Compcare MedX ED: in-and-out of hospital benefits (2022)

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

Pricing:

Medx ED - Jan 2022 prices
Main member: Adult member: Child member:
Total Cost pm: R1,899 R1,899 R594
(Pay only for first 3)
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims, though. See below, and see benefits.
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: (2021 benefits)

x
Medx ED
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 Netcare hospital
Penalty for using other hospital:
  • 30% penalty, with a R7,500 minimum
Specialised Radiology:
  • MRI, CT and PET Scans: R24,000 per family, unless PMB or otherwise authorised
  • No benefit for screening purposes
Supplementary Services: (Physio, etc)
  • R3,000 per family
Transplants:
  • PMBs only
Dialysis:
  • PMBs only
Day Hospitals:
  • No specific requirements for day hospital use are listed
Co-payments:
  • Gastroscopy: R4,900
  • Colonoscopy: R4,900
  • Cystoscopy: R4,900
  • Proctoscopy: R4,900
  • Nasal or sinus endoscopy: R 4,900
  • Functional nasal surgery and septoplasty: R9,000
  • Hysteroscopy: R4,900
  • Flexible sigmoidoscopy: R4,900
  • Arthroscopy: R9,000
  • Minor gynaecological laparoscopic procedure: R4,900
  • Dental: R4,900
  • Excision lesion- benign and malignant: R4,900
  • Joint replacements- arthroplasty: No benefit
  • Conservative back and neck treatment- spinal cord injections: No benefit
  • Laminectomy and spinal fusion: No benefit
  • Nissen fundoplication- reflux surgery: R23,000
  • Hysterectomy, except for cancer: R17,000
  • Laparoscopic hemi colectomy: R5,900
  • Laparoscopic inguinal hernia repair: R5,900
  • Laparoscopic appendectomy: R5,900
  • Adenoidectomy, myringotomy- grommets, tonsillectomy: R3,750
  • Laparoscopy, hysteroscopy, endometrial ablation: R9,000
  • Annual Limit for teh above procedures: R31,500
Alternatives to hospitals:
  • Home nursing: 20 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:
  • Pathology: R26,800 per family, in and out of hospital
  • Post hospital care: Bioniteticist, OT and physio. R3,800 per person and R2,800 per family
  • Treatment for injuries due to extreme sports are covered
Excluded:
  • Deep brain implants (e.g. Parkinson’s Disease) and internal nerve stimulators
  • Corneal transplants
  • Cochlear implants
  • Bunion surgery
  • All spinal surgery (including neck), except in the event of acute injury
  • All joint replacements, except in the event of acute injury.
  • Laminectomy and spinal fusion
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: (2021 benefits)

Medx ED
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
PMBs out of hospital:
  • 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.
General info:
GP consultations:
  • One wellness consult, excluding procedures
  • Otherwise, no benefit
Childcare:
  • 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
Specialists consultations:
  • From PMBs only
Pathology:
  • PMBs only
General radiology:
  • PMBs only
Specialised radiology:
  • PMBs only
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: PMBs only
General Appliances:
  • No benefit
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • See above
Note:
  • 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.


Medication cover: (2021 benefits)

Medx ED
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
Chronic:
  • PMBs only
Acute (presrcibed) medication:
  • No benefit
Over-the-counter:
  • No benefit
Birth Control:
  • R2,950 per person, including devices
On Discharge:
  • 7 days per admission
Biological:
  • R160,000 per family, with 25% co-payment unless PMB
Note:
  • 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.

Important!

  • Unless specified, assume that all benefits 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

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