Selfmed 80% 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:
Selfmed 80%
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:
Selfmed 80%
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:
  • Network
  • R12,800 per person per year for use of a non-network hospital
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • R1,100 co-payment
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Unlimited
Transplants: 2018 benefits coming soon. 2017 benefits:
  • Donor costs covered up to limits only if recipient is part of the scheme
Co-payments: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment for consults and clinical procedures
  • 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:
  • Benefits shared with GP consults and acute medicine
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.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Selfmed 80%
Scheme Benefits Gap benefits
Main: Adult: Child:
General info:
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and limited to M =consults, M1 = 30 consults and M2+ =45 consults
  • Shared with GP and Specialist consults>/li>
Childcare:
  • No extra benefit available
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and limited to M =consults, M1 = 30 consults and M2+ =45 consults
  • Shared with GP and Specialist consults>/li>
Pathology: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment
General radiology: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • 20% + R1,1000 co-payment
  • Scheme rate applies
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Medical and clinical technology: 20% co-payment
  • Physio, speech therapy, occupational therapy, podiatry, orthotic treatment, hearing aid acoustics, dieticians, chiropractors, osteopaths, homeopaths, naturopaths, herbalists and biokinetics: 20% co-payment and limited to R4,800 per person and R13,600 per family

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

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MATERNITY BENEFITS:
Selfmed 80%
Scheme Benefits Gap benefits
Hospital stay: 2018 benefits are coming soon!
Consultations: 2018 benefits coming soon. 2017 benefits:
  • Benefits shared with GP and specialist benefit
  • Antenatal classes: R1,400 shared with scan benefit
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2 x 2D scans
  • Additional scans: shared with antenatal class benefit up to R1,400 in total

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

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CANCER (ONCOLOGY):
Selfmed 80%
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • R408,500 per family
  • Biological medicine: R157,600

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Our quote will include the right gap cover for this plan

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DENTISTRY:
Selfmed 80%
Scheme Benefits Gap benefits
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry: 20% co-payment
  • Specialised dentistry: 20% co-payment and limited to R7,700 per person and R23,600 per family
  • Implants: 20% co-payment and limited to R5,600 per person
Orthodontics: 2018 benefits are coming soon!
Maxillo Facial Surgery: 2018 benefits coming soon. 2017 benefits:
  • Non-elective: 20% co-payment

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

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MEDICATION:
Selfmed 80%
Scheme Benefits Gap benefits
Chronic: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and R23,300 per person and R45,400 per family
Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and R5,800 per person and R17,200 per family
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and R1,500 per family
  • Shared with acute medicine and birth control benefit
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and R1,500 per family
  • Shared with acute medicine and OTC benefit
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • 7 days supply
Biological:

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

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OPTOMETRY:
Selfmed 80%
Scheme Benefits Gap benefits
Optometry: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment
  • Refractive surgery: No benefit

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

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MENTAL HEALTH:
Selfmed 80%
Scheme Benefits Gap benefits
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • Covered if part of Case Management Programme
Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and limited to R8,800
Trauma:

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

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OTHER BENEFITS:
Selfmed 80%
Scheme Benefits Gap benefits
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and limited to R5,300 per family
  • This may be increased to R15,900 with respect to certain appliances, under case management
  • No benefit
1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and limited to R16,200 per family
  • No benefit
1.2. Wheelchairs: 2018 benefits are coming soon!
  • No benefit
Dialysis: 2018 benefits coming soon. 2017 benefits:
  • Unlimited
HIV: 2018 benefits coming soon. 2017 benefits:
  • Covered if part of Disease management Programme
  • No benefit
Emergency Transport: ER24
  • No benefit
International Insurance: 2018 benefits are coming soon!
  • No benefit
Other: 2018 benefits coming soon. 2017 benefits:
  • Cochlear implant: R74,500 per implant

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

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WELLNESS/PREVENTATIVE BENEFITS:
Selfmed 80%
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 coming soon. 2017 benefits:
  • Covered
  • 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

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PROSTHETICS:
Selfmed 80%
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