• Benefits, Compcare Plan, in-hospital, out-hospital, Scheme Plans

Compcare SelfCare Plus:
in-and-out of hospital benefits (2025)

Contents:

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Compcare SelfCare Plus. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

Terminology:

  • PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
  • DSPs: Designated Service Providers. Where stipulated, you must use specific providers to get full benefit.
  • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product.
  • All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

Monthly Costs (2026)

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Compcare:SelfCare Plus (2025)
Main member: Adult member: Child member:
Total Cost pm:
  • R2,566
  • R2,566
  • R898
Savings:
  • R3,072
  • R3,072
  • R1,068
Children Rates:
  • Under 21yrs
  • Only pay for 3 children
medicalaid_guide
FREE GUIDE!
How to choose the right Medical Aid plan
Instant download when you subscribe

In-hospital Procedures (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Compcare: SelfCare Plus
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:
  • 100% scheme rate
Gap Cover:
Can push payout up to 700% scheme rate
(Plans coming soon)
Hospital Choice:
  • Choose any Netcare or Mediclinic hospital
Penalty for using other hospital:
  • 30% penalty, with a R7,500 minimum
 Gap Cover:
Can cover the penalty in full
(Plans coming soon)
Co-payments:
  • Specialised radiology: R3,800 co-payment
Note:
  • If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here
  • There might be other co-payments, especially if you don't use a DSP for a PMB or when buying medicine.
 Gap Cover:
Can cover most co-payments
(Plans coming soon)
Specialised Radiology:
  • MRI, CT Scans: R23,000 per family, with R3,800 co-payment unless PMB
  • In and out of hospital benefit
  • PET Scans: PMBs only
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Scopes: Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Supplementary Services: (Physio, etc)
  • R3,000 per family
Transplants:
  • PMBs only
Dialysis:
  • PMBs only
Exclusions: .
  • NB: See scheme's rules for all exclusions. All schemes have plenty!
 Gap Cover:
Coming soon
Alternatives to hospitals:
  • Step-down nursing, hospice and rehab, or in-lieu of hospitalisation: Unlimited, as authorised
Casualty/ER:
  • ER visit: R1,550 paid from Care Maximiser, for child under 6yrs
 Gap Cover:
Can cover ER claims
(Plans coming soon)
Other: .
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

Out-of-hospital Procedures (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Compcare: SelfCare Plus
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child:
Savings:
  • R3,072
  • R3,072
  • R1,068
Other Day-to-Day Funds:
PMBs out of hospital:
  • All schemes must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
  • This can include consults with specialists, blood or other tests, radiology and medicine.
  • PMB benefits must never be paid from your savings account.
  • Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
  • See our Guide to PMBs for more information.
GP consultations:
  • Virtual and face-to-face: Unlimited, with a R100 co-payment
Childcare:
  • Newborn hearing screening test
  • Newborn congenital hypothyroidism test
  • Baby Wellness consult
  • Immunisations
  • Initial Occupational Therapy consultation
  • Preschool eye, hearing and dental screening
  • School readiness assessments
  • Kid’s active benefit assessment and exercise prescription programme
  • Kid’s nutritional benefit assessment and healthy eating programme
 Gap Cover:
Can pay for child ER visits
(Plans coming soon)
Specialist consultations:
  • R2,260 and 2 consults per family with a R120 co-payment
  • Must have GP referral
Pathology:
  • Scheme rate, paid by Compcare
General radiology:
  • R1,730 per person, paid by Compcare
  • 35% co-payment, unless referred by GP.
Specialised radiology:
  • MRI, CT Scans: R23,000 per family, with R3,800 co-payment unless PMB
  • In and out of hospital benefit
  • PET scans: No benefit, unless PMB
  • No benefit for screening purposes
 Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)
Scopes: Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)
Supplementary Services: (Physio, etc)
  • Speech therapists, social workers, podiatrists, occupational therapists, homeopaths and naturopaths, dietitians, chiropractors (X-rays excluded), audiologist, physiotherapy and biokinetics in-and-out of hospital: R3,000 per family, from day-to-day benefit
General Appliances:
  • From day-to-day benefit
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

Medication Benefit (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Compcare: SelfCare Plus
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child:
Savings:
  • R3,072
  • R3,072
  • R1,068
Other Day-to-Day Funds:
Chronic: .
Acute (prescribed) medication:
  • From day-to-day benefit
Over-the-counter:
  • From day to day benefit
Birth Control:
  • From day-to-day benefit , or Care Maximizer
On Discharge:
  • 7 days per admission
Biological:
  • PMBs only
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

medicalaid_guide
FREE GUIDE!
How to choose the right Medical Aid plan
Instant download when you subscribe

More Information