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Maximise your benefit - Visit an In Network Provider

Your benefits are contractually better at a network provider - Scheme rules apply

To confirm that you or a dependent is entitled to optical benefit, SMS your request to 45119 with the following details:

Benefit,MembershipNumber,Surname,BirthDateDependent,MainMemberID,DependantNumber, UniqueMedicalAid Key

Example: SMS 45119 Message details: Benefit 277323232 Botha 19721220 7212205065089 0 44

Important information:

Replace each comma with a space in your SMS and ensure the details are accurate and only one space is between each requirement. Kindly make sure the birthdate is in the correct format as per the example. The information will return within 1 minute on a new SMS. The full benefit breakdown per dependent is available by logging in to the PPN website or a guideline is given below. Your schemes unique medical key is 44.

Aquarium

2022 Optical Benefit:

Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.

Member can claim either Spectacles OR Contact Lenses

Forensic protocols and AI screening included in design

The benefits are a guideline and scheme rules apply

Negotiated Tariff : PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)

Medscheme makes payment to all stakeholders

Network: One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
OR
Out of Network: Refraction to the value of R350

IN NETWORK : Frame and Lens Enhancement benefit up to the value of R 795

OR

OUT OF NETWORK/REFUND VALUE : Frame and Lens Enhancement benefit up to the value of R 596

AND
One pair of either Single Vision or Bifocal standard lenses

Network - Contact lenses: R 613  per beneficiary per annum

Contact lens re-examination at R245

OR

Out of Network - Contact lenses: R 400 per beneficiary per annum

Marine

2022 Optical Benefit:

Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.

Member can claim either Spectacles OR Contact Lenses

Forensic protocols and AI screening included in design

The benefits are a guideline and scheme rules apply

Negotiated Tariff : PPN 2 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)

Medsheme makes payment directly to stakeholders

Network: One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
OR
Out of Network: Refraction to the value of R357

  • IN NETWORK : Frame and Lens Enhancement benefit up to the value of R 1 326
OR
  • OUT OF NETWORK/REFUND VALUE : Frame and Lens Enhancement benefit up to the value of R 995
AND
  • One pair of either Single Vision or Bifocal or Multifocal clear standard lenses

Network - Contact lenses: R 1 628  per beneficiary per annum

Contact lens re-examination at R250

OR

Out of Network - Contact lenses: R 1 122 per beneficiary per annum

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