Makoti Primary D medical aid plan: 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:
Primary D
Quick Overview
Main: Adult: Child:
Total Cost pm: R R R

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

IN HOSPITAL PROCEDURES:
Primary D
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:
  • State hospitals
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • PMBs only, in state hospitals
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • PMBs only, in state hospitals
Transplants: 2018 benefits coming soon. 2017 benefits:
  • PMBs only, in state hospitals
Co-payments: None
  • 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 are coming soon!
Casualty: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Other: 2018 benefits are coming soon!
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)

No phone calls!
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.

.
.
.
.
OUT OF HOSPITAL BENEFITS (non-PMB):
Primary D
Scheme Benefits Gap benefits
Main: Adult: Child:
General info:
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • Chosen network GP: Unlimited
Childcare:
  • No extra benefit available
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • PMBs only, in state hospitals
Pathology: 2018 benefits coming soon. 2017 benefits:
  • Basic pathology covered by scheme
General radiology: 2018 benefits coming soon. 2017 benefits:
  • Basic radiology covered by scheme
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB

No phone calls!
Our quote will include the right gap cover for this plan

.
.
MATERNITY BENEFITS:
Primary D
Scheme Benefits Gap benefits
Hospital stay: 2018 benefits are coming soon!
Consultations: 2018 benefits coming soon. 2017 benefits:
  • Consults: With network GP
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2 x 2D scans, paid by scheme

No phone calls!
Our quote will include the right gap cover for this plan

.
.
CANCER (ONCOLOGY):
Primary D
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • PMBs only

No phone calls!
Our quote will include the right gap cover for this plan

.
.
DENTISTRY:
Primary D
Scheme Benefits Gap benefits
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry: consultations, fillings, extractions, and prevention are covered according to protocols
Orthodontics: 2018 benefits are coming soon!
Maxillo Facial Surgery: 2018 benefits are coming soon!

No phone calls!
Our quote will include the right gap cover for this plan

.
.
MEDICATION:
Primary D
Scheme Benefits Gap benefits
Chronic: 2018 benefits coming soon. 2017 benefits:
Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • Paid by scheme according to formulary
Over-the-counter:
Birth Control:
On Discharge:
Biological:

No phone calls!
Our quote will include the right gap cover for this plan

.
.
OPTOMETRY:
Primary D
Scheme Benefits Gap benefits
Optometry: 2018 benefits coming soon. 2017 benefits:
  • R700 per person every two years

No phone calls!
Our quote will include the right gap cover for this plan

.
.
MENTAL HEALTH:
Primary D
Scheme Benefits Gap benefits
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Trauma:

No phone calls!
Our quote will include the right gap cover for this plan

.
.
OTHER BENEFITS:
Primary D
Scheme Benefits Gap benefits
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
  • No benefit
1.1. Hearing Aids: 2018 benefits are coming soon!
  • No benefit
1.2. Wheelchairs: 2018 benefits are coming soon!
  • No benefit
Dialysis: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
HIV: 2018 benefits are coming soon!
  • No benefit
Emergency Transport: 2018 benefits are coming soon!
  • No benefit
International Insurance: 2018 benefits are coming soon!
  • No benefit
Other: 2018 benefits are coming soon!

No phone calls!
Our quote will include the right gap cover for this plan

.
.
WELLNESS/PREVENTATIVE BENEFITS:
Primary D
Scheme Benefits Gap benefits
Flu vaccination: 2018 benefits are coming soon!
  • 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 are coming soon!
  • No benefit
Child Immunisation: 2018 benefits are coming soon!
  • No benefit
Pap Smear: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Mammogram: 2018 benefits are coming soon!
  • No benefit
PAS Test: 2018 benefits are coming soon!
  • No benefit
HIV Test: 2018 benefits are coming soon!
  • No benefit
Other:
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

.
.
PROSTHETICS:
Primary D
Scheme Benefits Gap benefits
Overal Limit:
Sub-limits:

No phone calls!
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