Health Squared Flex: 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 Flex.

Pricing:

Flex
Main member: Adult member: Child member:
Total Cost pm: R3,106 R2,790 R966
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.
Extended Fund: RM = R2,675
M1+ = R3,394
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:

Flex
non-Network Specialists:
  • 100% scheme rate
network Specialists:
  • Full cost
non-Network GPs:
  • 100% scheme rate
network GPs:
  • Full cost
Hospital Choice:
  • Use the network hospitals
Penalty for using other hospital:
  • 30% co-payment
Specialised Radiology:
    MRI, CT scans:
  • R11,133 per family with a R3,612 co-payment, for non-PMBs
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
  • R132,733 per family, for non-PMB
Dialysis:
  • PMBs only
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
  • Tonsillectomy, Adenoidectomy: R3,000
  • Myringotomy: R3,134
  • Circumcision, Vasectomy, Colonoscopy, Dental admissions: R3,762
  • Arthroscopy: R4,800
  • Endometrial ablation, Laparoscopic Procedures, Urinary Incontinence Repair: R8,660
  • Nasal Surgery (including Endoscopy), Varicose veins: R7,524
  • Gastroscopy, Hernia Repair: R7,524
  • Conservative back: R7,524
  • Hysteroscopy, Hysterectomy: R10,032
  • Rotator Cuff Surgery, Reflux: R15,048
  • Joint replacement, Spinal Surgery: 25%
  • No co-payments for procedures performed in a day-hospital, except for specialised radiology
Alternatives to hospitals:
  • Hospice: 12 days per family
  • Home nursing: 5 days per family for non-PMB
  • Rehab and sub-acute: 12 days per family
Casualty:
  • R1,879 per family
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:

Flex
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
Extended Fund: RM = R2,675
M1+ = R3,394
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:
  • M: 6 visits
  • M+1: 10 visits
  • M+2+: 13 visits
Childcare:
  • From day-to-day benefit
Specialists consultations:
  • M: 2 visits
  • M+1: 3 visits
  • M+2+: 3 visits
Pathology:
  • No benefit
General radiology:
  • No benefit
Specialised radiology:
  • No benefit
Supplementary Services: (Physio, etc)
  • From day-to-day benefit
General Appliances:
  • External: R4,595 per family, with various sublimits
1.1. Hearing Aids:
  • See "General Appliances" limit
  • Every 3 years
1.2. Wheelchairs:
  • See "General Appliances" limit
  • Every 3 years
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:

Flex
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
Extended Fund: RM = R2,675
M1+ = R3,394
R R
Chronic:
  • 5 additional conditions covered.
Acute (presrcibed) medication:
  • From day-to-day benefit
Over-the-counter:
  • R678 per person and R1,025 per family
  • From day-to-day benefit
Birth Control:
  • R2,999 for all wellness benefits
  • Further sublimit of R1,776 per year (R148pm)
  • Covered, as part of above limits
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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