Benefit information
There are two health plans available
The N Option Plus is a comprehensive medical plan, including hospital and day-to-day cover, supported by a Medical Savings Account and an Above Threshold Benefit that becomes available as soon as your claims add up to a specific rand amount, called the Annual Threshold.
The N Option Basic has broad hospital cover and limited day-to-day cover.
» Naspers Benefit Brochure 2012
» Voordeel gids 2012
Hospital benefit
Call us on 0860 627 633 (0860 NASMED) to confirm your benefits and get authorisation for your hospital admission before you are admitted. If you do not confirm your admission beforehand, you may be responsible for costs that would otherwise be covered, or you may have to make co-payments. In a medical emergency, go straight to hospital but call us or get someone to call us within 12 hours.
Cover is subject to our rules
We pay medically appropriate claims. Your cover is subject to the Fund’s rules, funding guidelines and clinical protocols. There are some expenses you may incur while you are in hospital that are not medically necessary and that your Benefit Option does not cover, for example private ward costs. Certain procedures, medicines or new technologies need separate confirmation while you are in hospital.
Emergency cover when you need it most
A medical emergency is the sudden, unexpected onset of a health condition that needs immediate medical or surgical treatment. If this treatment is not provided, the person’s life would be at risk or result in serious impairment or dysfunction of an organ or body part.
If you need medically-equipped transport in a medical emergency, call 0860 999 911. This telephone line is managed by highly qualified emergency personnel who will send the most appropriate air or road emergency evacuation transport.
Cover for going to casualty
If you go to a casualty or emergency room and you are not admitted to hospital, we will pay the costs from your day-to-day benefit. Some casualties charge a facility fee, which we do not cover. If you are admitted to hospital from casualty, we will cover the costs of the casualty visit from your Hospital Benefit up to the overall annual limit, as long as we confirm your admission.
Day-to-day and out-of-hospital benefits
N Option Plus
Your Medical Savings Account is an amount that you get at the beginning of the year or when you join Naspers Medical Fund and is set according to the number of members on your membership. You have access to this amount from the day your benefits become available. If you have funds in your Medical Savings Account at the end of the year, we will carry these funds over to the next year.
You may need to pay for your day-to-day medical expenses if you have run out of money in your Medical Savings Account before your claims add up to the Annual Threshold. This is called the Self-payment Gap. The Annual Threshold is a set amount that your claims need to add up to, before we pay claims from the Above Threshold Benefit.
N Option Basic
You have specified day-to-day benefits available and there are limits on these based on the size of your family on your membership. These benefits form part of the overall annual limit.
If you do not use all or certain of the day-to-day benefits during the year, it will not be carried over to the following year.
Chronic Illness Benefit
Members on the N Option Plus and N Option Basic qualify for cover from the Chronic Illness Benefit. The N Option Basic offers cover for a list of specified conditions on the Chronic Disease List. The N Option Plus offers more extensive cover as it provides for cover for the conditions on the Chronic Disease List as well as conditions on the Additional Disease List.
For more information click here.
Programme to manage oncology
The Oncology Programme follows the South African Oncology Consortium guidelines to ensure you have access to the most appropriate level of treatment for the particular stage of your disease. We assign a personal case manager to coordinate your oncology benefits with your treating doctor. We pay most claims related to treating cancer from the Oncology Benefit. Call 0860 627 633 (0860 NASMED) to register on this programme.
For more information click here.
Programme to manage HIV and AIDS
The HIVCare Programme provides comprehensive disease management for members living with HIV and AIDS. Members registered on this programme can be sure of utmost confidentiality. They will have access to unlimited hospitalisation and antiretroviral treatment, subject to a formulary and reference pricing. Members who do not register on the programme will have their claims for HIV and AIDS treatment paid at 100% of the Fund Rate. To register on this programme, please call 0860 627 633 (0860 NASMED).