A Comparison of Comprehensive Medical Aid Plans 2016

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:
Genesis
Private Comprehensive
FedHealth
Maxima Standard
Discovery
Classic Priority
Momentum Extender
Option 1
Resolution Health
Millenium

 FedHealth
Maxima Exec
Discov Classic Delta Compr Resolution Health
Supreme

Discovery
Classic Comprehensive

Momentum
Extender Option 2

 
 
 GENESIS
PRIVATE COMPREHENSIVE
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
     
     
     
  Annual Sub-limits:  
   Psychiatric Treatment: 3 days in  
    hospital, 18 days in registered  
    facility limited to R35,000  
    Hospice Care R550,000  
       (shared limit with Oncology)  
     Oncology        R550,000  
       (shared limit with Hospice Care)     
               
    Internal Prosthesis          R30,000  
               
  CHRONIC MEDICATION BENEFIT  
  100% Medicine Price  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary,  
               
               
               
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
 
 
 
  R2520 Savings per adult per annum  
     
  4 GP consultations per adult p/annum  
   limited to R350 per consultation  
   Basic Dentistry limited to R25,000  
    per annum per person  
  AND  
   MRI and CT scans (excl back/neck)  
   paid at 50% of actual cost up to  
     Scheme rate limited to R6,000 per  
     person per annum  
    Medication benefit R3600 per adult  
    per annum  
      
       
     
     
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
     
     
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,175  
  Spouse/Adult dependant R 2,175  
  1st Child R 350  
   /Each Additionah Child R 275  
FEDHEALTH
MAXIMA STANDARD
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Co-payments are due for certain  
  procedures(eg: R2,000 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 6,754  
  Member+ Spouse R 11,974  
  Member+ Spouse + Child 1 R 13,166  
  Member+ Spouse + Child 2 R 14,358  
  Member+ Spouse + Child 3 R 15,550  
  Member + Child 1 R 7,946  
       
  Unlimited Network GP benefit    
       
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Member R 10,000  
  Mem+Spouse/Adtdependant R7,680  
  Per Child (Max 3) R 2,580  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,693  
  Spouse/Adult dependant R 2,294  
  Per Child R 806  
       
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 48,000  
  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 8,100  
  Member+Spouse R 14,472  
  Member+Spouse+Child1 R 17,712  
  Member+Spouse+Child2 R 20,952  
  Member+Spouse+Child3 R 24,192  
  Member+Child 1 R 11,340  
       
   Insured Network Benefit  
       
       
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 11,960  
  Spouse/Adult independant R 8,990  
  Per Child (Max 3) R 3,910  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,700  
  Spouse/Adult dependant R 2,125  
  Per Child (Max 3) R 1,080  
       
.
MOMENTUM EXTENDER OPTION
  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 R30,700   
    Hospice Care (including R42,700  
     rehab & step-down    
      facilities)    
       
   Oncology R500,000    
     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 8,300 per family  
  Only from state hospital  
               
               
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
  Limits per annum:  
 
 
  Member R 9,912  
  Member+Spouse R 17,364  
  Member+Spouse+Child1 R 20,412  
  Member+Spouse+Child2 R 23,460  
  Member+Spouse+Child3 R 26,508  
  Member+Child 1 R 12,960  
       
    For more savings, please enquire  
   about the Health Saver  
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 14,900  
  Spouse/Adult dependant R 12,900  
  Per Child (Max 3) R 4,400  
     
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 3,303  
  Spouse/Adult dependant R 2,483  
  Per Child (Max 3) R 1,107  
       
     
RESOLUTION HEALTH
MILLENIUM
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
     
  Co-payments are due for certain  
  procedures (eg R3,539 Arthroscopy)  
  *7 days Take Home Medicine  
  *Contracted Specialists paid at  
   150% Scheme Rate  
     
  Annual Sub-limits per person:  
  Psychiatric Treatment R17 693  
  Hospice Care 18 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 7 Chronic disease  
  conditions)  
     
  Annual Limit  
       
   Single R2,499  
   Family R5,009  
       
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
     
  Limits per annum  
       
       
  Member R8,628  
  Member + Spouse R16,008  
  Member+ Spouse +Child 1 R18,012  
  Member+ Spouse +Child 2 R20,016  
  Member+ Spouse +Child 3 R20,016  
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
     
  Principal Member                  R11,791  
  Spouse/Adult dependant        R9,770  
  Per Child                              R2,579  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 3,592  
  Spouse/Adult dependant R 3,078  
  Per Child (max 3) R 838  
       
       
 FEDHEALTH
MAXIMA EXEC
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
  Co-payments are due for certain  
  procedures(eg: R2,000 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 28,900
  Hospice Care R 27,900
  Oncology R500,000
  Specialised Medication R156,000
  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 6,430  
  Per Family R 11,900  
               
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
 
100% Scheme Rate
 
  Limits per annum:  
  Member R 8,570  
  Member + Spouse R 15,470  
  Member + Spouse + Child 1 R 17,118  
  Member + Spouse + Child 2 R 18,766  
  Member + Spouse + Child 3 R 20,414  
  Member + Child 1 R 10,218  
       
  Unlimited Network GP benefit    
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Member R 10,000  
  Mem+Spouse/Adtdependant R 7,680  
  Per Child (Max 3) R 2,580  
     
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 3,639  
  Spouse/Adult dependant R 3,100  
  Per Child R 1,086  
       
       
 
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 48,000  
  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 R 10,872  
  Member + Spouse R 21,168  
  Member + Spouse + Child1 R 23,328  
  Member+Spouse+Child2 R 25,488  
  Member+Spouse+Child3 R 27,648  
  Member+Child 1 R 13,032  
       
   Insured Network Benefit    
     
     
     
     
     
     
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 13,840  
  Spouse/Adult independant R 13,840  
  Per Child (Max 3) R 2 ,260  
       
       
  MONTHLY CONTRIBUTIONS  
              
  Principal Member R 3,626  
  Spouse /Adult R 3,432  
  dependant    
  Per Child (Max 3) R721  
RESOLUTION HEALTH
SUPREME
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
     
  Co-payments are due for certain  
  procedures (eg R3,539 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 R28,266  
  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 R5,177  
   Family R10,343  
       
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
     
  Out of Hospital Annual Limit  
       
       
  Member R13,356  
  Member + Spouse R23,373  
  Member+ Spouse + 1 Child R24,770  
  Member+ Spouse+ 2 Child. R26,167  
  Member+ Spouse+ 3 Child. R27,564  
       
  Additional Out of Hospital Benefit  
  Principal Member R7,004  
  Member + 1 R12,327  
  Family R13,388  
       
  ANNUAL THRESHOLD BENEFIT  
     
     
   Does not apply  
     
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 3,907  
  Spouse/Adult dependant R 3,715  
  Per Child (max 3) R 966  
       
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
     
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 48,000  
  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 R12,072  
  Member + Spouse R23,496  
  Member + Spouse + Child1 R25,896  
  Member+Spouse+Child2 R28,296  
  Member+Spouse+Child3 R30,696  
  Member+Child 1 14,472  
       
   Insured Network Benefit    
     
     
     
     
     
     
  ANNUAL THRESHOLD BENEFIT  
  Principal Member  R 13,840  
  Spouse/Adult independant R 13,840  
  Per Child (Max 3) R 2 ,620  
       
       
  MONTHLY CONTRIBUTIONS  
  Principal Member R4,026  
  Spouse /Adult R 3,809  
  dependant    
  Per Child (Max 3) R 802  
       

 
MOMENTUM EXTENDER OPTION
  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 R30,700    
   Hospice Care (including R42,700   
      rehab & step-down    
       facilities)    
       
    Oncology R500,000    
     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 8, 300 per family  
     
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
  Limits per annum:  
 
 
  Member R 12,180  
  Member+Spouse R 21,900  
  Member+Spouse+Child1 R 25,728  
  Member+Spouse+Child2 R 29,556  
  Member+Spouse+Child3 R 33,384  
  Member+Child 1 R 16,008  
       
   For more savings, please enquire  
   about the Health Saver  
   
   
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 14,900  
  Spouse/Adult dependant R 12,900  
  Per Child (Max 3) R 4,400  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 4,061  
  Spouse/Adult dependant R 3,241  
  Per Child (Max 3) R 1,275  
     
 
 
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
       
       
               
               
   
 
 
 
 
 
     
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
     
       
       
       
     
     
       
       
     
     
 
 
     
     
     
     
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
               
               
     
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
     
       
       
     
     
     
       
       
       
       
       
     

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.