Compcare UltraCare Plus:
in-and-out of hospital benefits (2025)

What's on this page:

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

Monthly Costs (2025)

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

UltraCare Plus 2025 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R9,056
  • R8,150
  • R3,170
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R16,000
  • R6,766
  • R2,631
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R10,200
  • R7,600
  • R2,800
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
    • Main= R9,660
    • Main+1= R17,200
Children Rates:
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:
In-hospital | 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.

Find all other open medical aid plans here.
.

In-hospital Procedures (2022):

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

Compcare: UltraCare Plus
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
non-Network Specialists:
  • 100% scheme rate
Scheme rate is set by Compcare
network Specialists:
  • 100% scheme rate
non-Network GPs:
  • 100% scheme rate
network GPs:
  • 100% scheme rate
Hospital Choice:
  • Any hospital
Day Hospitals:
  • No specific requirements for day hospital use are listed
Penalty for using other hospital:
  • n/a
 You don't pay a penalty if admission was unavoidable due an emergency
Other Co-payments:
  • Gastroscopy: R4,900 co-payment
  • Colonoscopy: R4,900 co-payment
  • Cystoscopy: R 4,900 co-payment
  • Proctoscopy: R4,900 co-payment
  • Nasal or sinus endoscopy: R 4,900 co-payment
  • Functional nasal surgery and septoplasty: R9,000 co-payment
  • Hysteroscopy: R4,900 co-payment
  • Flexible sigmoidoscopy: R4,900 co-payment
  • Arthroscopy: R9,000 co-payment
  • Minor gynaecological laparoscopic procedure: R4,900 co-payment
  • Dental: R4,900 co-payment
  • Excision lesion- benign and malignant: R4,900 co-payment
  • Joint replacements- arthroplasty: R26,000 co-payment
  • Conservative back and neck treatment- spinal cord injections: R23,000 co-payment
  • Laminectomy and spinal fusion: R39,500 co-payment
  • Nissen fundoplication- reflux surgery: R23,000 co-payment
  • Hysterectomy, except for cancer: R17,000 co-payment
  • Laparoscopic hemi colectomy: R5,900 co-payment
  • Laparoscopic inguinal hernia repair: R5,900 co-payment
  • Laparoscopic appendectomy: R5,900 co-payment
  • Adenoidectomy, myringotomy- grommets, tonsillectomy: R3,750 co-payment
  • Laparoscopy, hysteroscopy, endometrial ablation: R9,000 co-payment
  • Annual Limit for the above procedures: R35,500
 * There might be other co-payments if you don't use scheme-chosen provider for some services.

* Treatment required for PMB level care is always paid by scheme, with no co-payment, if you follow the protocols.
That means that these co-payments might not apply in your case! More info here
Specialised Radiology:
  • MRI, CT and PET Scans: R27,000 per family, unless PMB or otherwise authorised
  • No benefit for screening purposes
  • In and out of hospital
 No limits or co-payments for PMB level care and/or for emergency
Scopes: No limits or co-payments for PMB level care and/or for emergency
Supplementary Services: (Physio, etc)
  • R3,200 per family, in and out of hospital
 No limits or co-payments for PMB level care and/or for emergency
Transplants:
  • PMBs only
Dialysis:
  • PMBs only
Exclusions: Exclusions:
  • Note: All schemes have extensive exclusions. We've tried to list the major ones here, but please consult your scheme or broker to get the full list.
 * Treatment required for PMB level of care is always paid by scheme, if you follow the protocols. It cannot be excluded. More info here.

Alternatives to hospitals:
  • Home nursing: 20 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:
In-hospital | 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.

Find all other open medical aid plans here.
.

Out-of-hospital Procedures (2022):

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

Compcare: UltraCare Plus
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R16,000
  • R6,766
  • R2,631
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R10,200
  • R7,600
  • R2,800
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
    • Main= R9,660
    • Main+1= R17,200
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 paid from fund. When this is finished, some additional benefits become available
GP consultations:
  • Unlimited consults for children under 6yrs, and up to below limits for adults, if day-to-day benefits are depleted
  • Otherwise, from day-to-day benefit, up to:
    M =6 consults
    M1 =8 consults
    M2 =10 consults
    M3+ =11 consults
  • One wellness consult, excluding procedures, paid by scheme
 Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
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
 Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Pathology:
  • From day-to-day benefits
General radiology:
  • From day-to-day benefits
Specialised radiology:
  • MRI, CT and PET Scans: R27,000 per family or otherwise authorised
  • No benefit for screening purposes
  • In and out of hospital
 Scans required for PMB level care are paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Scopes: No limits or co-payments for PMB level care and/or for emergency
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: R3,200 per family, from day-to-day benefit
General Appliances:
  • R11,400, from day-to-day benefit
1.1. Hearing Aids:
  • R8,700, from savings account only, every 3 years
1.2. Wheelchairs:
  • R1,100, 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:
In-hospital | 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.

Find all other open medical aid plans here.
.

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 Benefit (2022):

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

Compcare: UltraCare Plus
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R16,000
  • R6,766
  • R2,631
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R10,200
  • R7,600
  • R2,800
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
    • Main= R9,660
    • Main+1= R17,200
Chronic:
  • Additional 10 conditions: from day-to-day benefit
 You might be required to use specific pharmacies and be limited to specific medicines
Acute (presrcibed) medication:
  • From day-to-day benefit
Over-the-counter:
  • R650 per person and R1,250 per family.
  • R200 per script
  • From day to day benefit
Birth Control:
  • R2,950 per person, including devices
On Discharge:
  • 7 days per admission
Biological:
  • R160,000 per family, with 25% co-payment
 Treatment that is required (by law) for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here.)
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:
In-hospital | 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.

Find all other open medical aid plans here.
.

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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