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A Comparison of Comprehensive Medical Aid Plans 2013

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.
 
Comprehensive
Plans:		 FedHealth Maxima Standard Discovery Classic Priority Resolution Millenium
Spectramed Spectra Azure FedHealth Maxima Exec Momentum Extender Opt 1
Disc. Classic Delta Compr. Medshield MediBonus Momentum Extender Opt 2
Discovery Classic Compr.  Resolution Supreme  
 
FEDHEALTH
MAXIMA STANDARD
  IN HOSPITAL BENEFIT  
  100% Non Network  
  200% Network Partners  
  No Overall Annual Limit  
  Co-payments are due for certain  
  procedures(eg: R1,800 Arthroscopy)  
  *30 days Post Hospital Cover  
  *7 days Take Home Medicine  
  Oral Contraceptives  
  *Emergency Trauma at Out Patients  
  Annual Sub-limits per person:  
  Psychiatric Treatment R 19,200  
  Hospice Care R 14,500  
  Oncology(Only at DSP) R 424,000  
  Internal Prosthesis:    
  See detailed benefits    
       
  CHRONIC MEDICATION BENEFIT  
  100% Medicine Price  
  27 PMB Chronic Disease Conditions  
  Additional 14 Chronic Disease Conditions  
  Annual limit:  
  Single R 4,340  
  Per Family R 8,630  
               
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)		  
 
100% Scheme Rate
  
  Limits  per annum:  
  Member R 5,620  
  Member+ Spouse R 9,958  
  Member+ Spouse + Child 1 R 10,943  
  Member+ Spouse + Child 2 R 11,928  
  Member+ Spouse + Child 3 R 12,913  
  Member + Child 1 R 6,605  
       
  Unlimited Network GP benefit    
       
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 8,500  
  Spouse/Adult dependant R 6,500  
  Per Child (Max 3) R 2,200  
     
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,055  
  Spouse/Adult dependant R 1,751  
  Per Child R 616  
     
     
     
     
     
     
     
     
     
DISCOVERY HEALTH
CLASSIC PRIORITY
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
  Co-payments apply for certain  
  procedures  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 31,000  
  Oncology R200 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit schedule  
               
               
               
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 MB Chronic Disease Conditions  
  Subject to scheme formulary  
     
     
     
     
     
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)		  
  100% Scheme Rate  
  Limits per annum:  
  Member R 6,204  
  Member+Spouse R 11,088  
  Member+Spouse+Child1 R 13,572  
  Member+Spouse+Child2 R 16.065  
  Member+Spouse+Child3 R 18,540  
  Member+Child 1 R 8,688  
       
  Insured Network Benefit  
       
       
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 9,170  
  Spouse/Adult dependant R 6,890  
  Per Child (Max 3) R 3,000  
       
       
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,069  
  Spouse/Adult dependant R 1,629  
  Per Child (Max 3) R 828  
       
       
       
       
       
       
       
       
       
RESOLUTION HEALTH
MILLENIUM
  IN HOSPITAL BENEFIT  
  150% Scheme Rate  
  No Overall Annual Limit  
     
  Co-payments are due for certain  
 
procedures (eg R3,000 Arthroscopy)
 
  *7 days Take Home Medicine  
     
  Annual Sub-limits per person:  
  Psychiatric Treatment R15,000  
  Hospice Care 18 days  
  Oncology (subject to ICON R200,000  
   network & scheme    
   protocols    
    Internal Prosthesis    
     (see detailed benefits)    
       
  CHRONIC MEDICATION BENEFIT  
  100% Medicine Price  
  27 PMB Chronic Disease Conditions  
  (Additional 4 Chronic disease  
  conditions)  
     
  Annual Limit  
       
   Single R2,120  
   Family R4,240  
       
  ANNUAL DAY TO DAY BENEFIT
(including savings)		  
  100% Scheme Rate  
     
  Limits per annum  
       
       
   Member R6,048  
  Member + Spouse R11,004  
  Member+ Spouse +Child 1 R12,456  
  Member+ Spouse +Child 2 R13,908  
  Member+ Spouse +Child 3 R15,360  
       
       
  ANNUAL THRESHOLD BENEFIT  
     
  Principal Member                   R8,560  
  Spouse/Adult dependant        R6,860  
  Per Child                              R1,910  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,518  
  Spouse/Adult dependant R 2,065  
  Per Child (max 3) R 604  
               
       
       
       
       
       
       
       
       
 
SPECTRAMED
SPECTRA AZURE
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  * 3 days Take Home Medicine  
  * Co-payments apply for certain  
  procedures  
     
  Annual Sub-limits:  
  Psychiatric Treatment R 16,800  
  Hospice Care R 7,350  
  Oncology R500,000  
     
     
       
       
       
       
       
       
       
  CHRONIC MEDICATION BENEFIT  
  100% Medicine Price  
  27 PMB Chronic Disease Conditions  
  Only from Optipharm  
  Subject to scheme formulary.  
  (Add. 7 Chronic Disease Conditions)  
       
       
       
  ANNUAL DAY TO DAY BENEFIT  
  (including savings)  
  100% Scheme Rate  
     
  Benefits Booster (spec dentistry,  
  Psych, Screening) limits per annum  
  Member R 4,725  
  Member + 1 R 5,900  
  Member + 2 R 7,080  
  Member + 3 R 8,270  
  Member +4 + R 9,400  
       
  My Saver:    
  limits per annum    
  Income pm:              R0 - R11,500  
  Member R5,544  
  Member+Spouse R8,604  
  Member+Spouse+Child 1 R10,272  
  Member+Spouse+Child 2 R11,160  
  Member+Spouse+Child 3 R11,724  
       
  Income pm   R11,501 - R14,700    
  Member R5,820  
  Member+Spouse R9,456  
  Member+Spouse+Child 1 R11,352  
  Member+Spouse+Child 2 R12,660  
  Member+Spouse+Child 3 R13,536  
       
  Income pm   R14,701+    
  Member R6,096  
  Member+Spouse R10,368  
  Member+Spouse+Child 1 R12,504  
  Member+Spouse+Child 2 R14,340  
  Member+Spouse+Child 3 R16,176  
               
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
     
     
               
  MONTHLY CONTRIBUTIONS  
  Income p/m R0 - R11,500  
  Principal Member R 2,309  
  Spouse/Adult dependant R 1,237  
  1st Child R 696  
  2nd Child R 371  
  3rd Child R 233  
       
  Income p/m       R11,501-R14,700  
  Principal Member R 2,426  
  Spouse/Adult dependant R 1,516  
  1st Child R 788  
  2nd Child R 547  
  3rd Child R 366  
       
  Income p/m R14,701 +  
  Principal Member R 2,541  
  Spouse/Adult dependant R 1,781  
  1st Child R 892  
  2nd Child R 765  
  3rd Child + R 765  
  3rd Child + R 699  
     
     
 FEDHEALTH
MAXIMA EXEC
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
  Co-payments are due for certain  
  procedures(eg: R1,800 Arthroscopy)  
  *30 days Post Hospital Cover  
  *7 days Take Home Medicine  
  Oral Contraceptives  
  *Emergency Trauma at Out Patients  
  Annual Sub-limits per person:  
  Psychiatric Treatment R 24,500
  Hospice Care R 14,500
  Oncology Unlimited
  Specialised Medication R132,500
  Benefit  
  Internal Prosthesis:  
  See detailed benefits  
     
     
     
  CHRONIC MEDICATION BENEFIT  
  100% Medicine Price  
  27 PMB Chronic Disease Conditions  
  Additional 26 Chronic Disease Conditions  
  Annual limit:  
  Single R 5,450  
  Per Family R 10,200  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)		  
 
100% Scheme Rate
  
  Limits per annum:  
  Member R 7,042  
  Member + Spouse R 12,712  
  Member + Spouse + Child 1 R 14,037  
  Member + Spouse + Child 2 R 15,362  
  Member + Spouse + Child 3 R 16,687  
  Member + Child 1 R 8,367  
       
  Unlimited Network GP benefit    
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 8,500  
  Spouse/Adult dependant R 6,500  
  Per Child (Max 3) R 2,200  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,558  
  Spouse/Adult dependant R 2,179  
  Per Child R 763  
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
       
       
       
MOMENTUM EXTENDER OPTION
ASSOCIATED HOSPITAL & STATE FOR OUT-OF-HOSPITAL
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
  *7 days Take Home Medicine  
  *Co-payments apply for certain  
  procedures  
  Associated Hospitals to be used  
  (Life and Mediclinics)  
  Annual Sub-limits :  
       
    Psychiatric Treament R26,000   
    Hospice Care (including R36,000  
     rehab & step-down    
      facilities)    
       
   Oncology R480,000    
     thereafter 20% co-pay    
  Internal Prostheses:    
     see detailed benefits    
       
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 Chronic Disease Conditions  
  Subject to scheme formulary  
  36 additional conditions limited to  
  R 7,000 per family  
  Only from state hospital  
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)		  
  100% Scheme Rate  
  Limits per annum:  
 
 
  Member R 7,728  
  Member+Spouse R 13,428  
  Member+Spouse+Child1 R 15,852  
  Member+Spouse+Child2 R 18,276  
  Member+Spouse+Child3 R 20,700  
  Member+Child 1 R 10,152  
       
    For more savings, please enquire  
   about the Health Saver  
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 12,000  
  Spouse/Adult dependant R 10,500  
  Per Child (Max 3) R 3,300  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,577  
  Spouse/Adult dependant R 1,899  
  Per Child (Max 3) R 809  
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       

 

DISCOVERY HEALTH
CLASSIC DELTA COMPREHENSIVE
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
  Network Hospitals to be used  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 31,000  
  Oncology R400 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit schedule  
  Specialised medicine & technology  
   benefit R200,000  
     
     
     
     
     
     
     
     
  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 8,340  
  Member+Spouse R 16,224  
  Member+Spouse+Child1 R 17,880  
  Member+Spouse+Child2 R 19,536  
  Member+Spouse+Child3 R 21,192  
  Member+Child 1 R 9,996  
       
   Insured Network Benefit  
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 10,375  
  Spouse/Adult independant R 10,375  
  Per Child (Max 3) R 1,950  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,780  
  Spouse/Adult dependant R 2,629  
  Per Child (Max 3) R 553  
       
       
       
       
       
MEDSHIELD
MEDIBONUS
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
  Co-payments apply for certain  
  procedures  
  Take home medicine limited to  
  R300 per admission   
  Annual Sub-limits per family:  
     
  Psychiatric treatment     R35,000  
   (subject to PMB)  
  Hospice Care                R70,000  
  Oncology                      R450,000  
  Internal Prosthesis        R38,000  
     
       
       
       
       
       
       
  CHRONIC MEDICATION BENEFIT  
  100% Medicine Price  
  27 PMB Chronic Disease Conditions  
  subject to scheme formulary  
  Additional Disease list  
     
  Annual limit:  
  Single R 10,500  
  Family R 21, 000  
     
  ANNUAL DAY TO DAY BENEFIT (including savings)  
  100% Scheme Rate  
     
  Member R 5 600  
  Member + 1 R 7 900  
  Member + 2 R 8 750  
  Member + 3 R 9 600  
  Member + 4+ R 10 400  
       
   
  GP Benefit  
       
  Member 13 visits  
  Member + 1 15 visits  
  Member + 2 17 visits  
  Member + 3 19 visits  
  Member + 4 21 visits  
  Member + 5+ 23 visits  
       
       
       
  Optical benefits  
  Paid from the annual day to day  
   benefit  
     
    Single R2,200   
    Per family R3,350   
  1 eye test pp per annum    
  1 pair of spectacles pp per annum     
       
  Reader sub-limit R120  
       
       
  ANNUAL THRESHOLD BENEFIT  
       
  does not apply  
     
     
  MONTHLY CONTRIBUTIONS  
  Member R 2,787  
  Spouse/Adult dependant R 1,881  
  Per Child R 540  
       
       
       
       
     
MOMENTUM EXTENDER OPTION
ASSOCIATED HOSPITAL & ANY FOR OUT-OF-HOSPITAL
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
  *7 days Take Home Medicine  
  *Co-payments apply for certain  
  procedures  
  Associated Hospitals to be used  
  (Life and Mediclinics)  
  Annual Sub-limits :  
       
   Psychiatric Treament R26,000    
   Hospice Care (including R36,000   
      rehab & step-down    
       facilities)    
       
    Oncology R480,000    
     thereafter 20% co-pay    
   Internal Prostheses:    
      see detailed benefits    
       
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 Chronic Disease Conditions  
  Subject to scheme formulary  
  36 additional conditions limited to  
  R 7, 000 per family  
     
     
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)		  
  100% Scheme Rate  
  Limits per annum:  
 
 
  Member R 9,228  
  Member+Spouse R 16,596  
  Member+Spouse+Child1 R 19,488  
  Member+Spouse+Child2 R 22,380  
  Member+Spouse+Child3 R 25,272  
  Member+Child 1 R 12,120  
       
   For more savings, please enquire  
   about the Health Saver  
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 12,000  
  Spouse/Adult dependant R 10,500  
  Per Child (Max 3) R 3,300  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 3,077  
  Spouse/Adult dependant R 2,456  
  Per Child (Max 3) R 965  
       
     
     
     
     
 
DISCOVERY HEALTH
CLASSIC COMPREHENSIVE
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 31,000  
  Oncology R400 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit schedule  
  Specialised medicine & technology  
   benefit R200,00  
     
     
     
     
     
     
     
     
  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 9,252  
  Member+Spouse R 18,000  
  Member+Spouse+Child1 R 19,848  
  Member+Spouse+Child2 R 21,696  
  Member+Spouse+Child3 R 23,544  
  Member+Child 1 R 11,100  
       
   Insured Network Benefit  
       
       
       
       
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 10,375  
  Spouse/Adult independant R 10,375  
  Per Child (Max 3) R 1,950  
     
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 3,086  
  Spouse/Adult dependant R 2,918  
  Per Child (Max 3) R 616  
               
       
       
       
       
     
RESOLUTION HEALTH
SUPREME
  IN HOSPITAL BENEFIT  
  220% Scheme Rate  
  No Overall Annual Limit  
     
  Co-payments are due for certain  
 
procedures (eg R3,000 Arthroscopy)
 
  *7 days Take Home Medicine  
  Emergency Casualty Annual   
   Limit: R1,270 per family  
     
  Annual Sub-limits per person:  
  Psychiatric Treatment R24,000  
  Hospice Care 21 days  
  Oncology (subject to ICON Unlimited  
   network & scheme    
   protocols    
    Internal Prosthesis    
     (see detailed benefits)    
       
       
  CHRONIC MEDICATION BENEFIT  
  100% Medicine Price  
  27 PMB Chronic Disease Conditions  
  (Additional 24 Chronic disease  
  conditions)  
     
  Annual Limit  
       
   Single R4,400  
   Family R8,800  
       
  ANNUAL DAY TO DAY BENEFIT
(including savings)		  
  100% Scheme Rate  
     
  Out of Hospital Annual Limit  
       
       
   Member R12,000  
  Member + Spouse R21,000  
  Member+ Spouse + 1 Child R22,260  
  Member+ Spouse+ 2 Child. R23,520  
  Member+ Spouse+ 3 Child. R24,780  
       
       
       
       
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
     
     
   Does not apply  
     
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,712  
  Spouse/Adult dependant R 2,637  
  Per Child (max 3) R 694  
               
     
     
     
     
     
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