Hosmed Essential B medical aid plan: 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

Essential B
2018 Costs:
Total Cost pm:

Main member:

R

Adult:

R

Child:

R
2019 Costs:
Total Cost pm:

Main member:

R
(%)

Adult:

R

Child:

R
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In brief (2018): See full benefits below

IN HOSPITAL PROCEDURES:
Essential B
Scheme Benefits: Gap Benefits:
Specialists: 2018 benefits coming soon. 2017 benefits:
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice: 2018 benefits coming soon. 2017 benefits:
  • Netcare
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • 2 scans per person, in and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • 100% scheme rate
Transplants: 2018 benefits are coming soon!
Co-payments:
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Casualty: 2018 benefits coming soon. 2017 benefits:
  • See GP benefit, above
Other: 2018 benefits coming soon. 2017 benefits:
  • Pathology and radiology: R5,300 per person
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 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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Our quote will include the right gap cover for this plan

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):
Essential B
Scheme Benefits Gap benefits
Main: Adult: Child:
General info:
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • Network GP: Unlimited
Childcare:
  • No extra benefit available
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • Network: 3 consults per family
Pathology: 2018 benefits coming soon. 2017 benefits:
  • R740 per person
General radiology: 2018 benefits coming soon. 2017 benefits:
  • R740 per person
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • 2 scans per person
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB

No phone calls!
Our quote will include the right gap cover for this plan

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MATERNITY BENEFITS:
Essential B
Scheme Benefits Gap benefits
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • Natural Birth: 2 days
  • Caesar: 3 days
  • Home Births: R4,000 per pregnancy
Consultations: 2018 benefits coming soon. 2017 benefits:
  • Unlimited at Network GP
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2 x 2D scans

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Our quote will include the right gap cover for this plan

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CANCER (ONCOLOGY):
Essential B
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • PMB level of care

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Our quote will include the right gap cover for this plan

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DENTISTRY:
Essential B
Scheme Benefits Gap benefits
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry: paid by scheme
  • Specialised dentistry: 1 set acrylic/plastic dentures per person every 4 years
Orthodontics: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Maxillo Facial Surgery: 2018 benefits are coming soon!

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Our quote will include the right gap cover for this plan

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MEDICATION:
Essential B
Scheme Benefits Gap benefits
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMBs chronic: paid by scheme
Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • Unlimited if dispensed by network GP
  • R950 per person, and R2,650 per family if obtained from pharmacy
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • R210 per family, with a maximum of R80 per script
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • R55 per person, limited to R660 per family per year
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • 5 days
Biological:

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Our quote will include the right gap cover for this plan

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OPTOMETRY:
Essential B
Scheme Benefits Gap benefits
Optometry: 2018 benefits coming soon. 2017 benefits:
  • Benefit available every 24 months
  • Frames: R195 per person
  • Lens: R165 each; Bifocal/Multifocal: R360 each
  • Contact lenses: R525 per person

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Our quote will include the right gap cover for this plan

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MENTAL HEALTH:
Essential B
Scheme Benefits Gap benefits
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Trauma:

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Our quote will include the right gap cover for this plan

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OTHER BENEFITS:
Essential B
Scheme Benefits Gap benefits
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • R2,500 per family,PMBs only
  • No benefit
1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
  • See "General Appliances" limit
  • No benefit
1.2. Wheelchairs: 2018 benefits coming soon. 2017 benefits:
  • See "General Appliances" limit
  • No benefit
Dialysis: -
HIV: 2018 benefits coming soon. 2017 benefits:
  • 100% scheme rate
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
  • No benefit
Emergency Transport: Netcare911
  • No benefit
International Insurance: -
  • No benefit
Other: -

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Our quote will include the right gap cover for this plan

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WELLNESS/PREVENTATIVE BENEFITS:
Essential B
Scheme Benefits Gap benefits
Flu vaccination: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Pneumonia vaccines: 2018 benefits are coming soon!
  • No benefit
Back Rehabilitation Programme: 2018 benefits are coming soon!
  • No benefit
Biometric Screening: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Child Immunisation: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Pap Smear: 2018 benefits coming soon. 2017 benefits:
  • Covered, 18yrs+
  • No benefit
Mammogram: 2018 benefits coming soon. 2017 benefits:
  • Covered, 40yrs+ every two years
  • No benefit
PAS Test: 2018 benefits coming soon. 2017 benefits:
  • Covered, 40yrs+
  • No benefit
HIV Test: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Other: Colon Cancer blood test for 50yrs+
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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PROSTHETICS:
Essential B
Scheme Benefits Gap benefits
Overal Limit:
Sub-limits:

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Our quote will include the right gap cover for this plan


    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