Compcare Dynamix: in-and-out of hospital benefits (2021)

January 31, 2021

This page shows the In-hospital, Out-of-hospital and Medicine benefits for Compcare Dynamix.

Pricing:

Dynamix
	Main member:	Adult member:	Child member:
Total Cost pm:	R5,563	R4,345	R1,551 (Pay only for first 3)
Savings:	R9,324	R7,284	R2,592
Extended Fund:	R3,144	R2,436	R872
Self Payment Gap:	R6,660	R4,944	R1,728
Above Threshold:	R6,900 per person R12,230 per family	No limit	No limit
Children Rates:	Under 21 yrs, unless student or financially dependent. Then, under 27yrs. (Pay only for first 3)
Note:	Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list. All treatments and procedures are subject to authorisation and protocols All benefits are listed as an indication only. Please verify with your broker and scheme
View other benefits: Inhospital \| Out of hospital \| Medication \| Maternity \| Cancer \| Mental Health \| Dentistry \| Optometry \| Other/Extra Benefits \| Wellness \| Prosthetics You can also: Compare any two plans, side by side \| View all the Compcare plans, with costs and brief summary

In-hospital Procedures:

Dynamix
non-Network Specialists:	Up to 100% scheme rate
network Specialists:	Up to 100% scheme rate
non-Network GPs:	Up to 100% scheme rate
network GPs:	Up to 100% scheme rate
Hospital Choice:	Choose any hospital
Penalty for using other hospital:	n/a
Specialised Radiology:	R2,250 co-payment
Supplementary Services: (Physio, etc)	R7,200 per family, in and out of hospital
Transplants:	PMBs only
Dialysis:	PMBs only
Day Hospitals:	No specific requirements for day hospital use are listed
Co-payments:	Gastroscopy: R2,500 Colonoscopy: R2,500 Cystoscopy: R2,500 Nasal or sinus endoscopy: R2,500 Functional nasal surgery and septoplasty: R2,500 Hysteroscopy: R2,500 Flexible sigmoidoscopy: R2,500 Arthroscopy: R2,500 Minor gynaecological laparoscopic procedure: R2,500 Dental: R2,500 Excision lesion- benign and malignant: R2,500 Joint replacements- arthroplasty: R2,500 Conservative back and neck treatment- spinal cord injections: R2,500 Laminectomy and spinal fusion: R2,500 Nissen fundoplication- reflux surgery: R2,500 Hysterectomy, except for cancer: R2,500 Laparoscopic hemi colectomy: R2,500 Laparoscopic inguinal hernia repair: R2,500 Laparoscopic appendectomy: R2,500
Alternatives to hospitals:	Home nursing: 40 days per family Step-down nursing, hospice and rehab: as authorised
Casualty:	ER visits as a result of physical injury caused by an external force: paid in full by scheme ER visits that result in admission: paid by scheme One visit per child under 6 yrs: R1 250
Other:	Treatment for injuries due to extreme sports are covered
Note:	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 Provders. Where stipulated, you must use specific 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 Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones here, but you must consult with your scheme to get the full list.
View other benefits: Inhospital \| Out of hospital \| Medication \| Maternity \| Cancer \| Mental Health \| Dentistry \| Optometry \| Other/Extra Benefits \| Wellness \| Prosthetics You can also: Compare any two plans, side by side \| View all the Compcare plans, with costs and brief summary

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.

Out-of-hospital Procedures:

Dynamix

	Main Member:	Adult:	Child:
Savings /yr:	R9,324	R7,284	R2,592
Extended Fund:	R3,144	R2,436	R872
Self Payment Gap:	R6,660	R4,944	R1,728
Above Threshold:	R6,900 per person R12,230 per family	No limit	No limit

How do medical aids pay for day-to-day claims?

All medical aids 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
The benefit is paid by the scheme, and not out of your savings account
If you have no day-to-day funds, you still have cover for PMBs
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.

From day-to-day benefit

Baby Wellness visits, childhood immunisations, school readiness assessments, pre-school eye and hearing screening, a dental screening, and one additional emergency room visit limited to R1 250 per event for children < 6 years.
Unlimited GP consultations and basic dentistry for children under 6yrs
Initial Occupational Therapy consultation
Kid’s active benefit assessment and exercise prescription programme
Kid’s nutritional benefit assessment and healthy eating programme

From day-to-day benefit
Sublimit of R4,300 per family from threshold benefit

From day-to-day benefits
R3,350 per family limit from threshold benefit, combined with radiology

From day-to-day benefits
R3,350 per family limit from threshold benefit, combined with radiology

R2,500 co-payment
Balance paid by scheme

R7,200 per family, in and out of hospital
From day-to-day benefit

R 17,200 per family
From day-to-day benefit, subject to appliance limit

R17,000, from day-to-day benefit, every 3 years

R4,500 , from day-to-day benefit, and every 3 years

PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
DSPs: Designated Service Provders. Where stipulated, you must use specific 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

Medication cover: