PHAROS OPTICAL TARIFFS - 2007
Methcare Option
Optical benefit – subject to Iso Leso
Network only
Test when no spectacles are prescribed or
claimed
Examination including Frame and Lenses
Single Vision
Bifocals/Multifocals
R250 per beneficiary per annum
R500 per beneficiary per annum
R800 per beneficiary per annum
Paladin Comprehensive Option
OPTICAL BENEFITS – Subject to Iso Leso Benefit
Test.
Up to R250 per test from Yearly
Limit subject to Extended Cover.
Frame.
Up to R400 per frame from Yearly
Limit subject to Extended Cover.
Lenses - single and bifocal.
Low power single vision lenses
limited to R166 each.
High power single vision lenses
limited to R166 each.
Bifocal lenses limited to R401
each.
From Yearly Limit, subject to
Extended Cover
Bifocals limited to patients over 40
years.
Lenses - multi-focal.
Multi-focal lenses limited to R696
each.
Nurse Administrator pre-authorisation
required.
(Does not accumulate to threshold unless From Yearly Limit, subject to
Extended Cover.
medically indicated).
Contact lenses
Limited to R982 (age under 40) and
R1452 (age over 40) per annum
(Optional alternative to glasses, no
from Yearly Limit.
benefit for both glasses and contacts in
Extended Cover according to
same benefit year)
Clinical protocol and Nurse
Administrator pre-authorisation.
Footprint Comprehensive Option
OPTICAL BENEFITS – Subject to Iso Leso Benefit
Test
Limited to R250 per test from
Yearly Limit, subject to Extended
(Only applicable when no spectacles are
Cover.
prescribed)
Examination, including frames and lenses. Single vision glasses limited to
R500 and 1 (one) per beneficiary in
24 months.
Bifocals limited to patients over 40
years & limited to R800 and 1 (one)
per beneficiary in 24 months.
From Yearly Limit, subject to
Extended Cover.
Lenses - multi-focal.
No benefit.
Contact lenses.
No benefit.
Rainbow Plus (Savings account option. Plus Account = Savings
OPTICAL BENEFITS
100% of Cost from the Plus
Lenses - single vision and bi-focal.
Account.
100% of Cost from the Plus
Lenses - multi-focal.
Account.
100% of Cost from the Plus
Frames.
Account.
100% of Cost from the Plus
Contact lenses.
Account.
Rainbow and Creation Comprehensive
(Members use their annual routine benefit (Yearly Limit) which varies in
amounts as they can roll over funds, after that extended cover applies for basic
lenses and consultation for which we use the Paladin Comprehensive benefit as a
guideline price)
OPTICAL BENEFITS
Lenses - single vision and bi-focal.
Up to 100% of Cost from Yearly
Limit.
Thereafter subject to Extended
Cover.
Lenses - multi-focal.
Up to 100% of Cost from Yearly
Limit.
Nurse Administrator pre-authorisation
.
required.
(Does not accumulate to threshold unless
medically indicated).
Frames.
Up to 100% of Cost from Yearly
Limit.
(Amounts exceeding R1000 do not
Thereafter subject to Limited
accumulate to threshold).
Extended Cover. Extended Cover
Limited to R800.
Contact lenses.
Up to 100% of Cost for lenses from
Yearly Limit.
(Optional alternative to glasses, no
Extended Cover according to
benefit for both glasses and contacts in
Clinical protocol and Nurse
same benefit year)
Administrator pre-authorisation.
Rainbow Primary – no benefit
Footprint Primary – no benefit