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Hosmed Plus: in-and-out of hospital benefits (2021)

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This page shows the In-hospital, Out-of-hospital and Medicine benefits for Hosmed Plus.

Pricing:

Plus
Main member: Adult member: Child member:
Total Cost pm: R5,642 R4,693 R1052
Above Threshold:
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 other benefits:
Inhospital | 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 Hosmed plans, with costs and brief summary

In-hospital Procedures:

Plus
non-Network Specialists:
  • 200% scheme rate
network Specialists:
  • 200% scheme rate
non-Network GPs:
  • 200% scheme rate
network GPs:
  • 200% scheme rate
Hospital Choice:
  • Choose any hospital
Penalty for using other hospital:
  • n/a
Specialised Radiology:
  • 2 scans, with a 10% co-payment, unless PMB.
Supplementary Services: (Physio, etc) .
Transplants:
  • 100% scheme rate
Dialysis:
  • 100% scheme rate, in and out of hospital
Day Hospitals: These are covered at Day hospitals:
  • Umbilical and Inguinal hernia repair
  • Colonoscopy
  • Cystoscopy
  • Gastroscopy and Oesophagoscopy
  • Hysteroscopy
  • Grommets
  • Termination of pregnancy
  • Breast biopsy
  • Cataracts
  • Circumcision
  • ERCP
  • Haemorrhoidectomy
  • Vasectomy
  • Tubal Ligation
  • Excision of extensive skin lesions or repair of wounds and skin grafts
  • Dental procedures
  • Repair nail bed & Removal of toenails
  • Minor orthopaedic procedures such as tennis elbow, dupuytren’s contracture, trigger finger, ganglion, carpal tunnel syndrome Minor Gynaecological procedures – cone biopsy, colposcopy, D&C
  • Co-payments:
    • Specialised radiology: 10% co-payment
    • Laparoscopic hospitalisation: R7,500
    • Back and Neck surgery: R5,000 co-payment, unless PMB
    Alternatives to hospitals:
    • Alternatives to hospitalisation/ rehabilitation/ step down: 14 days per person
    • Private nursing: 14 days
    Casualty:
    • From day-to-day benefit
    Other:
    • Pathology and radiology: R5,425 per person, in and out of hospital
    • Sterilisation/Vasectomy/Tubal Ligation: R16,000 per person
    • Stereotactic Radio-surgery: Primary central nervous system tumours only
    • Hyberabic Oxygen Therapy: R49,420 per family
    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.
    View other benefits:
    Inhospital | 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 Hosmed plans, with costs and brief summary

    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.



    Out-of-hospital Procedures:

    Plus
    Summary of day-to-day benefits:
    Main Member: Adult: Child:
    Above Threshold:
    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:
    • 16 visits per person and 26 visits per family
    • 30% co-payment after 10th visit per person
    Childcare:
    • Immunisations, up to 12months
    Specialists consultations:
    • M = 5 visits
    • M +1 = 7 visits
    • M 2+ = 9 visits
    Pathology:
    • R5,100 per person
    • Combined limit of R5,425 for pathology and radiology
    General radiology:
    • R3,750 per person
    • Combined limit of R5,425 for pathology and radiology
    Specialised radiology: .
    Supplementary Services: (Physio, etc)
    • Alternative services: R4,080 per family
    • Remedial and other therapies : R5,170 per family
    • Physio: R2,730 per person and R4,370 per family
    General Appliances:
    • Out of hospital: R14,470 per family
    • Blood pressure monitors: R550 for people with hypertension
    • Stoma Care: R7,580 per family, subject to above limit
    1.1. Hearing Aids:
    • 1 claim per person every 24 months
    1.2. Wheelchairs:
    • 1 claim per person every 36 months
    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
    View other benefits:
    Inhospital | 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 Hosmed plans, with costs and brief summary

    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 cover:

    Plus
    Summary of day-to-day benefits:
    Main Member: Adult: Child:
    Above Threshold:
    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
    • Other chronic medicines: R14,683 per person and R28,083 per family
    Acute (presrcibed) medication:
    • R9,025 per person and R15,350 per family
    • 30% co-payment after R9,920 per family
    Over-the-counter:
    • R3,210 per family
    • R230 per script
    Birth Control:
    • R1,680 per family
    On Discharge:
    • 7 days
    Biological: .
    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 other benefits:
    Inhospital | 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 Hosmed plans, with costs and brief summary

    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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