A Comparison of Comprehensive Medical Aid Plans 2012
Comprehensive Medical Aid plans have unlimited hospital cover and comprehensive day-to-day benefits. In new generation plans, initial claims will be funded from a medical savings account. Thereafter when all accumulated day-to-day claims reach a specified threshold, another risk benefit kicks in and continues to pay claims until the end of the year.
Traditional options have generous amounts of day-to-day cover for all the different medical providers except for GP's consultations and conservative dentistry where cover is generally unlimited and no benefits carry forward to the next year.
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IN HOSPITAL BENEFIT |
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200% Scheme Rate |
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No Overall Annual Limit |
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Co-payments apply for certain |
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procedures |
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*30 days Post Hospital Cover |
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*7 days Take Home Medicine |
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*Oral Contraceptives |
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*Emergency Trauma at Out Patients |
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Annual Sub-limits per person: |
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Oncology & Organ |
R 280,000 ea |
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Transplant |
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Renal Dialysis |
R 280,000 |
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Psychiatric Treatment |
R 17,250 |
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Internal Prosthesis: |
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See detailed benefits |
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CHRONIC MEDICATION BENEFIT |
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100% Medicine Price |
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27 PMB Chronic Disease Conditions |
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Add. 14 Chronic Disease Conditions |
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Annual limit: |
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Single |
R 3,870 |
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Per Family |
R 7,740 |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% NHRPL Rate |
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Limits per annum: |
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Member |
R 5,056 |
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Member +Spouse |
R 8,954 |
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Member +Spouse +Child 1 |
R 9,840 |
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Member +Spouse +Child 2 |
R 10,726 |
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Member +Spouse +Child 3 |
R 11,612 |
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Member +Child 1 |
R 5,924 |
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Unlimited GP Network |
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benefit |
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ANNUAL THRESHOLD BENEFIT |
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Principal Member |
R 8,800 |
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Spouse/Adult dependant |
R 6,700 |
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Per Child (Max 3) |
R 2,250 |
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MONTHLY CONTRIBUTIONS |
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Principal Me mber |
R 1,785 |
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Spouse/Adult dependant |
R 1,520 |
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Per Child |
R 535 |
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IN HOSPITAL BENEFIT |
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200% Scheme Rate |
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No Overall Annual Limit |
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Co-payments apply for certain |
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procedures |
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Annual Sub-limits per person: |
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Mental Health Benefit |
21 days |
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Terminal Care Benefit |
R 28,000 |
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Alcohol and Drug |
21 days |
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Rehabilitation |
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Internal Prostheses: |
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See detailed benefit schedule |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 MB Chronic Disease Conditions |
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Subject to scheme formulary |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% Scheme Rate |
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Limits per annum: |
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Member |
R 5,544 |
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Member+Spouse |
R 9,912 |
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Member+Spouse+Child1 |
R 12,132 |
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Member+Spouse+Child2 |
R 14.352 |
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Member+Spouse+Child3 |
R 16,572 |
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Member+Child 1 |
R 7,764 |
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Insured Network Benefit |
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ANNUAL THRESHOLD BENEFIT |
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Principal Member |
R 8,200 |
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Spouse/Adult dependant |
R 6,150 |
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Per Child (Max 3) |
R 2,690 |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 1,850 |
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Spouse/Adult dependant |
R 1,457 |
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Per Child (Max 3) |
R 740 |
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| RESOLUTION HEALTH |
| PRESTIGE PLAN |
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IN HOSPITAL BENEFIT |
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220% Scheme Rate |
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No Overall Annual Limit |
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*7 days Take Home Medicine |
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Co-payments apply for certain |
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procedures |
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Emergency Casualty Annual Limit: |
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R1,200 per family |
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Annual Sub-limits per person: |
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Prosthesis (subject to |
R50,000 |
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prosthesis sub-limits) |
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Hospice,Rehab & |
R29,500 |
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Step down |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 PMB Chronic Disease Conditions |
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Subject to scheme formulary |
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Non-PMB Annual Limit |
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Single |
R4,150 |
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Family |
R8,300 |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% NHRPL Rate |
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GP's: Unlimited at Network |
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provider |
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Specialists: |
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Member |
4 visits |
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Member + 1 |
5 visits |
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Family |
6 visits |
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Conservative & Specialist |
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Dentistry |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 2,083 |
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Spouse/Adult dependant |
R 2,026 |
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Per Child |
R 534 |
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IN HOSPITAL BENEFIT |
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100% Scheme Rate |
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No Overall Annual Limit |
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* 3 days Take Home Medicine |
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* Co-payments apply for certain |
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procedures |
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Annual Sub-limits: |
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Psychiatric Treatment |
R 16,000 |
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Hospice Care |
R 7,000 |
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Oncology |
R500,000 |
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CHRONIC MEDICATION BENEFIT |
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100% Medicine Price |
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27 PMB Chronic Disease Conditions |
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Only from Mediscor |
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Subject to scheme formulary. |
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(Add. 7 Chronic Disease Conditions) |
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ANNUAL DAY TO DAY BENEFIT |
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(including savings) |
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100% Scheme Rate |
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Benefits Booster (spec dentistry, |
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Psych, Screening) limits per annum |
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Member |
R 4,500 |
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Member + 1 |
R 5,625 |
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Member + 2 |
R 6,750 |
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Member + 3 |
R 7,875 |
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Member +4 + |
R 9,000 |
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My Saver: |
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limits per annum |
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Income pm: R0 - R11,500 |
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Member |
R5,064 |
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Member+Spouse |
R7,860 |
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Member+Spouse+Child 1 |
R9,384 |
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Member+Spouse+Child 2 |
R10,200 |
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Member+Spouse+Child 3 |
R10,716 |
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Income pm R11,501 - |
R14,700 |
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Member |
R5,328 |
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Member+Spouse |
R8,652 |
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Member+Spouse+Child 1 |
R10,380 |
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Member+Spouse+Child 2 |
R11,580 |
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Member+Spouse+Child 3 |
R12,384 |
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Income pm R14,701+ |
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Member |
R5,580 |
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Member+Spouse |
R9,492 |
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Member+Spouse+Child 1 |
R11,448 |
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Member+Spouse+Child 2 |
R13,128 |
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Member+Spouse+Child 3 |
R14,808 |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Income p/m |
R0 - R11,500 |
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Principal Member |
R 2,111 |
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Spouse/Adult dependant |
R 1,164 |
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1st Child |
R 636 |
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2nd Child |
R 339 |
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3rd Child |
R 213 |
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Income p/m R11,501-R14,700 |
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Principal Member |
R 2,218 |
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Spouse/Adult dependant |
R 1,386 |
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1st Child |
R 720 |
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2nd Child |
R 500 |
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3rd Child |
R 335 |
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Income p/m |
R14,701 + |
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Principal Member |
R 2,323 |
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Spouse/Adult dependant |
R 1,628 |
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1st Child |
R 815 |
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2nd Child |
R 699 |
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3rd Child + |
R 699 |
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IN HOSPITAL BENEFIT |
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200% Scheme Rate |
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No Overall Annual Limit |
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Co-payments apply for certain |
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procedures |
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*30 days Post Hospital Cover |
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*7 days Take Home Medicine |
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*Oral Contraceptives |
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*Emergency Trauma at Out Patients |
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Annual Sub-limits per person: |
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Oncology |
No Limit |
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Renal Dialysis & |
R 300,000 |
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Organ Transplant |
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Psychiatric Treatment |
R 22,000 |
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Specialised Medication |
R120,000 |
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Benefit |
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Internal Prosthesis: |
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See detailed benefits |
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CHRONIC MEDICATION BENEFIT |
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100% Medicine Price |
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27 PMB Chronic Disease Conditions |
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Add. 26 Chronic Disease Conditions |
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Annual limit: |
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Single |
R 4,900 |
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Per Family |
R 9,200 |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% NHRPL Rate |
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Limits per annum: |
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Member |
R 6,320 |
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Member +Spouse |
R 11,416 |
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Member +Spouse +Child 1 |
R 12,606 |
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Member +Spouse +Child 2 |
R 13,796 |
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Member +Spouse +Child 3 |
R 14,986 |
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Member +Child 1 |
R 7,510 |
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Unlimited GP Network |
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benefit |
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ANNUAL THRESHOLD BENEFIT |
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Principal Member |
R 8,800 |
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Spouse/Adult dependant |
R 6,700 |
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Per Child (Max 3) |
R 2,250 |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 2,130 |
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Spouse/Adult dependant |
R 1,815 |
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Per Child |
R 635 |
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IN HOSPITAL BENEFIT |
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200% Scheme Rate |
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No Overall Annual Limit |
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*7 days Take Home Medicine |
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*Co-payments apply for certain |
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procedures |
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Associated Hospitals to be used |
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(Life and Mediclinics) |
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Annual Sub-limits : |
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Surgical Appliances |
R 4,250 |
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(eg. support stockings) |
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Mental Health |
R 24,300 |
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Rehabilitation, Private |
R 33, 500 |
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nursing, Hospice and |
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step-down facilities |
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Oncology |
R465,000 |
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thereafter 20% co-pay |
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Internal Prostheses: |
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see detailed benefits |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 Chronic Disease Conditions |
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Subject to scheme formulary |
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36 additional conditions limited to |
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R 6, 600 per family |
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Only from state hospital |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% Scheme Rate |
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Limits per annum: |
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Member |
R 7,008 |
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Member+Spouse |
R 12,168 |
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Member+Spouse+Child1 |
R 14,364 |
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Member+Spouse+Child2 |
R 16,560 |
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Member+Spouse+Child3 |
R 18,756 |
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Member+Child 1 |
R 9,204 |
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For more savings, please enquire |
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about the Health Saver |
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ANNUAL THRESHOLD BENEFIT |
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Principal Member |
R 10,800 |
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Spouse/Adult dependant |
R 9,400 |
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Per Child (Max 3) |
R 3,000 |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 2,336 |
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Spouse/Adult dependant |
R 1,721 |
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Per Child (Max 3) |
R 733 |
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IN HOSPITAL BENEFIT |
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200% Scheme Rate |
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No Overall Annual Limit |
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Network Hospitals to be used |
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Annual Sub-limits per person: |
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Mental Health Benefit |
21 days |
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Terminal Care Benefit |
R 28,000 |
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Alcohol and Drug |
21 days |
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Rehabilitation |
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Internal Prostheses: |
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See detailed benefit schedule |
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Specialised medicine & technology |
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benefit up to R200,000 per person |
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per anuum |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 PMB Chronic Disease Conditions |
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Subject to scheme formulary |
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(Add. 33 Chronic Disease Conditions) |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% Scheme Rate |
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Limits per annum: |
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Member |
R 7,452 |
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Member+Spouse |
R 14,496 |
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Member+Spouse+Child1 |
R 15,972 |
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Member+Spouse+Child2 |
R 17,448 |
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Member+Spouse+Child3 |
R 18,924 |
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Member+Child 1 |
R 8,928 |
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Insured Network Benefit |
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ANNUAL THRESHOLD BENEFIT |
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Principal Member |
R 10,090 |
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Spouse/Adult independant |
R 10,090 |
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Per Child (Max 3) |
R 1,900 |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 2,485 |
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Spouse/Adult dependant |
R 2,350 |
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Per Child (Max 3) |
R 494 |
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IN HOSPITAL BENEFIT |
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200% Scheme Rate |
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No Overall Annual Limit |
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Co-payments apply for certain |
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procedures |
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Take home medicine limited to |
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R300 per admission |
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Annual Sub-limits per family: |
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Psychiatric treatment R35,000 |
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(subject to PMB) |
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Hospice Care R70,000 |
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Oncology R450,000 |
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Internal Prosthesis R38,000 |
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CHRONIC MEDICATION BENEFIT |
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100% Medicine Price |
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27 PMB Chronic Disease Conditions |
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Additopnal Disease list (co-payment |
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aply for certain procedures) |
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Annual limit: |
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Single |
R 10,500 |
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Family |
R 21, 000 |
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ANNUAL DAY TO DAY BENEFIT (including savings) |
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100% Scheme Rate |
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Member |
R 5 300 |
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Member + 1 |
R 7 500 |
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Member + 2 |
R 8 300 |
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Member + 3 |
R 9 100 |
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Member + 4+ |
R 9 900 |
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GP Benefit |
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Member |
13 visits |
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Member + 1 |
15 visits |
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Member + 2 |
17 visits |
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Member + 3 |
19 visits |
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Member + 4 |
21 visits |
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Member + 5+ |
23 visits |
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Optical benefits |
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Paid from the annual day to day |
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benefit |
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Single |
R2,100 |
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Per family |
R3,200 |
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1 eye test pp per annum |
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1 pair of spectacles pp per |
annum |
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Frame sub-limit R1,200 |
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Reader sub-limit |
R120 |
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ANNUAL THRESHOLD BENEFIT |
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does not apply |
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MONTHLY CONTRIBUTIONS |
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Member |
R 2,592 |
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Spouse/Adult dependant |
R 1,749 |
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Per Child |
R 501 |
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IN HOSPITAL BENEFIT |
|
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200% Scheme Rate |
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No Overall Annual Limit |
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*7 days Take Home Medicine |
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*Co-payments apply for certain |
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procedures |
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Associated Hospitals to be used |
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(Life and Mediclinics) |
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Annual Sub-limits : |
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Surgical Appliances |
R 4,250 |
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(eg. support stockings) |
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Mental Health |
R 24,300 |
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Rehabilitation, Private |
R 33, 500 |
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nursing, Hospice and |
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step-down facilities |
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Oncology |
R465,000 |
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thereafter 20% co-pay |
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Internal Prostheses: |
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see detailed benefits |
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CHRONIC MEDICATION BENEFIT |
|
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100% Scheme Rate |
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27 Chronic Disease Conditions |
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Subject to scheme formulary |
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36 additional conditions limited to |
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R 6, 600 per family |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
|
| |
100% Scheme Rate |
|
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Limits per annum: |
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|
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Member |
R 8,256 |
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Member+Spouse |
R 14,844 |
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Member+Spouse+Child1 |
R 17,346 |
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Member+Spouse+Child2 |
R 20,028 |
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Member+Spouse+Child3 |
R 22,620 |
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Member+Child 1 |
R 10,848 |
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For more savings, please enquire |
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about the Health Saver |
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ANNUAL THRESHOLD BENEFIT |
|
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Principal Member |
R 10,800 |
|
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Spouse/Adult dependant |
R 9,400 |
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Per Child (Max 3) |
R 3,000 |
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MONTHLY CONTRIBUTIONS |
|
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Principal Member |
R 2,751 |
|
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Spouse/Adult dependant |
R 2,196 |
|
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Per Child (Max 3) |
R 863 |
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IN HOSPITAL BENEFIT |
|
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200% Scheme Rate |
|
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No Overall Annual Limit |
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Annual Sub-limits per person: |
|
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Mental Health Benefit |
21 days |
|
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Terminal Care Benefit |
R 28,000 |
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Alcohol and Drug |
21 days |
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Rehabilitation |
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Internal Prostheses: |
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See detailed benefit schedule |
|
| |
Specialised medicine & technology |
|
| |
benefit up to R200,00 per person |
|
| |
per annum |
|
| |
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|
| |
CHRONIC MEDICATION BENEFIT |
|
| |
100% Scheme Rate |
|
| |
27 PMB Chronic Disease Conditions |
|
| |
Subject to scheme formulary |
|
| |
Add. 33 Chronic Disease Conditions |
|
| |
|
|
| |
|
|
|
|
|
|
|
|
| |
ANNUAL DAY TO DAY BENEFIT
(including savings) |
|
| |
100% Scheme Rate |
|
| |
Limits per annum: |
|
| |
Member |
R 8,280 |
|
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Member+Spouse |
R 16,104 |
|
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Member+Spouse+Child1 |
R 17,760 |
|
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Member+Spouse+Child2 |
R 19,416 |
|
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Member+Spouse+Child3 |
R 21,072 |
|
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Member+Child 1 |
R 9,936 |
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| |
|
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|
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Insured Network Benefit |
|
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ANNUAL THRESHOLD BENEFIT |
|
| |
Principal Member |
R 10,090 |
|
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Spouse/Adult independant |
R 10,090 |
|
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Per Child (Max 3) |
R 1,900 |
|
| |
|
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MONTHLY CONTRIBUTIONS |
|
| |
Principal Member |
R 2760 |
|
| |
Spouse/Adult dependant |
R 2,609 |
|
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Per Child (Max 3) |
R 552 |
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As additional Comprehensive Medical Aid Plans are made available we will continue to update this page in our effort to provide our clients with the most up to date information and advice on the medical aid industry in South Africa. If you are still deciding which plan type is best suited to your situation, why not take a look at the Medical Aid Plans page to see the full range of plans.
For more detailed information on any of the above plans, just click on the name of the relevant hospital plan in the tables above. If you already know what you want, why not make use of our site to download the relevant Medical Aid Application form and then fax it back to us on 0866 200 320 . Alternatively, if you would like us to confirm some of the finer details and pricing just fill in our Medical Aid Quote Request form and we will get back to you promptly.
Finally, we invite you to contact us on +27 21 712-8866 at any point in your decision making process for further information on these Comprhensive Medical Aid Plans. |
