Health Squared Cobalt: in-and-out of hospital benefits (2021)

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Table of Contents

This page shows the In-hospital, Out-of-hospital and Medicine benefits for Health Squared Cobalt.

Pricing:

Cobalt
Main member: Adult member: Child member:
Total Cost pm: R9,025 R8,738 R3218
Savings: R18408 R17820 R6564
Extended Fund: RM = R10,398
M1 = R12,635
M2 =R14,316
M3 =R17,442
M4+ =R19,567
R R
Children:
View all benefits: Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics
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

You can also:

In-hospital Procedures:

Cobalt
non-Network Specialists:
  • 100% scheme rate
network Specialists:
  • Full cost
non-Network GPs:
  • 100% scheme rate
network GPs:
  • Full cost
Hospital Choice:
  • For planned PMB procedures, you must use the DSP network
Penalty for using other hospital:
  • Not using a DSP when required: 30% co-payment
Specialised Radiology:
    MRI, CT scans, PET, Nuclear Medicine:
  • R24,934 per family with a R3,612 co-payment, for non-PMBs
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
  • Covered
Dialysis:
  • Covered
Day Hospitals:
  • No co-payments for procedures performed in a day-hospital, except for specialised radiology
Co-payments:
  • Cystoscopy, Excision nail bed, Skin lesions, Specialised Radiology (MRI, CT, PET scans): R3,612
  • Circumcision, Vasectomy, Colonoscopy, Dental admissions: R3,762
  • Arthroscopy: R4,800
  • Endometrial ablation, Laparoscopic Procedures, Urinary Incontinence Repair, varicose veins: R8,660
  • Gastroscopy, Hernia Repair: R7,524
  • Conservative back/spine treatment, Hysteroscopy, Hysterectomy: R7,524
  • Rotator Cuff Surgery: R6,000
  • Joint replacement, Spinal Surgery: R15,048
  • No co-payments for procedures performed in a day-hospital, except for specialised radiology
Alternatives to hospitals:
  • Hospice and home nursing: R15,989 per family
  • Rehab and sub-acute: R15,989 per family
Casualty:
  • From day-to-day benefit
Other: .
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.

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.

Looking for this plan's other benefits?

Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics


Out-of-hospital Procedures:

Cobalt
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: R18408 R17820 R6564
Extended Fund: RM = R10,398
M1 = R12,635
M2 =R14,316
M3 =R17,442
M4+ =R19,567
R R
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:
  • From day-to-day benefit
Childcare:
  • From day-to-day benefit
Specialists consultations:
  • From day-to-day benefit
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
    MRI, CT scans, PET, Nuclear Medicine:
  • R24,934 per family with a R3,612 co-payment, for non-PMBs
Supplementary Services: (Physio, etc)
  • From day-to-day benefit
General Appliances:
  • Paid by scheme from "Benefit Booster". See limits below
  • This is shared by optometry, specialised dentistry, mental health and welllness (preventative) benefits and external appliances
  • Limits:
    • M: R10,398
    • M+1: R12,635
    • M+2: R14,316
    • M+3: R17,442
    • M+4+: R19,567
1.1. Hearing Aids:
  • See "General Appliances" limit
1.2. Wheelchairs:
  • See "General Appliances" limit
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

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.

Looking for this plan's other benefits?

Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics


Medication cover:

Cobalt
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: R18408 R17820 R6564
Extended Fund: RM = R10,398
M1 = R12,635
M2 =R14,316
M3 =R17,442
M4+ =R19,567
R R
Chronic:
  • 13 additional conditions covered.
Acute (presrcibed) medication:
  • From day-to-day benefit
Over-the-counter:
  • From day-to-day benefit
Birth Control:
  • From day-to-day benefit
On Discharge:
  • 7 days
Biological:
  • No benefit
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

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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