Hosmed Value medical aid scheme: 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

COSTS and OVERVIEW:
Value
Quick Overview
Main: Adult: Child:
Total Cost pm: R R R

Gap (optional):
  • Varies. See below for specific recommendation for this plan.
In brief: See full benefits below

IN HOSPITAL PROCEDURES:
Value
Scheme Benefits: Gap Benefits:
Specialists: 2018 benefits coming soon. 2017 benefits:
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice: 2018 benefits coming soon. 2017 benefits:
  • Unlimited
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • Unlimited
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • 100% scheme rate
Transplants: 2018 benefits are coming soon!
Co-payments: n/a
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Casualty: 2018 benefits coming soon. 2017 benefits:
  • See GP benefit, above
Other: 2018 benefits coming soon. 2017 benefits:
  • Sterilization: R13,000 per person
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)

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Our quote will include the right gap cover for this plan

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Value
Scheme Benefits Gap benefits
Main: Adult: Child:
General info:
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • 10 consults per person, and 20 consults per family
Childcare:
  • No extra benefit available
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • M =3 visit, M+1= 5 visits, M2+ =7 visits
  • Applies to GPs and Outpatient Facilities
Pathology: 2018 benefits coming soon. 2017 benefits:
  • R2,385 per person
General radiology: 2018 benefits coming soon. 2017 benefits:
  • R1,855 per person
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • 2 scans per person
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Alternative services: R3,220 per family
  • Remedial and other therapies: R3,110 per family
  • Physiotherapy and Biokinetics: R1,460 per person limited to R2,420 per family

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Our quote will include the right gap cover for this plan

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MATERNITY BENEFITS:
Value
Scheme Benefits Gap benefits
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • Natural Birth: 2 nights and 3 days
  • Caesar: 3 nights and 4 days
  • Home Births: R5,000 per pregnancy
Consultations: 2018 benefits coming soon. 2017 benefits:
  • Additional 2 visits per pregnancy at GP or Specialist
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2 x 2D scans

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Our quote will include the right gap cover for this plan

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CANCER (ONCOLOGY):
Value
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • R247,000 per person

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Our quote will include the right gap cover for this plan

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DENTISTRY:
Value
Scheme Benefits Gap benefits
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry: paid by scheme
  • Specialised dentistry: R3,820 per person and R5,460 per family
Orthodontics: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Maxillo Facial Surgery: 2018 benefits are coming soon!

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Our quote will include the right gap cover for this plan

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MEDICATION:
Value
Scheme Benefits Gap benefits
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: R5,936 per person, and R11,980 per family
Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • R3,040 per person, and R6,170 per family
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • R600 per family, with a maximum of R135 per script
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • R100 per person, limited to R1,200 per family per year
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • 7 days
Biological:

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Our quote will include the right gap cover for this plan

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OPTOMETRY:
Value
Scheme Benefits Gap benefits
Optometry: 2018 benefits coming soon. 2017 benefits:
  • Benefit available every 24 months
  • Frames: R580 per person
  • Lens: R165 each; Bifocal: R360 each; Multifocal: R660 each
  • Contact lenses: R1,810 per person

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Our quote will include the right gap cover for this plan

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MENTAL HEALTH:
Value
Scheme Benefits Gap benefits
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs: 21 days per person
  • non-PMBs:R17,600 per family
Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • R2,530 per person and R6,360 per family
Trauma:

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Our quote will include the right gap cover for this plan

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OTHER BENEFITS:
Value
Scheme Benefits Gap benefits
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • R12,020 per family
  • No benefit
1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
  • See "General Appliances" limit
  • No benefit
1.2. Wheelchairs: 2018 benefits coming soon. 2017 benefits:
  • See "General Appliances" limit
  • No benefit
Dialysis: 2018 benefits are coming soon!
HIV: 2018 benefits coming soon. 2017 benefits:
  • 100% scheme rate
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
  • No benefit
Emergency Transport: Netcare911
  • No benefit
International Insurance: 2018 benefits are coming soon!
  • No benefit
Other: 2018 benefits are coming soon!

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Our quote will include the right gap cover for this plan

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WELLNESS/PREVENTATIVE BENEFITS:
Value
Scheme Benefits Gap benefits
Flu vaccination: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Pneumonia vaccines: 2018 benefits are coming soon!
  • No benefit
Back Rehabilitation Programme: 2018 benefits are coming soon!
  • No benefit
Biometric Screening: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Child Immunisation: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Pap Smear: 2018 benefits coming soon. 2017 benefits:
  • Covered, 18yrs+
  • No benefit
Mammogram: 2018 benefits coming soon. 2017 benefits:
  • Covered, 40yrs+ every two years
  • No benefit
PAS Test: 2018 benefits coming soon. 2017 benefits:
  • Covered, 40yrs+
  • No benefit
HIV Test: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Other: Colon Cancer blood test for 50yrs+
  • No benefit

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Our quote will include the right gap cover for this plan

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PROSTHETICS:
Value
Scheme Benefits Gap benefits
Overal Limit:
Sub-limits:

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Our quote will include the right gap cover for this plan


    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised