A Comparison of Comprehensive Medical Aid Plans 2018

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 Exec
Discovery Delta Comprehensive
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 23,900  
  Hospice Care R 29,500  
  Oncology(Only at DSP) R 423,200  
  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 5,410  
  Per Family R10,800  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
 
100% Scheme Rate
 
  Limits  per annum:  
  Member R 7,152  
  Member+ Spouse R 13,392  
  Member+ Spouse + Child 1 R 15,552  
  Member+ Spouse + Child 2 R 17,712  
  Member+ Spouse + Child 3 R 19,872  
  Member + Child 1 R 9,312  
  Member + Child 2 R 11,472  
  Member + Child 3 R 13,632   
       
  Unlimited Network GP benefit    
       
  ANNUAL THRESHOLD BENEFIT  
  Member R 12,320  
  Mem+Spouse/Adtdependant R 9,460  
  Per Child (Max 3) R 3,168  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 3,310  
  Spouse/Adult dependant R 2,890  
  Per Child R 998  
     
     
     
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 57,000  
  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  
     
     
     
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
    Limits per annum:  
  Member R 9,636  
  Member + Spouse R 17,232  
  Member + Spouse + Child1 R 21,084  
  Member+Spouse+Child2 R 24,936  
  Member+Spouse+Child3 R 28,788  
  Member+Child 1 R 13,488  
  Member+Child 2 R 17,340  
  Member+Child 3 R 21,192  
     
   Day-to-Day Extender Benefit  
     
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 14,240  
  Spouse/Adult independant R 10,670  
  Per Child (Max 3) R 4,660  
       
  MONTHLY CONTRIBUTIONS  
              
  Principal Member R 3,214  
  Spouse /Adult R 2,534  
  dependant    
  Per Child (Max 3) R1,286  
       
 FEDHEALTH
MAXIMA EXEC
  IN HOSPITAL BENEFIT  
  200% 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 30,500
  Hospice Care R 29,500
  Oncology R529,000
  Specialised Medication R165,000
  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 6,800  
  Per Family R 12,500  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
 
100% Scheme Rate
 
  Limits per annum:  
  Member R 9,672  
  Member + Spouse R 17,508  
  Member + Spouse + Child 1 R 19,460  
  Member + Spouse + Child 2 R 21,412  
  Member + Spouse + Child 3 R 23,364  
  Member + Child 1 R 11,624  
  Member + Child 2 R 13,576  
  Member + Child 3 R 15,528  
       
   Unlimited Network GP benefit    
       
  ANNUAL THRESHOLD BENEFIT  
  Member R 12,300  
  Mem+Spouse/Adtdependant R 9,460  
  Per Child (Max 3) R 3,168  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 4,805  
  Spouse/Adult dependant R 4,103  
  Per Child R 1,463  
     
     
     
.
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 57,000  
  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 MedXpress  
   (Add. 23 Chronic Disease Conditions)  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% scheme rate  
    Limits per annum:  
  Member R13,188  
  Member + Spouse R25,668  
  Member + Spouse + Child1 R28,284  
  Member+Spouse+Child2 R30,900  
  Member+Spouse+Child3 R33,516  
  Member+Child 1 R15,804  
  Member+Child 2 R18,420  
  Member+Child 3 R21,036  
       
  Day-to-Day Extender Benefit    
     
     
  ANNUAL THRESHOLD BENEFIT  
  Principal Member  R 16,790  
  Spouse/Adult independant R 16,790  
  Per Child (Max 3) R 3,200  
       
       
  MONTHLY CONTRIBUTIONS  
     
  Principal Member R 4,398  
  Spouse /Adult R 4,162  
  dependant    
  Per Child (Max 3) R 874  
       
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
     
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 57,000  
  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  
     
   (Add. 23 Chronic Disease Conditions)  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
   100% scheme rate  
   Limits per annum:  
   Member  R14,640  
   Member+Spouse  R28,488  
   Member+Spouse+Child1  R31,404  
   Member+Spouse+Child2  R34,320  
   Member+Spouse+Child3  R37,236  
   Member+Child1  R17,556  
   Member+Child2  R20,472  
   Member+Child3  R23,388  
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
     
 
Principal Member                 R16,790
 
  Spouse /Adult dependant     R16,790  
  Per Child (Max 3)                R3,200  
     
  MONTHLY CONTRIBUTIONS  
     
  Principal Member R 4,882  
  Spouse /Adult R 4,618  
  dependant    
  Per Child (Max 3) R 974  
       
 
 
     

 
     

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.