This plan is offered to members who would like a higher service offering than the Primary Scheme. It has higher subscription. The main scheme gives maximum return on the subscription with an access level that defies the level of contribution. It is ideal for mid-level staff in the corporate sector.
Benefit limits for Main Scheme are paid per beneficiary per membership year and accrue from the date the beneficiary joins the Society subject to waiting periods. Awards are made at AHFoZ tariffs. All benefits are paid up to applicable sublimit.
Where usage is considered excessive the Society reserves the right to restrict usage or recommend cost effective treatment options.
The following benefits are paid at to tariff.
- Access to Government & Council healthcare facilities.
- In-hospital drugs.
- General practitioners.
- Specialist Treatment is covered upon referral by a primary care service provider.
- Pathology and Radiology Services at Private and Government facilities.
- Blood Transfusion Services (BTS).
- Prescription drugs paid at the Railmed tariff up to an annual individual limit.
- Optical benefit up to package sublimit once every two (2) year period.
This caters for general and preventive dentistry including inlays, root-treatment, fillings, crowns and bridges, implants and orthodontic work.
- Claims are paid at AHFoZ tariff up to sub limit.
- Prior authorization is required for crowns, bridges, dentures and orthodontic treatment.
The following benefit waiting periods apply to those joining the Society for the first time or where there has been a lapse in the membership. The Society reserves the right to waive waiting periods for members. There are no waiting periods for accessing Railmed internal facilities. These waiting periods include:
Three months for:-
- A mandatory four (3) months waiting period will apply to all new members
- General Practitioner visits
- General X-Rays
- Upgrading to a higher scheme
Four months for:
- Admission or treatment at a hospital
Six months for:
- Specialist treatment
- Spectacles/Contact lenses
- Elective Surgery
- Dental treatment
- Appliances, medical & Surgical
Nine months for:
- Maternity benefits
One (1) year for:
- MRI, CT scans and Nuclear medicine
18 months for:
- Oncology benefit
Two (2) years for:
- All internal and external prosthetic devices
- To access treatment for chronic conditions members, need to contact the Adjudication department. The Society does not guarantee full cover where a member/service provider does not seek pre-authorisation before accessing services.