Selfmed MedXXI 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:
MexXXI
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:
MexXXI
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:
  • R1,600 co-payment. In and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • 100% scheme tariff
  • 2018 benefits coming soon. 2017 benefits:
    Transplants: 2018 benefits coming soon. 2017 benefits:
    • Donor costs covered up to limits only if recipient is part of the scheme
    Co-payments:
    • 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:
    • R1,000 per family
    Other: 2018 benefits coming soon. 2017 benefits:
    • Joint replacements: no benefit, unless PMBs
    • Spinal surgery: no benefit, unless PMBs
    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):
    MexXXI
    Scheme Benefits Gap benefits
    Main: Adult: Child:
    General info:
    GP consultations: 2018 benefits coming soon. 2017 benefits:
    • No benefit
    Childcare:
    • No extra benefit available
    Specialists consultations: 2018 benefits coming soon. 2017 benefits:
    • Some day procedures covered
    Pathology: 2018 benefits coming soon. 2017 benefits:
    • No benefit, unless PMB
    General radiology: 2018 benefits coming soon. 2017 benefits:
    • No benefit, unless PMB
    Specialised radiology: 2018 benefits coming soon. 2017 benefits:
    • R1,600 co-payment. In and out of hospital
    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

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    MATERNITY BENEFITS:
    MexXXI
    Scheme Benefits Gap benefits
    Hospital stay: 2018 benefits are coming soon!
    Consultations: 2018 benefits coming soon. 2017 benefits:
    • 2 consults per year
    • Antenatal classes: R1,600 shared with scan benefit
    Scans: 2018 benefits coming soon. 2017 benefits:
    • R1,600 per family, shared with antenatal class benefit

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

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    CANCER (ONCOLOGY):
    MexXXI
    Scheme Benefits Gap benefits
    Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
    • R176,600 per family
    • Biological medicine: No benefit

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

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    DENTISTRY:
    MexXXI
    Scheme Benefits Gap benefits
    Dentistry: 2018 benefits coming soon. 2017 benefits:
    • No benefit, unless PMB
    Orthodontics: 2018 benefits coming soon. 2017 benefits:
    • No benefit
    Maxillo Facial Surgery: 2018 benefits coming soon. 2017 benefits:
    • R1,100 co-payment, unless PMB

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

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    MEDICATION:
    MexXXI
    Scheme Benefits Gap benefits
    Chronic: 2018 benefits coming soon. 2017 benefits:
    • PMB chronic: paid by scheme
    Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
    • No benefit
    Over-the-counter: 2018 benefits coming soon. 2017 benefits:
    • No benefit
    Birth Control: 2018 benefits coming soon. 2017 benefits:
    • R1,500 per family
    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:
    MexXXI
    Scheme Benefits Gap benefits
    Optometry: 2018 benefits coming soon. 2017 benefits:
    • No benefit

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

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    MENTAL HEALTH:
    MexXXI
    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:
    • No benefit
    Trauma:

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

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    OTHER BENEFITS:
    MexXXI
    Scheme Benefits Gap benefits
    General Appliances: 2018 benefits are coming soon!
    • No benefit
    1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
    • No benefit
    • No benefit
    1.2. Wheelchairs: 2018 benefits coming soon. 2017 benefits:
    • No benefit
    • 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: R30,200 per implant

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

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    WELLNESS/PREVENTATIVE BENEFITS:
    MexXXI
    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:
    MexXXI
    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