Resolution Foundation C 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:
Fundation C
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:
Fundation C
Scheme Benefits: Gap Benefits:
Specialists:
  • 100% scheme rate
  • You or gap cover pay the balance, if any
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • Recommended for this plan: Plan Blue, R295pm per family where no member is older than 64yrs (otherwise, R435pm per family)
Hospital Choice:
  • Network or R3,896 co-payment
  • No benefit
Specialised Radiology:
  • No benefit
Supplementary Services: (Physio, etc) TBC
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals, for non-PMB treatment
  • No benefit for out-of-hospital services
Transplants:
  • PMBs only
  • No extra benefit available (PMB benefits are paid in full by medical aid)
Co-payments:
    Co-payments might apply, depending on scheme protocols and alternative available treatment
  • Gap cover pays co-payments for procedures approved by medical aid
Alternatives to hospitals:
  • Home nursing: no benefit, unless in lieu of hospitalisation
Casualty:
  • No benefit, unless PMB
  • Pays up to R20,000 per person per year for emergency medical treatment not paid for by medical aid
Other:
  • N/A
  • N/A
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.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Fundation C
Scheme Benefits Gap benefits
Main: Adult: Child:
General info:
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
GP consultations:
  • Network GP: Unlimited
Childcare:
  • No extra benefit available
Specialists consultations:
  • No benefit, unless PMB
Pathology:
  • No benefit, unless PMB
General radiology:
  • No benefit, unless PMB
Specialised radiology:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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

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MATERNITY BENEFITS:
Fundation C
Scheme Benefits Gap benefits
Hospital stay:
  • Vaginal birth: 3 days, 2 nights
  • Caesarean birth: 4 days, 3 nights
  • Elective Caesarean: no benefit
Consultations:
  • Consults by GP or midwife only. Specialists require authorisation
  • Antenatal classes: no benefit
Scans:
  • 2 x 2D scans, paid by scheme

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

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CANCER (ONCOLOGY):
Fundation C
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • R76,686 per family

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

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DENTISTRY:
Fundation C
Scheme Benefits Gap benefits
Dentistry:
  • Standard dentistry: R1,870 per person and R3,116 per family, with sub limits
  • Specialised dentistry: No benefit
Orthodontics:
  • You pay this out of pocket
  • No extra benefit available
Maxillo Facial Surgery: 2018 benefits are coming soon!
  • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)

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

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MEDICATION:
Fundation C
Scheme Benefits Gap benefits
Chronic:
  • PMB chronic: paid by scheme
Acute (presrcibed) medication:
  • Limited to network providers and formularies
Over-the-counter:
  • Limited to network providers and formularies
Birth Control:
  • No benefit
On Discharge:
  • 7 days supply
Biological:

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

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OPTOMETRY:
Fundation C
Scheme Benefits Gap benefits
Optometry:
  • Single vision: R1,046 per person incl frame, lenses and consult
  • Bifocal: R1,592per person incl frame, lenses and consult
  • Multifocal: no benefit
  • Contact lenses: no benefit
  • Every 2 years
  • Pays shortfalls and co-payments for any non-PMB in-hospital treatment approved by scheme. (PMBs are paid in full by scheme if you use DSP)

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

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MENTAL HEALTH:
Fundation C
Scheme Benefits Gap benefits
In-hospital:
  • PMBs only
Out-of-hospital:
  • PMBs only
Trauma:

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

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OTHER BENEFITS:
Fundation C
Scheme Benefits Gap benefits
General Appliances: 2018 benefits are coming soon!
  • No benefit
1.1. Hearing Aids: 2018 benefits are coming soon!
  • No benefit
1.2. Wheelchairs: 2018 benefits are coming soon!
  • No benefit
Dialysis:
  • PMBs only, at network providers
HIV:
  • Covered at network hospitals if on HIV Management Programme
  • No benefit
Emergency Transport: Netcare 911
  • No benefit
International Insurance:
  • No benefit
  • No benefit
Other:
  • Cochlear implants: no benefit

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

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WELLNESS/PREVENTATIVE BENEFITS:
Fundation C
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:
  • Covered
  • No benefit
Mammogram: 2018 benefits are coming soon!
  • No benefit
PAS Test:
  • Covered
  • No benefit
HIV Test:
  • Covered
  • No benefit
Other:
  • No benefit

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

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PROSTHETICS:
Fundation C
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