Health Squared Rise medical aid plan: 2020

View all plans in this scheme.
Always consult with your broker before making final decisions regarding your healthcare cover.

Rise
Total Cost pm:

Main member:

R1,589

Adult:

R1,509

Child:

R548
Savings (per year):
  • No savings option on this plan

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IN HOSPITAL PROCEDURES:
Rise
Scheme Benefits: Notes and Links:
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 hospital, but a DSP (designated service provider) must be used for planned PMB procedures
Penalty for using other hospital:
  • 30% or minimum R7,000 if a non-DSP is used for planned PMB procedures
  • n/a
Specialised Radiology:
  • PMB only/strong>
Supplementary Services: (Physio, etc)
  • Physiotherapy: 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
Transplants:
  • PMB only
  • , in State facilities
Co-payments:
  • Cystoscopy, Excision nail bed, skin lesions, specialised radiology: R2,090 co-payment
  • Myringotomy: R2,612 co-payment
  • Circumcision, Vasectomy, colonoscopy, dental admissions: R3,135 co-payment
  • Arthroscopy: R4,000 co-payment
  • Endometrial ablation, laparoscopic procedures, urinary incontinence repair: R4,180 co-payment
  • Gatroscopy, Hernia repair: R5,225 co-payment
  • Nasal surgery, , varicose veins: R6,270 co-payment
  • Tonisllectomy, Adenoidectomy: R2,500
  • Rotator cuff surgery: R10,540 co-payment
  • Reflux surgery: R12,540 co-payment
Alternatives to hospitals:
  • Home nursing: authorisation required
  • Rehab and subacute facilities: in lieu of hospital care
Casualty:
  • PMB only/strong>
  • 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):
Rise
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:
  • From day-to-day benefit, unless PMB
  • See Primary Health Care benefit above
Childcare: 2020 benefits coming soon
Specialists consultations:
  • From day-to-day benefit, unless PMB
  • See Primary Health Care benefit above
Pathology:
  • From day-to-day benefit, unless PMB
  • See Primary Health Care benefit above
General radiology:
  • From day-to-day benefit, unless PMB
  • See Primary Health Care benefit above
Specialised radiology:
  • PMB only/strong>
Supplementary Services: (Physio, etc)
  • Physiotherapy: R2,592 per person

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MATERNITY BENEFITS:
Rise
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:
  • From day-to-day benefits
Scans:
  • 2 x 2D scans, paid by scheme

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CANCER (ONCOLOGY):
Rise
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • PMB only/strong>

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DENTISTRY:
Rise
Scheme Benefits Notes and Links:
Standard Dentistry:
  • No benefit
  • 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 benefit
In-Hospital Dentistry:
  • Impacted wisdom teeth and treatment for children under 5yrs
  • R3,135 co-payment
Orthodontics:
  • No benefit
Maxillo Facial Surgery: 2020 benefits coming soon

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MEDICATION:
Rise
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:
  • No benefit, unless PMB
  • Consider getting Primary Health Care (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
Over-the-counter:
  • No benefit
Birth Control:
  • No benefit
On Discharge:
  • 7 days supply
Biological:
  • PMB only/strong>

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OPTOMETRY:
Rise
Scheme Benefits: Notes and Links:
Optometry:
  • No benefit
  • Consider getting Primary Health Care (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

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

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OTHER BENEFITS:
Rise
Scheme Benefits Notes and Links:
General Appliances:
  • PMB only
1.1. Hearing Aids:
  • See above
1.2. Wheelchairs:
  • See above
Dialysis:
  • PMB only
International Insurance: 2020 benefits coming soon
Other:

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WELLNESS/PREVENTATIVE BENEFITS:
Rise
Scheme Benefits: Notes and Links:
Flu vaccination:
  • No benefit
Pneumonia vaccines:
  • No benefit
Biometric Screening:
  • No benefit
Child Immunisation:
  • No benefit
Pap Smear:
  • No benefit
Mammogram:
  • No benefit
PAS Test:
  • No benefit
HIV Test:
  • No benefit
Other:
  • No benefit

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PROSTHETICS:
Rise
Scheme Benefits: Notes and Links:
Overal Limit:
  • PMB 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