Compcare Pinnacle ED:
cancer, maternity and mental health (2024)

This page has information on: Costs, Maternity, Oncology, Mental Health for Compcare Pinnacle ED

We also have information on: In-hospital, Out of hospital, Medicine, Dentistry, Optometry, Other/Extra Benefits, Wellness and Preventative and Prosthetics

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Monthly Costs:

Pinnacle ED 2024 prices
	Main member:	Adult member:	Child member:
Total Cost pm:	R8,172	R6,359	R2,276 Only pay for 3 children
Savings:	R19,608	R15,252	R5,460
Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account	R4,032	R3,144	R1,116
Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit)	R3,660	R2,520	R756
"Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid* the self payment gap.*	Main= R10,700 Main+1= R22,050
Children Rates:	Under 21 yrs, unless student or financially dependent. Then, under 27yrs. Only pay for 3 children
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 all the other benefits for this plan:♦️ 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
.

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Cancer/ Oncology benefits for 2022:

Compcare: Pinnacle ED
Assume scheme pays all these costs, unless otherwise stated
Overall coverage (in and out of hospital):	Chemotherapy and radiotherapy: Unlimited Biological medication: R310,000 per family	Treatment required for PMB conditions is always paid by scheme, with no co-payment, if you follow the protocols. Most cancers are PMBs! More info here Most schemes require use of specific providers (DSPs) for oncology treatment.
♦️View all the other benefits for this plan:♦️ 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
.

Maternity benefits for 2022:

Compcare: Pinnacle ED
Assume scheme pays all these costs, unless otherwise stated
Hospital stay:	100% scheme rate	Usually covered for 2 nights* for natural birth, and 3 nights for C-sections. All newborns receive immediate full medical aid cover at birth, even if parents are on a waiting period.*
Consultations:	Compcare pays for: 12 antenatal consults
Scans:	Compcare pays for: 2 x 2D scans 1 amniocentesis
Note:	If you are pregnant and don't have medical aid, your pregnancy will most likely be excluded for new cover, but your baby will be covered from birth. Read more about pregnancy cover if you don’t have medical aid.
♦️View all the other benefits for this plan:♦️ 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
.

Mental Health benefits for 2022:

Compcare: Pinnacle ED
Assume scheme pays all these costs, unless otherwise stated
In-hospital:	PMBs: Covered in full at DSP, up to 21 days admission Alcoholism/Drug Addiction: 21 days admission Psychologists for non-psychiatric admissions: R4,700 per family
Out-of-hospital:	PMBs: 10+ consults, paid by scheme Psychiatrist: R 5,700 per family, from day-to-day benefit, (but not from above-threshold benefit) Psychologist: R 18,750 per family, from day-to-day benefit, (but not from above-threshold benefit)
Trauma:	PMB conditions are covered for in and out of hospital treatment. For a full list see here. Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts
Note:	PMBs: Prescribed Minimum Benefits. Here is a list of PMB conditions: Mental Illness. 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 all the other benefits for this plan:♦️ 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
.

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

All the medical aid jargon explained (2024)

Medical aid and PMBs? DSPs? PPNs? We decipher the medical aid jargon in plain English so that you are not as confused 🙂

How do I make a medical aid plan change (2024)?

A quick guide to how you can change your medical aid plan, including the resignation procedure, and things to look out for, such as imposed waiting periods from your new scheme

Medical Aid waiting periods: what you need to know (2024)

Waiting periods can prevent you from getting the cover that you need – but they are not always applied. Find out rules here.

Compcare Pinnacle ED:
cancer, maternity and mental health (2024)

Monthly Costs:

Cancer/ Oncology benefits for 2022:

Maternity benefits for 2022:

Mental Health benefits for 2022:

All the medical aid jargon explained (2024)

How do I make a medical aid plan change (2024)?

Medical Aid waiting periods: what you need to know (2024)

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Compcare Pinnacle ED: cancer, maternity and mental health (2024)

Monthly Costs:

Cancer/ Oncology benefits for 2022:

Maternity benefits for 2022:

Mental Health benefits for 2022:

Also see these:

Compcare Pinnacle ED:
cancer, maternity and mental health (2024)