.
|
| non-Network Specialists: |
|
| network Specialists: |
|
| non-Network GPs: |
|
| network GPs: |
|
| Hospital Choice: |
|
| Penalty for using other hospital: |
|
| Specialised Radiology: |
- MRI, CT and PET Scans: Unlimited
- R2,250 co-payment, unless PMB
- No benefit for screening purposes
- In and out of hospital
|
| Supplementary Services: (Physio, etc) |
- R7,500 per family, in and out of hospital
|
| Transplants: |
|
| Dialysis: |
|
| Day Hospitals: |
- No specific requirements for day hospital use are listed
|
| Co-payments: |
- Gastroscopy: R2,800
- Colonoscopy: R2,800
- Cystoscopy: R2,800
- Nasal or sinus endoscopy: R2,600
- Functional nasal surgery and septoplasty: R2,600
- Hysteroscopy: R2,600
- Flexible sigmoidoscopy: R2,600
- Arthroscopy: R2,600
- Minor gynaecological laparoscopic procedure: R2,600
- Dental: R2,600
- Excision lesion- benign and malignant: R2,600
- Joint replacements- arthroplasty: R2,000
- Conservative back and neck treatment- spinal cord injections: R2,000
- Laminectomy and spinal fusion: R2,600
- Nissen fundoplication- reflux surgery: R2,600
- Hysterectomy, except for cancer: R2,600
- Laparoscopic hemi colectomy: R2,600
- Laparoscopic inguinal hernia repair: R2,600
- Laparoscopic appendectomy: R2,600
- Annual Limit for the above procedures: R43,000
|
| 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: |
- Surgical procedures out of hospital: Unlimited
- Treatment for injuries due to extreme sports are covered
- Internal nerve stimulators:R120,000
|
| 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
|
x
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.
|
|
Main Member: |
Adult: |
Child: |
| Savings /yr: |
R9,876 |
R7,716 |
R2,748 |
| Extended Fund: |
R3,276 |
R2,532 |
R900 |
Self Payment Gap:
|
R7,992 |
R5,940 |
R2,076 |
| Above Threshold: |
R8,280 per person
R14,676 per family |
|
|
|
- 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.
|
Claims are first paid Savings Account, then from Fund (AFB). When this is finished, member pays self-payment gap out of pocket. During this period, claims will accumulate to the annual threshold at the scheme rate. Once the annual threshold is reached, specific Above Threshold Benefits (ATB) will be available up to a limit of R8,280 per person and R14,676 per family
|
|
- Baby Wellness visits: 2 per year, for 4m-18m
- Unlimited GP consultations and basic dentistry for children under 6yrs
- Initial Occupational Therapy consultation
- School readiness assessments
- Kid’s active benefit assessment and exercise prescription
programme
- Kid’s nutritional benefit assessment and healthy eating programme
|
- From day-to-day benefits, with a 30% co-payment if not referred by GP
- Sublimit of R4,500 per family from above threshold benefit
|
- From day-to-day benefits
- R3,400 per family limit from threshold benefit, combined with radiology
|
- From day-to-day benefits
- R3,500 per family limit from threshold benefit, combined with radiology
|
- MRI, CT and PET Scans: Unlimited
- R2,250 co-payment, unless PMB
- No benefit for screening purposes
- In and out of hospital
|
- Speech therapists, social workers, podiatrists, occupational therapists, homeopaths and naturopaths, dietitians, chiropractors (X-rays excluded), audiologist, physiotherapy and biokinetics in-and-out of hospital:
R7,500 per family from day to day benenfit
|
- R17,900, from day-to-day benefit
|
- R17,000, from day-to-day benefit, 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
|
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.
|
|
Main Member: |
Adult: |
Child: |
| Savings /yr: |
R9,876 |
R7,716 |
R2,748 |
| Extended Fund: |
R3,276 |
R2,532 |
R900 |
Self Payment Gap:
|
R7,992 |
R5,940 |
R2,076 |
| Above Threshold: |
R8,280 per person
R14,676 per family |
|
|
|
- Additional 38 conditions, paid from from day-to-day benefit, limited to R10,000 per person and R17,000 per family, and R3,500 per family from Above Threshold Benefit
|
- R3,350 per family, when in threshold
|
- R220 per script
- No sublimit in savings
- R1,100 per person and R1,450 per family from fund
- Does not accumulate to threshold
|
- R2,950 per person, including devices
|
|
- R230,000 per family, with 25% co-payment unless PMB
|
- Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
- Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
- 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
|
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.
