Gems

Beryl

Optical services (eye examinations, frames, lenses and contact lenses (permanent and disposable) and acute medicine)

•  Subject to use of optometry network and approved list of frame

•  1 examination per beneficiary per year 

• 1 frame and a pair of lenses OR 4 boxes of disposable contact lenses OR 1 set of permanent contact lenses 

•  Limited to R1 301 per beneficiary every second year

•  Acute medicine prescribed by network FP and subject to formulary

• Benefit is not pro-rated 

• Post-cataract surgery, optical PMB entitlement limited to the cost of a bifocal lens not more than R1 004 for both lens and frame, with a sub-limit of R199 for frame

•  Includes tinted lenses for albinism and proven photophobia, subject to pre-authorisation

Emerald

Optical services (frames, lenses and contact lenses (permanent and disposable), refractive eye surgery examinations)

•  All services included in benefit subject to optical managed care programme

•  Either spectacles or contact lenses (not both) can be claimed for in a benefit year

•  Sub-limit of R2 097 per beneficiary every second year and yearly limit of R4 191 per family

•  Frames limited to R1 223

•  Limited to 1 eye examination per beneficiary per year

• Excludes variable tint and photochromic lenses 

•  Benefit not pro-rated

• Post cataract surgery, optical PMB entitlement limited up to the cost of bifocal lens and not more than R1 004 for both lens and frame, with a sub-limit of R199 for frame 

•  Includes tinted lenses for albinism and proven photophobia, subject to pre-authorisation 

Onyx

Optical services (eye examinations, frames, lenses and contact lenses (hard and disposable), refractive eye surgery)

•  Overall limit of R2 474 per beneficiary every second year and a yearly limit of R4 961 per family 

•  Sub-limit of R1 978 per frame

•  Either spectacles or contact lenses (not both) can be claimed for in a benefit year

•  Limited to 1 eye examination per beneficiary per year

•  Excludes variable tint and photochromic lense

•  Benefit is not pro-rated 

•  Post-cataract surgery, optical PMB entitlement limited to the cost of a bifocal lens and not more than R1 004 for both lens and frame, with a sub-limit of R198 for frame

•  Includes tinted lenses for albinism and proven photophobia, subject to pre-authorisation

Ruby

Optical services (eye examinations, frames, lenses and contact lenses (permanent and disposable), refractive eye surgery)

•  Subject to optical managed care programme

•  Limited to PMSA and block benefit

• Either spectacles or contact lenses (not both) can be claimed in a benefit year

•  Limited to 1 eye examination per beneficiary per year

•  Excludes variable tint and photochromic lense

• Benefit not pro-rated

•  Post-cataract surgery, optical PMB entitlement limited to the cost of bifocal lens not more than R1 000 for both lens and frame, with a sub-limit of R202 for frame

•  Frame sub-limit of R848 from the block benefit per beneficiary once PMSA is exhausted

•  Includes tinted lenses for albinism and proven photophobia

Sapphire

Optical services (eye examinations, frames, lenses and acute medicine

•  Subject to use of optometry network and approved list of frame

•  Limit of R3 843 per family every second year

•  Limited to 1 eye examination, 1 frame and 1 pair of lenses OR 4 boxes of disposable contact lenses OR 1 set of permanent contact lenses per beneficiary every second year

•  Acute medicine prescribed by a network FP and subject to formulary

•  Benefit not pro-rated

•  Post-cataract surgery, PMB benefit limited to the cost of a bifocal lens not more than R1 004 for both lens and frame, with a sub-limit of R199 for the frame

•  Either spectacles or contact lenses will be funded in a benefit cycle, not both

•  Includes tinted lenses for albinism and proven photophobia, subject to pre-authorisation

For more information, please visit: https://www.gems.gov.za/

Medical aid benefits as displayed are subject to change, final confirmation must be obtained from the medical aid.

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