Resolution Supreme 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:
Supreme
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:
Supreme
Scheme Benefits: Gap Benefits:
Specialists:
  • 220% scheme rate for contracted providers, otherwise 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:
  • Choose any hospital
  • No benefit
Specialised Radiology:
  • Limited to R19,787 per family with R1,996 co-payment paid by you or your gap cover
  • In and out of hospital
  • Co-payment paid
  • Sublimit increased as necessary, for approved procedures
  • No benefit for exclusions
  • Out of hospital, co-payment and sublimit increase is for MRI and CT scans only
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:
  • PMB only
  • No extra benefit available (PMB benefits are paid in full by medical aid)
Co-payments:
  • No co-payments if performed out of hospital (except for specialised radiology), or if PMB
  • Dental admissions: R2,642 co-payment
  • Specialised radiology: R1,996
  • Hysteroscopy: R2,971 co-payment
  • Arthroscopy, endometrial ablation, laparoscopic procedures, urinary incontinence repair, varicose veins, conservative back, spinal treatment: R3,957 co-payment
  • Joint replacements: R7,550 co-payment
  • Spinal surgery: R8,255 co-payment
  • Co-payments paid by you or your gap cover
  • Gap cover pays co-payments for procedures approved by medical aid
Alternatives to hospitals:
  • Home nursing: 12 days per family
  • Hospice, rehab and step down facility: 21 days per family
Casualty:
  • R1,680 per family
  • 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)

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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):
Supreme
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:
  • Unlimited
Childcare:
  • No extra benefit available
Specialists consultations:
  • M= 4 consults, M1 =5 consults, M2+ =6 consults, unless PMB
Pathology:
  • Sublimit: M =R3,358; M1 =R4,122; M2+ =R4,979
  • Shared with standard radiology benefit
  • Subject to day-to-day benefit
General radiology:
  • Sublimit: M =R3,358; M1 =R4,122; M2+ =R4,979
  • Shared with pathology benefit
  • Subject to day-to-day benefit
Specialised radiology:
  • R19,787 per family with R1,996 co-payment. In and out of hospital
Supplementary Services: (Physio, etc)
  • Sub limits: M =R3,358; M1 =4,979; M2+ =R6,587
  • Physio sublimit: R1,469 per family
  • Speech therapy and audiology sublimit: R1,680 per family
  • From day-to-day benefit

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Our quote will include the right gap cover for this plan

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MATERNITY BENEFITS:
Supreme
Scheme Benefits Gap benefits
Hospital stay:
  • Vaginal birth: 3 days, 2 nights
  • Caesarean birth: 4 days, 3 nights
Consultations:
  • 9 consults, paid by scheme
  • Antenatal classes: no benefit
  • Baby care products: R968 at DSP
Scans:
  • 2 x 2D scans, paid by scheme

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Our quote will include the right gap cover for this plan

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CANCER (ONCOLOGY):
Supreme
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • Unlimited subject to DSP

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Our quote will include the right gap cover for this plan

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DENTISTRY:
Supreme
Scheme Benefits Gap benefits
Dentistry:
  • Overall limit: M=R14,936
    Adult dependant= R11,202
    Child dependant (max 3) = R1,562
  • Standard dentistry: from overall limit
  • Specialised dentistry: R14,091 sublimit. Includes crowns, bridges, implants, metal dentures, periodontics
  • No cover for orthognathic surgery
Orthodontics:
  • See above
  • 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)

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Our quote will include the right gap cover for this plan

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MEDICATION:
Supreme
Scheme Benefits Gap benefits
Chronic:
  • PMB chronic: paid by scheme
  • non-PMBs: Additional 28 conditions covered
  • R5,790. Thereafter, only PMBs covered.
Acute (presrcibed) medication:
  • From day-to-day benefit
Over-the-counter:
  • From day-to-day benefit
  • Sublimit: M=R2,372
    M1= R4,086
    M2+=R4,462
Birth Control:
  • R1,584 per female, from preventative benefit limit
On Discharge:
  • 7 days supply
Biological:

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Our quote will include the right gap cover for this plan

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OPTOMETRY:
Supreme
Scheme Benefits Gap benefits
Optometry:
  • Single vision: R2,104 per person incl frame, lenses and consult
  • Bifocal: R2,538 per person incl frame, lenses and consult
  • Multifocal: R3,183 per person incl frame, lenses and consult
  • or, Contact lenses: R2,371 per person
"
  • Paid from limit below, every 2 years.
  • Limit shared with GPs, specialists, dentistry and optometry
  • MainAdultChild
    R14,157R10,618R1,481
    • 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:
    Supreme
    Scheme Benefits Gap benefits
    In-hospital:
    • R31,610 per family
    Out-of-hospital:
    • R1,680 per family from day-to-day benefit
    Trauma:
    • 3 psychologist consults per person
    • R693 per consult

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    Our quote will include the right gap cover for this plan

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    OTHER BENEFITS:
    Supreme
    Scheme Benefits Gap benefits
    General Appliances:
    • External appliances: R15,805, with sub limits
    • No benefit
    1.1. Hearing Aids: See above
    • No benefit
    1.2. Wheelchairs: See above
    • No benefit
    Dialysis:
    • Unlimited, at network providers
    HIV:
    • Covered at network hospitals if on HIV Management Programme
    • No benefit
    Emergency Transport: Netcare 911
    • No benefit
    International Insurance:
    • Available, contact scheme
    • No benefit
    Other:
    • Cochlear implants: R131,935 per family
    • Oxygen: R15,805
    • Sleep apnoea: R15,805 for infant younger than 1yr

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

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    WELLNESS/PREVENTATIVE BENEFITS:
    Supreme
    Scheme Benefits Gap benefits
    Flu vaccination:
    • Covered subject to overall R3,957 per family for preventative care benefits
    • No benefit
    Pneumonia vaccines: 2018 benefits are coming soon!
    • No benefit
    Back Rehabilitation Programme: 2018 benefits are coming soon!
    • No benefit
    Biometric Screening:
    • Covered subject to overall R3,957 per family for preventative care benefits
    • No benefit
    Child Immunisation:
    • Covered subject to overall R3,751 per family for preventative care benefits
    • No benefit
    Pap Smear:
    • Covered subject to overall R3,751 per family for preventative care benefits
    • No benefit
    Mammogram:
    • Covered subject to overall R3,751 per family for preventative care benefits. 35yrs+.
    • No benefit
    PAS Test:
    • Covered subject to overall R3,751 per family for preventative care benefits
    • No benefit
    HIV Test:
    • Covered subject to overall R3,751 per family for preventative care benefits
    • No benefit
    Other:
    • HPV vaccine
    • Oral contraceptive: R1,496
    • Subject to overall R3,751 per family for preventative care benefits
    • No benefit

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

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    PROSTHETICS:
    Supreme
    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