Providence MediMed MEDISAVE ESSENTIAL PEGP

Each beneficiary is entitled to:

CONSULTATION:

100% of cost in network of R235 at a non-network provider. 

AND EITHER: SPECTACLES: CONSISTING OF

A PPN Frame or an alternative Frame and\or lens enhancements to the Benefit of R 200.00

Lenses
 

Spectacle Lenses Clear Single Vision Lenses: 2 at R140.00 per lens OR Bifocal Lenses: 2 at R310.00 per lens. OR Multifocal Lenses covered up to the limit of Bifocal lenses: 2 at R310.00 per lens.

OR CONTACTLENSES:

Contact Lenses to the value of R 650.00

The benefits are subject to the below clinical and prescribe rules:
1. No single vision Rx < 0.50 Diopter will be paid or considered for payment.
2. No bifocal/Varifocals adds for less than 1 Diopter will be paid or considered for payment.
3. Bifocal/Varifocals lenses for adults under the age of 40 years old must be motivated.
4. No Varifocals to children under age 18 years will be paid or considered for payment with the exception of post cataract surgery. Bifocals to be considered for children under the age of 18 years on motivation only.
5. No contact lenses to children under age 16 years unless motivated.
6. Motivations are required for composite consultations performed on children under the age of 5 years old.
7. Vertical prism > 1 Diopter should be motivated.
8. Only claims that meet the VALIDATE IT criterion in terms of PPN accredited laboratories will be approved. CLAIMS 086110147.

Leave a comment