A Comparison of Comprehensive Medical Aid Plans 2017

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 FedHealth Maxima Standard
Discovery Classic Delta
Discovery Classic Comprehensive





 
 
FEDHEALTH
MAXIMA STANDARD
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Co-payments are due for certain  
  procedures(eg: R2,100 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 22,600  
  Hospice Care R 27,900  
  Oncology(Only at DSP) R 400,000  
  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 5,120  
  Per Family R10,200  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
 
100% Scheme Rate
 
  Limits  per annum:  
  Member R 6,768  
  Member+ Spouse R 12,348  
  Member+ Spouse + Child 1 R 14,304  
  Member+ Spouse + Child 2 R 16,260  
  Member+ Spouse + Child 3 R 18,216  
  Member + Child 1 R 8,724  
       
       
  Unlimited Network GP benefit    
       
  ANNUAL THRESHOLD BENEFIT  
  Member R 11,200  
  Mem+Spouse/Adtdependant R8,600  
  Per Child (Max 3) R 2,880  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 3,032  
  Spouse/Adult dependant R 2,583  
  Per Child R 907  
     
     
     
DISCOVERY HEALTH
  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 52,750  
  Oncology R200,000 thereafter 20%  
   co-payment  
     
     
  Internal Prostheses: See detailed  
   benefit schedule  
               
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions          
  Subject to scheme formulary  
   Only from a Network Pharmacy  
               
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
    Limits per annum:  
  Member R 8,904  
  Member + Spouse R 15,912  
  Member + Spouse + Child1 R 19,464  
  Member+Spouse+Child2 R 23,016  
  Member+Spouse+Child3 R 26,568  
  Member+Child 1 R 12,456  
       
   Insured Network Benefit    
     
     
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 13,150  
  Spouse/Adult independant R 9,850  
  Per Child (Max 3) R 4,300  
       
  MONTHLY CONTRIBUTIONS  
              
  Principal Member R 2,968  
  Spouse /Adult R 2,337  
  dependant    
  Per Child (Max 3) R1,187  
       
FEDHEALTH
MAXIMA STANDARD
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Co-payments are due for certain  
  procedures(eg: R2,100 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 22,600  
  Hospice Care R 27,900  
  Oncology(Only at DSP) R 400,000  
  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 5,120  
  Per Family R10,200  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
 
100% Scheme Rate
 
  Limits  per annum:  
  Member R 6,768  
  Member+ Spouse R 12,348  
  Member+ Spouse + Child 1 R 14,304  
  Member+ Spouse + Child 2 R 16,260  
  Member+ Spouse + Child 3 R 18,216  
  Member + Child 1 R 8,724  
       
       
  Unlimited Network GP benefit    
       
  ANNUAL THRESHOLD BENEFIT  
  Member R 11,200  
  Mem+Spouse/Adtdependant R8,600  
  Per Child (Max 3) R 2,880  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 3,032  
  Spouse/Adult dependant R 2,583  
  Per Child R 907  
     
     
     
.
DISCOVERY HEALTH
  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 52,750  
  Oncology R400,000 thereafter 20%  
    co-payment  
   Specialised Medicine & Technology      
    benefit: R200,000  
   Internal Prostheses: See detailed  
    benefit schedule  
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
   Only from a Network Pharmacy  
   (Add. 23 Chronic Disease Conditions)  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% scheme rate  
    Limits per annum:  
  Member R12,168  
  Member + Spouse R23,688  
  Member + Spouse + Child1 R26,100  
  Member+Spouse+Child2 R28,512  
  Member+Spouse+Child3 R30,924  
  Member+Child 1 R14,580  
       
   Insured Network Benefit    
     
     
  ANNUAL THRESHOLD BENEFIT  
  Principal Member  R 15,500  
  Spouse/Adult independant R 15,500  
  Per Child (Max 3) R 2 ,950  
       
       
  MONTHLY CONTRIBUTIONS  
     
  Principal Member R 4,059  
  Spouse /Adult R 3,842  
  dependant    
  Per Child (Max 3) R 807  
       
     
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
     
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 52,750  
  Oncology R400,000 thereafter 20%  
   co-payment    
   Specialised Medicine & Technology       
    benefit R200,000  
               
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
   Only from a Network Pharmacy  
   (Add. 23 Chronic Disease Conditions)  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
     
   Member  R13,512  
   Member+Spouse  R26,304  
   Member+Spouse+Child1  R28,992  
   Member+Spouse+Child2  R31,680  
   Member+Spouse+Child3  R34,368  
   Member+Child1  R16,200  
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
     
 
Principal Member                R15,500
 
  Spouse /Adult dependant  R15,500  
  Per Child (Max 3)                R2,950  
     
  MONTHLY CONTRIBUTIONS  
     
  Principal Member R 4,506  
  Spouse /Adult R 4,264  
  dependant    
  Per Child (Max 3) R 898  
       
       
 
 
     

 
     

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.