Compcare Symmetry ED:
in-and-out of hospital benefits (2024)

This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Compcare Symmetry ED.

We also have information on: Dentistry, Optometry, Wellness and Preventative, Other, Maternity, Cancer, Mental Health and Prosthetics benefits.

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Monthly Costs:

Symmetry ED 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R5,118
  • R3,982
  • R1,436
  • Only pay for 3 children
Savings:
  • R6,132
  • R4,776
  • R1,716
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R4,380
  • R3,396
  • R1,200
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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In-hospital Procedures for 2022:

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

Compcare: Symmetry ED
Assume scheme pays all these costs, unless otherwise stated
non-Network Specialists:
  • 100% scheme rate
network Specialists:
  • 100% scheme rate
non-Network GPs:
  • 100% scheme rate
network GPs:
  • 100% scheme rate
Hospital Choice:
  • Choose any Netcare hospital
Day Hospitals:
  • No specific requirements for day hospital use are listed
Penalty for using other hospital:
  • 30% co-payment, with a R7,500 minimum
Other Co-payments:
  • Gastroscopy: R3,000 co-payment
  • Colonoscopy: R3,000 co-payment
  • Cystoscopy: R 3,000 co-payment
  • Proctoscopy: R3,000 co-payment
  • Nasal or sinus endoscopy: R3,000 co-payment
  • Functional nasal surgery and septoplasty: R9,000 co-payment
  • Hysteroscopy: R3,000 co-payment
  • Flexible sigmoidoscopy: R3,000 co-payment
  • Arthroscopy: R3,000 co-payment
  • Minor gynaecological laparoscopic procedure: R3,000 co-payment
  • Dental: R3,000 co-payment
  • Excision lesion- benign and malignant: R3,000 co-payment
  • Joint replacements- arthroplasty: R17,500 co-payment
  • Conservative back and neck treatment- spinal cord injections: R13,500 co-payment
  • Laminectomy and spinal fusion: R28,000 co-payment
  • Nissen fundoplication- reflux surgery: R16,800 co-payment
  • Hysterectomy, except for cancer: R11,500 co-payment
  • Laparoscopic hemi colectomy: R4,300 co-payment
  • Laparoscopic inguinal hernia repair: R3,000 co-payment
  • Laparoscopic appendectomy: R3,000 co-payment
  • Adenoidectomy, myringotomy- grommets, tonsillectomy: R3,750 co-payment
  • Laparoscopy, hysteroscopy, endometrial ablation: R9,000 co-payment
  • Annual Limit for the above procedures: R38,000
Specialised Radiology:
  • MRI, CT and PET Scans: R30,000 per family, unless PMB or otherwise authorised
  • R1,500 co-payment, unless PMB
  • No benefit for screening purposes
  • In and out of hospital
Supplementary Services: (Physio, etc)
  • R5,400 per family, in and out of hospital
Transplants:
  • PMBs only
Dialysis:
  • PMBs only
Exclusions:
Alternatives to hospitals:
  • Home nursing: 30 days per family
  • Step-down nursing, hospice and rehab: as authorised
Casualty:
  • One visit per child under 6 yrs: R1 300 paid by scheme
Other:
  • Surgical procedures out of hospital: Unlimited
  • 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
♦️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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.

Out-of-hospital Procedures for 2022:

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

Compcare: Symmetry ED
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings:
  • R6,132
  • R4,776
  • R1,716
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R4,380
  • R3,396
  • R1,200
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:
  • Claims are first paid savings account, then from fund (AFB). When AFB is finished, some additional benefits are available.
GP consultations:
  • From day-to-day benefit
  • Then, Unlimited once day-to-day has run out
  • Unlimited GP consultations and basic dentistry for children under 6yrs
Childcare:
  • Baby Wellness consults: 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 day-to-day benefits, with a 30% co-payment if not referred by GP
Pathology:
  • From day-to-day benefits
General radiology:
  • From day-to-day benefits
Specialised radiology:
  • MRI, CT and PET Scans: R30,000 per family or otherwise authorised
  • R1,500 co-payment
  • No benefit for screening purposes
  • In and out of hospital
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: R5,400 per family from day to day benefit
General Appliances:
  • R12,500, from day-to-day benefit
1.1. Hearing Aids:
  • R10,800, from day-to-day benefit, every 3 years
1.2. Wheelchairs:
  • R4,600, from above Appliance limit
Note:
  • PMBs: Prescribed Minimum Benefits. 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 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
.

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.

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Medication Benefit for 2022:

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

Compcare: Symmetry ED
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings:
  • R6,132
  • R4,776
  • R1,716
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R4,380
  • R3,396
  • R1,200
Chronic:
  • Additional 21 conditions: from day-to-day benefit, up to R5,000 per person and R7,500 per family
Acute (presrcibed) medication:
  • From day-to-day benefit
Over-the-counter:
  • R200 per script
  • No sublimit in savings
  • R780 per person and R1,300 per family
Birth Control:
  • R2,950 per person, including devices
On Discharge:
  • 7 days per admission
Biological:
  • R160,000 per family, with 25% co-payment
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 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
.

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.

Also see these: