up to the rate of a 2D scan

• Up to the rate of R877

Which plans have access to private ward cover for maternity admissions?

• Executive plan only

• Executive and Comprehensive plans (except Classic Smart Comp)

• Executive and Comprehensive plans

• All plans

A member is going on a business trip to Switzerland for 2 weeks. Which benefit will the member have access to?

• Overseas Treatment Benefit

• International Travel Benefit

• Africa Benefit

• Shengen Benefit

How much is the deductible that is payable for a Classic Saver member who does not use the Day Surgery Network?

• R5 000

• R5 500

• R8 400

• R9 650