Health Squared Foundation A medical aid plan: 2020

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Always consult with your broker before making final decisions regarding your healthcare cover.

Foundation A
Total Cost pm:

Main member:

R1,553

Adult:

R1,553

Child:

R535
Savings (per year):
  • No savings option on this plan
Income band:

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IN HOSPITAL PROCEDURES:
Foundation A
Scheme Benefits: Notes and Links:
non-Network Specialists:
  • PMBs only
network Specialists:
  • PMBs only
non-Network GPs:
  • PMBs only
network GPs:
  • PMBs only
Hospital Choice:
  • Choose Network (DSP) hospital
Penalty for using other hospital:
  • 30% or minimum R7,000 if a non-DSP is used for planned PMB procedures
  • n/a
Specialised Radiology:
  • PMBs only
Supplementary Services: (Physio, etc)
  • PMBs only
  • The Blue Plan gap cover will increase this to 500% scheme rate
Transplants:
  • PMBs only
Co-payments: (To be confirmed)
Alternatives to hospitals:
  • Home nursing: authorisation required
Casualty:
  • PMB: Paid by scheme
  • Both the Blue Plan and Red Plan gap cover will pay up to R10,000 per person for unpaid casualty costs in event of emergency
Other: 2020 benefits coming soon
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R165,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R165,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)

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All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Foundation A
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
General info:
  • Consider getting Primary Health Care (PHC) (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
GP consultations:
  • Unlimited, at DSP
  • 2 x consults, at non-DSP GP
  • See Primary Health Care benefit above
Childcare: 2020 benefits coming soon
Specialists consultations: To be confirmed
  • See Primary Health Care benefit above
Pathology:
  • PMBs only
  • See Primary Health Care benefit above
General radiology:
  • PMBs only
  • See Primary Health Care benefit above
Specialised radiology:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc)
  • No cover, unless PMB

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MATERNITY BENEFITS:
Foundation A
Scheme Benefits Notes and Links:
Hospital stay:
  • Elective C-section: R11,521 limit, unless pre-authorisation is obtained.
  • Otherwise, 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
Consultations:
  • 9 x consults, with GP or midwife
Scans:
  • 2 x 2D scans, paid by scheme

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CANCER (ONCOLOGY):
Foundation A
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • R88,772 per family, subject to specific protocols and formularies

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DENTISTRY:
Foundation A
Scheme Benefits Notes and Links:
Standard Dentistry:
  • M= R2,165 and M+ =R3,606
  • Consider getting Primary Health Care (medical insurance) that will cover you for a lot of out of hospital claims, including standard dentistry like scaling, polishing, fillings, extractions, root canals and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
Specialised Dentistry:
  • No cover, unless PMB
In-Hospital Dentistry:
  • Impacted wisdom teeth and treatment for children under 5yrs: R5,065 per person
  • R3,135 co-payment
Orthodontics:
  • No benefit
Maxillo Facial Surgery: 2020 benefits coming soon

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MEDICATION:
Foundation A
Scheme Benefits: Notes and Links:
Chronic:
  • All medical aid plans pay for treatment of the 27 CDL conditions as required by law. This includes medicine as well as GP or specialist consults, tests etc. Find out more
Acute (presrcibed) medication:
  • As prescribed
Over-the-counter:
  • No benefit
Birth Control:
  • No benefit
On Discharge:
  • 7 days supply
Biological:
  • PMB only

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OPTOMETRY:
Foundation A
Scheme Benefits: Notes and Links:
Optometry:
Limit:Paid by scheme, once every 2 years
Consult:1 per person
Frames:1 per person, incl lenses
Single lensesR1,211 per person (incl frame and consult)
Bifocals:R1,843 (incl frame and consult)
Multifocals
ContactsOption of contacts or glasses
Refractive Surgery:n/a
Notes:From network providers

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MENTAL HEALTH:
Foundation A
Scheme Benefits Notes and Links:
In-hospital:
  • PMB only
Out-of-hospital:
  • No benefit, unless PMB
Trauma: 2020 benefits coming soon

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OTHER BENEFITS:
Foundation A
Scheme Benefits Notes and Links:
General Appliances:
  • R2,156 per family, with sublimits
1.1. Hearing Aids:
  • See above
1.2. Wheelchairs:
  • See above
Dialysis:
  • PMB only
International Insurance: 2020 benefits coming soon
Other: 2020 benefits coming soon

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WELLNESS/PREVENTATIVE BENEFITS:
Foundation A
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered, subject to
Pneumonia vaccines: 2020 benefits coming soon
Biometric Screening:
  • Covered, subject to
Child Immunisation:
  • Covered, subject to
Pap Smear:
  • Covered, subject to
Mammogram: 2020 benefits coming soon
PAS Test:
  • Covered, subject to
HIV Test:
  • Covered, subject to
Other: 2020 benefits coming soon

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PROSTHETICS:
Foundation A
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal prosthetic limit: R41,350, PMBs only
Sub-limits:
  • Speak to us about specific sub-limits

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    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