My Health Table

Plan Option Premium Premium Lite Classic Basic Hospital Assist & Cash Back Hospital Assist Plan
Hospital Access Rapha Network, PSMI Hospitals & Clinics, Municipal Clinics, Government and Mission Hospitals. Municipal Clinics, Government and Mission Hospitals. Selected GPs Municipal Clinics, Government and Mission Hospitals. Selected GPs Municipal Clinics, Government and Mission Hospitals. Selected GPs This Plan Pays for in-hospital admissions only:

$50 per day directly to the hospital in the event of an admission For a maximum of 30 days

Cash back of $50 per day to the member for a maximum of 30 days in the event of an admission

Funeral cash of 500 in the event of death
This Plan Pays for in-hospital admissions only:

$50 per day directly to the hospital in the event of an admission For a maximum of 30 days

Funeral cash of 500 in the event of death
Annual Limit

Hospital Limit

Dental

Medication
$4,000.00

$2,500.00

$200.00 (PSMI Facilities

$100.00 (Pay and Claim)
$4,000.00

$2,500.00

$200.00

$100.00
$2,000.00

$1,000.00

$100.00

$100.00
$2,000.00

$1,000.00

$100.00

$100.00
GP & Specialist Services 100% of AHFoZ Tariffs Specialist services at Government and Mission Hospitals Pre-Authorization for hospital procedures Rapha Network, PSMI Hospitals & Clinics 100% of AHFoZ tariff, Specialist Services at Government & Mission hospitals. GP Benefit limited to selected Doctors 100% of AHFoZ tariff, Specialist Services at Government & Mission hospitals. GP Benefit limited to selected Doctors 100% of AHFoZ tariff, Specialist Services at Government & Mission hospitals. GP Benefit limited to selected Doctors
Pathology & Radiology 100% of AHFoZ Tariffs 100% of AHFoZ 100% of AHFoZ 100% of AHFoZ
Ambulance

Optical (Two years)

Psychiatry

Rehabilitation Services

Funeral benefit
Paid in full

$150.00

$200.00

$300.00

$100.00
Paid in full

$150.00

$200.00

$300.00

$100.00
Paid in full

$150.00

$200.00

$200.00

$100.00
Paid in full

$150.00

$200.00

$200.00

$100.00
Hospital Cash Back $40/day after 48 hours $40/day after 48 hours $40/day after 48 hours None
Pricing (per month $12.50 $9.50 $6.50 $5.50 $4.00 $3.00
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