MEDICAL AID
QUOTES

Select your medical aid

Complete the form.

Submit the form and we

will send you a quote

Nimas

Nimas provides Cost-Effective and Affordable Healthcare Cover

NIMAS has been established for 60 years;
NIMAS provides a range of easy to understand benefit options;
Pay contributions for only the first three children;
Certain day-to-day benefits are paid from risk
- MRI/Cat scans out-of-hospital
- Post Hospital Benefits
- Optical Benefits
- Preventative Benefits
Children qualify for child rates until the end of the year in which they turn 23;
Administered by Metropolitan Health, an industry leader in customer service;
Access to Wellness Programme, Multiply.

Members pay contributions for three children only and the rest enjoy free cover.

CORE (Hospital plan)

The Core Option is a hospital option that provides hospital benefits for members who are looking for well-balanced hospital cover.

Major medical expenses are covered under risk benefits at 100% of the NIMAS rate. Certain sub-limits apply. Benefits are provided at designated hospitals. A deductible applies for certain specific high-cost in-hospital procedures unless the hospital service was obtained involuntarily. Certain out-of-hospital procedures are paid from risk benefits.

The Core Option is a hospital option, which means that day-to-day and dental benefits are not covered.

CLASSIC (Traditional Plan)

The Classic Option is a traditional benefit-based option that provides benefits for members who are looking well-balanced risk cover and appropriate day-to-day benefits.

Major medical expenses are covered under risk benefits at 100% of the NIMAS rate. Certain sub-limits apply. Benefits for hospitalisation are provided at designated hospitals. A deductible applies for certain specific high-cost in-hospital procedures unless the hospital service was obtained involuntarily. Certain out-of-hospital procedures are paid from risk benefits.

All day-to-day medical expenses are paid from the Out-of-Hospital (OOH) benefit. Optometry is paid from a separate benefit. All dental services, including dental expenses incurred in hospital, are paid from the out-of-hospital benefit up to the basic or advanced dentistry sub-limits.

MILLENNIUM (Comprehensive Plan with Savings & ATB)

The Millennium Option is a new generation option that combines the flexibility of a medical savings plan with an above threshold benefit when day-to-day expenses are particularly high. Members are rewarded for low claims by retaining any unused medical savings. Hospital and chronic medication benefits are also comprehensive.

A portion of the monthly contribution is allocated to a medical savings account from which day-to-day medical expenses are paid. The full benefit year's medical savings (12 x the medical savings portion of the monthly contribution) is available from 1 January. If a member has any medical savings left at the end of the benefit year, these will be carried over to his/her medical savings account for the following benefit year. Optometry is not paid from the medical savings or the above threshold benefit but from a separate benefit. Optical expenses exceeding the optometry benefit may be paid from the medical savings account but will not accumulate to the threshold level. All dental services, including dental expenses incurred in hospital, are paid from the medical savings or the above threshold benefit up to the basic or advanced dentistry sub-limits.

The above threshold benefit provides relief for members when their day-to-day medical expenses are very high. Once this level is reached, you have access to the above threshold benefit. All further day-to-day medical expenses will then be paid from this benefit at the NIMAS rate and not from your medical savings account or your own pocket, unless the service provider charges in excess of the NIMAS rate. If you deplete the above threshold benefit, you will need to pay for further day-to-day expenses, unless you still have a positive balance in your medical savings account which will then be used to cover further claims.

SUPREME (Comprehensive Plan)

The Supreme Option provides comprehensive benefits and is designed for members looking for maximum cover and generous day-to-day benefits.

Major medical expenses are covered under risk benefits. The services of certain in-hospital providers are paid at 150% of the NIMAS rate. Certain sub-limits apply. There are no deductibles on procedures payable by Supreme members.

Benefits for hospitalisation are provided at designated hospitals. Certain out-of-hospital procedures are paid from risk benefits.

Almost all day-to-day medical expenses are paid from a very generous overall out-of-hospital benefit, with high sub-limits. GP and specialist consultations are paid at 150% of the NIMAS rate. Optometry is paid from an additional benefit. All dental services, including dental expenses incurred in hospital, are paid from your out-of-hospital benefit up to the basic or advanced dentistry sub-limits.

Hospital Pre-Authorisation

What is pre-authorisation?

Pre-authorisation is required to ensure cover for an in-hospital procedure by the Scheme. Pre-authorisation can be obtained by contacting 0860 646 272 at least four working days prior to hospital admission. In the event of an emergency where you are unable to obtain pre-authorisation, please do so within 24 hours of admission to hospital.

Should the emergency occur over a weekend, hospital pre-authorisation must be obtained on the first working day after the weekend. In the case where no preauthorization was obtained, a deductible of 10% of the total hospital cost up to a maximum of R5 000 will apply.

Designated Providers

A designated provider is an organisation with which the Scheme has contracted to provide you and your dependants with certain benefits. If you voluntarily choose to use a non-designated provider, a deductible may apply when purchasing medical goods or services.

Medication

Core, Classic and Millennium options

You may obtain your medication from designated pharmacies. Benefits will be paid to a maximum of 75% of the NIMAS rate if a non-designated pharmacy is used.

Supreme Option

Medication can be obtained from designated pharmacies or all Atlas, Clicks, Dis-Chem and Sparkport pharmacies. You may however also obtain medication from a pharmacy of your choice, but you will be liable for any fees charged in excess of the fee recommended by the Department of Health.

Oncology benefits

Upon registration on the Oncology Management Programme, members will be informed about the designated providers in their area, or visit www.nimas.co.za for a detailed list.