The Trauma Recovery Extender Benefit (TREB) helps extend your day-to-day cover
The TREB helps to preserve the funds in your day-to-day benefits after certain traumatic events by giving you access to additional cover for certain day-to-day treatment after you are discharged from hospital. The benefit pays the day-to-day medical care costs of the traumatic event in the year it happened and, in the year after it happened, without using the funds in your day-to-day benefits.
You will not qualify for the TREB if the traumatic event happened in a previous benefit year while you were on a benefit option that did not offer this benefit or while you were a member of another medical scheme.
You have to be a member of the Scheme at the time that the trauma happens to qualify for cover from the TREB.
The benefit covers only the claims for the member who is registered for the benefit and claims that are related to the original diagnosis after the specific trauma.
Members must meet the clinical entry criteria to access cover on the Trauma Recovery Extender Benefit
The TREB extends your cover for certain day-to-day medical costs resulting from any of the following:
| Trauma condition | To qualify for the benefit (clinical entry criteria) |
|---|---|
|
Conditions resulting from a near-drowning, severe anaphylactic reaction, poisoning and crime-related injuries |
The condition must require a high acuity admission ie high care ward Intensive Care Unit (ICU) |
|
Paraplegia, hemiplegia, quadriplegia and tetraplegia |
The condition must require a high acuity admission ie high care ward Intensive Care Unit (ICU) |
| Burns | The condition must require a high acuity admission ie high care ward Intensive Care Unit (ICU) |
|
Head injuries:
Internal head injuries (skull, blood vessels or brain) |
The condition must require a high acuity admission ie high care ward Intensive Care Unit (ICU) |
| Loss of limb, or part thereof, as a result of trauma |
Trauma-related loss of limb, for example due to direct blunt force trauma. The condition must require high acuity admission in a high care ward or any amount of days in the Intensive Care Unit (ICU) A limit is applicable to the cost of a prosthetic limb, where the loss of limb was as a result of trauma. This does not apply to the loss of fingers or toes. |
Members who qualify have automatic access to the Trauma Recovery Extender Benefit
Members will have automatic access to this benefit if the entry criteria in the table above are met. The benefit will be activated after the member has been admitted for one of the specific trauma conditions and the event has been appropriately reviewed and the benefits approved.
We pay for healthcare services from these allied, therapeutic and psychology healthcare professionals with as per the Allied cover on your benefit option.
- Acousticians
- Biokineticists
- Chiropractors
- Physiotherapists
- Psychologists (clinical, counselling and educational)
- Occupational therapists
- Social workers
Allied, therapeutic and psychology healthcare professionals
We will fund Allied services up to a limit based on the size of the family, from risk:
| Single member | R9 300 |
| With one dependant | R14 000 |
| With two dependants | R17 400 |
| With three or more dependants | R20 950 |
External medical items
Limited to R30 500 per member per year, with a sub-limit of R17 000 for Hearing Aids.
Prosthetic limbs
Prosthetic limbs where the loss of the limb was due to a trauma, is limited to R98 800 per member per year.
Prescribed Medicine
We will fund prescribed medicine based on the size of the family:
| Single member | R18 100 |
| With one dependant | R21 450 |
| With two dependants | R25 450 |
| With three or more dependants | R30 950 |
Radiology and Pathology
Radiology and Pathology will fund from risk with no limit, as long as referral from your treating doctor.
Counselling sessions with a Psychologist, Clinical social worker or Registered counsellor
We will fund for counselling sessions for the rest of the family on the membership - 6 sessions per person in the year of the trauma and to the end of the next year.
Certain healthcare services are not covered on the Trauma Recovery Extender Benefit
- The TREB does not cover the cost of dentistry, optometry, antenatal classes or over-the-counter (schedule 0, 1 and 2) medicine.
- The general scheme exclusions apply to the TREB.
About how we pay accounts from the Trauma Recovery Extender Benefit
- The TREB provides cover up to the Scheme rate, unless stated otherwise.
- We will pay prescribed medicine (that is schedule 3 and above) from the benefit according to your plan. We pay medicine at the MMAP rate.