Individual Schemes DS and DH
| Benefits Schedules for 2012 | DS Standard |
DH High |
||
| (within the above, the following limits apply i.e 1.1,1.2 and 1.3) | ||||
| 1.1 Dreaded Disease cover - strictly in accordance with the BOMaid approved list and pre-authorization. | up to limit 1.0 |
up to limit 1.0 |
up to limit 1.0 |
up to limit 1.0 |
| 1.1.1 Daily maximum Room Rate** (at agreed tariff) | ||||
| 1.2 Chronic/Professional/ Hospitalization maximum* | 85,000 |
100,000 |
374,500 |
487,000 |
| (within the above, the following sub-limits will apply) same as 1.1.1 1.2.1 Acute post trauma maxillo-facial surgery^ limit |
10,000 |
15,000 |
20,000 |
35,000 |
| 1.2.2 Chronic medication (SUPPLIED THROUGH BOMAID DISPENSARY in accordance with BOMaid approved program) | 10,000 |
12,000 |
36,000 |
42,000 |
| 1.2.3 Chemotherapy/Radiotherapy | 20,000 |
20,000 |
80,000 |
80,000 |
| 1.2.4 Renal dialysis | 20,000 |
20,000 |
90,000 |
90,000 |
| 1.2.5 Psychiatric^ – Inpatient – in a recognized psychiatric facility | 10,000 |
10,000 |
30,000 |
40,000 |
| 1.2.6 Internal Prosthesis^ | 5,000 |
5,000 |
20,000 |
30,000 |
| 1.2.7 Normal delivery hospitalization fees (include forceps delivery and vacuum extraction) | 7,500 |
7,500 |
7,500 |
7,500 |
| 1.2.8 Birthing unit delivery global fee (by a registered unit/facility) | 2,000 |
2,000 |
2,000 |
2,000 |
| 1.2.9 Caesarian delivery - hospitalization fees | 11,000 |
11,000 |
11,000 |
11,000 |
| Professional fees | ||||
| 1.2.10 Confinement (Each sub limit subject to tariff limit) | 3,500 |
3,500 |
3,500 |
3,500 |
| Normal delivery Professional fee (includes post natal care) | 2,189 |
2,189 |
2,189 |
2,189 |
| Or | ||||
| Caesarian section Professional fee (includes post natal care) | 2,070 |
2,070 |
2,070 |
2,070 |
| Anesthetist fees (for Caesarian Section) | 500 |
500 |
500 |
500 |
| 1.2.11 Procedures | 5,000 |
7,000 |
20,000 |
30,000 |
| 1.2.12 Laboratory excluding HIV monitoring | 1,000 |
1,200 |
5,000 |
6,500 |
| 1.2.13 Radiology | 3,000 |
3,500 |
10,000 |
15,000 |
| 1.2.14 Post admission step down (max. 30 days) | 13,600 |
13,600 |
13,600 |
13,600 |
| 1.2.15 Neonates hospitalizations | 100,000 |
60,000 |
60,000 |
100,000 |
| ** Where fixed fee arrangement has been entered into, those fees will apply. | - |
- |
- |
- |
| ° Guaranteed ^ Cover on assessment *Pre-authorization required | - |
- |
- |
- |
| (Consult./Drugs/Investigations/Procedures) Within the above overall limit, the following sub limits will apply i.e. 2.1 to 2.5 | - |
- |
- |
- |
| 2.1 Consultation* (GP/Specialist) limit. (Include ante-natal visits, exam of newborn baby and two subsequent follow ups) | 2,070 |
2,690 |
3,614 |
5,421 |
| 2.2 Drugs/Prescribed medicine limit | 3,100 |
4,700 |
5,200 |
7,500 |
| 2.2.1 Self Medication (Prescribed by Pharmacist) | 100 |
200 |
200 |
300 |
| 2.2.2 Doctors dispensing (acute) | 500 |
750 |
750 |
1,125 |
| 2.2.3 Pharmacy dispensed medicine (include Dental & Ophthalmic prescribed) | 2,500 |
3,750 |
3,750 |
5,625 |
| 2.2.4 Medication (through BOMaid dispensary) | up to 2.2 |
up to 2.2 |
up to 2.2 |
up to 2.2 |
| 2.3 See 1.0 above | - |
- |
- |
- |
| 2.4 Diagnostic/Investigation limit | 4,370 |
6,556 |
10,500 |
15,000 |
| 2.4.1 Laboratory investigations/tests excluding HIV monitoring | 585 |
1,078 |
1,500 |
2,500 |
| 2.4.2 X-ray/Ultrasound (exclude two pre-authorized obstetric ultra-sounds)** | 585 |
978 |
1,800 |
2,800 |
| 2.4.2.1 Obstetric ultrasound (max. 2 pre-authorised) | 400 |
400 |
400 |
400 |
| 2.4.3 MRI/CT Scan | 3,000 |
4,500 |
5,000 |
7,500 |
| 2.4.4 Infertility diagnostic procedures | Nil |
Nil |
2,500 |
3,750 |
| 2.5 Medical/Surgical Procedure Limit | 4,450 |
6,500 |
8,000 |
12,000 |
| 2.5.1 Approved specialist major diagnostic** | 2,750 |
4,125 |
5,500 |
7,250 |
| 2.5.2 Minor medical procedure | 850 |
1,125 |
1,250 |
1,875 |
| 2.5.3 Minor surgical procedure | 850 |
1,125 |
1,250 |
1,875 |
| 2.5.4 Major procedure (ambulatory) | up to 2.5 |
up to 2.5 |
up to 2.5 |
up to 2.5 |
| *Refers to rates at agreed tariffs **Pre-authorization required | - |
- |
- |
- |
1. HIV/AIDS COVER IN ACCORDANCE WITH THE SBF PROGRAM
2. MEMBER'S ATTENTION IS SPECIFICALLY DRAWN TO RULE 15 (20): “In all benefit categories any one family member cannot claim in excess of the single member's limit”.
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