A Comparison of Comprehensive Medical Aid Plans 2015

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:
Discov Classic Compr Discovery Classic Priority Resolution Supreme
Discov Classic Delta Compr Fedhealth Maxima Exec
 
 
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 44,000  
  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. 23 Chronic Disease Conditions  
     
     
     
     
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
  Limits per annum:  
  Member R 11,088  
  Member+Spouse R 21,576  
  Member+Spouse+Child1 R 23,784  
  Member+Spouse+Child2 R 25,992  
  Member+Spouse+Child3 R 28,200  
  Member+Child 1 R 13,296  
       
   Insured Network Benefit  
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 12,590  
  Spouse/Adult independant R 12,590  
  Per Child (Max 3) R 2,380  
     
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 3,696  
  Spouse/Adult dependant R 3,496  
  Per Child (Max 3) R 737  
     
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 44,000  
  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 7,428  
  Member+Spouse R 13,272  
  Member+Spouse+Child1 R 16,248  
  Member+Spouse+Child2 R 19.224  
  Member+Spouse+Child3 R 22,200  
  Member+Child 1 R 10,404  
       
  Insured Network Benefit  
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 10,980  
  Spouse/Adult dependant R 8,250  
  Per Child (Max 3) R 3,590  
       
       
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,478  
  Spouse/Adult dependant R 1,950  
  Per Child (Max 3) R 992  
       
RESOLUTION HEALTH
SUPREME
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
     
  Co-payments are due for certain  
  procedures (eg R3,370 Arthroscopy)  
  *7 days Take Home Medicine  
  Contracted Specialist paid 220%  
  Scheme rate  
  Emergency Casualty Annual   
   Limit: R1,430 per family  
     
  Annual Sub-limits per person:  
  Psychiatric Treatment R26,920  
  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 25 Chronic disease  
  conditions)  
     
  Annual Limit  
       
   Single R4,930  
   Family R9,850  
       
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
     
  Out of Hospital Annual Limit  
       
       
  Member R12,720  
  Member + Spouse R22,260  
  Member+ Spouse + 1 Child R23,590  
  Member+ Spouse+ 2 Child. R24,920  
  Member+ Spouse+ 3 Child. R26,280  
       
  Additional Out of Hospital Benefit  
  Principal Member R6,670  
  Member + 1 R11, 740  
  Family R12,750  
       
  ANNUAL THRESHOLD BENEFIT  
     
     
   Does not apply  
     
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 3,442  
  Spouse/Adult dependant R 3,305  
  Per Child (max 3) R 878  
       
.
 FEDHEALTH
MAXIMA EXEC
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
  Co-payments are due for certain  
  procedures(eg: R2,500 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 27,400
  Hospice Care R 26,500
  Oncology Unlimited
  Specialised Medication R148,000
  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 6,100  
  Per Family R 11,300  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
 
100% Scheme Rate
 
  Limits per annum:  
  Member R 7,882  
  Member + Spouse R 14,236  
  Member + Spouse + Child 1 R 15,728  
  Member + Spouse + Child 2 R 17,220  
  Member + Spouse + Child 3 R 18,712  
  Member + Child 1 R 9,374  
       
  Unlimited Network GP benefit    
       
       
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 9,520  
  Spouse/Adult dependant R 7,280  
  Per Child (Max 3) R 2,450  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 3,178  
  Spouse/Adult dependant R 2,708  
  Per Child R 948  
     
     
     
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 44,000  
  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. 23 Chronic Disease Conditions)  
  Only from MedXpress  
               
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
  Limits per annum:  
  Member R 9,984  
  Member+Spouse R 19,428  
  Member+Spouse+Child1 R 21,408  
  Member+Spouse+Child2 R 23,388  
  Member+Spouse+Child3 R 25,368  
  Member+Child 1 R 11,964  
       
   Insured Network Benefit  
       
       
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 12,590  
  Spouse/Adult independant R 12,590  
  Per Child (Max 3) R 2,380  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 3,329  
  Spouse/Adult dependant R 3,149  
  Per Child (Max 3) R 662  
       
       
       
 
  IN HOSPITAL BENEFIT  
     
     
     
     
     
     
       
       
       
       
       
       
       
       
       
       
               
  CHRONIC MEDICATION BENEFIT  
     
     
     
     
     
               
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
     
     
       
       
       
       
     
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
       
       
       
     
  MONTHLY CONTRIBUTIONS  
       
       
       
       
       
       

 

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.