A Comparison of Hospital Plans
A Hospital Plan will cover all the services provided in a hospital including the anesthetist and surgeon. You would have to be admitted to a hospital, out patients and trauma units are generally not considered a hospital event if you are not admitted.
The anesthetist and surgeon charge separately and have the choice of charging anywhere between NRPL (National Reference Price List) and Private Rates, which are generally three times higher than the NRPL Rate. Some plans pay at NRPL Rate and some at Private Rates. Hospitals normally have an agreed tariff with the medical aids and if this is the case, the hospital and related bills will be paid in full.
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IN HOSPITAL BENEFIT |
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100% MSR |
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No Overall Annual Limit |
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Network Hospitals to be used |
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Annual Sub-limits per person: |
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Mental Health Benefit |
21 days |
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Terminal Care Benefit |
R 16,950 |
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Alcohol and Drug |
21 days |
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Rehabilitation |
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CHRONIC MEDICATION BENEFIT |
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100% MSR |
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27 PMB Chronic Disease Conditions |
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Subject to scheme formulary |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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Does not apply |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Income p/m: |
R0 - R6,000 |
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Principal Member |
R 396 |
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Spouse /Adult |
R 396 |
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dependant |
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Per Child (Max 3) |
R99 |
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Income p/m: |
R6,001 - R8,000 |
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Principal Member |
R 492 |
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Spouse /Adult |
R 492 |
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dependant |
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Per Child (Max 3) |
R 123 |
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Income p/m: |
R8,001+ |
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Principal Member |
R 761 |
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Spouse /Adult |
R 761 |
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dependant |
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Per Child (Max 3) |
R 171 |
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| RESOLUTION HEALTH |
| HOSPITAL |
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IN HOSPITAL BENEFIT |
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100% NHRPL rate |
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No Overall Annual Limit |
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*7 days Take Home Medicine |
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Co-payments apply for certain |
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procedures |
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Emergency Ward treatment which |
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does not result in hospitalisation |
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R1,050 |
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Annual Sub-limits per person: |
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Post hospitalisation: |
R15,750 |
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Rehabilitation, Step-down |
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and terminal care |
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International travel 90 days |
R5 million |
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per trip |
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Removal of impacted |
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wisdom teeth in hospital |
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paid from risk,excl dental |
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practitioner's fee |
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CHRONIC MEDICATION BENEFIT |
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100% MSR |
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27 PMB Chronic Disease Conditions |
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Subject to Hospital formulary |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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Preventative Care Benefits to the |
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value of R2,600 |
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See detailed list: |
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Maternity: Out of hospital |
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3 Gynae Consultations |
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2 2D scans |
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R500 Ante-Natal classes once |
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registered on ResoBaby |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 753 |
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Spouse/Adult dependant |
R 556 |
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Per Child |
R 174 |
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IN HOSPITAL BENEFIT |
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100% MSR |
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No Overall Annual Limit |
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Annual Sub-limits per person: |
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Mental Health Benefit |
21 days |
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Terminal Care Benefit |
R 23,400 |
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Alcohol and Drug |
21 days |
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Rehabilitation |
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Internal Prostheses: |
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See detailed benefit schedule |
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Designed for members in coastal |
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provinces using a Network of |
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Coastal Hospitals |
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CHRONIC MEDICATION BENEFIT |
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100% MSR |
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27 PMB Chronic Disease Conditions |
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Subject to scheme formulary |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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No Benefit |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 759 |
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Spouse/Adult dependant |
R 569 |
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Per Child (Max 3) |
R 303 |
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IN HOSPITAL BENEFIT |
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200% NHRPL rate |
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No Overall Annual Limit |
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Co-payments apply for certain |
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procedures |
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*30 days Post Hospital Cover |
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*7 days Take Home Medicine |
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*Emergency Trauma at Out Patients |
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Annual Sub-limits per person: |
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Oncology & Organ |
R 162 750 |
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Transplant |
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Renal Dialysis |
R 195,300 |
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Psychiatric Treatment |
R 17,250 |
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Specialised Medication |
R 120,000 |
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Benefit |
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Internal Prosthesis: |
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See detailed benefits |
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CHRONIC MEDICATION BENEFIT |
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100% Medicine Price |
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27 PMB Chronic Disease Conditions |
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Annual limit: |
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Single |
R 1,207 |
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Family |
R 2,415 |
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ANNUAL DAY TO DAY BENEFIT (including savings) |
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100% NHRPL Rate |
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Limits per annum: |
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Member |
R 180 |
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Member +Spouse |
R 248 |
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Member +Spouse +Child 1 |
R 408 |
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Member +Spouse +Child 2 |
R 468 |
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Member +Spouse +Child 3 |
R 528 |
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Member +Child 1 |
R 240 |
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ANNUAL THRESHOLD BENEFIT |
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Member |
R 7,720 |
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Spouse/Adult dependant |
R 5,900 |
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Per Child (Max 3) |
R 2,050 |
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MONTHLY CONTRIBUTIONS |
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Member |
R 1,029 |
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Spouse/Adult dependant |
R 876 |
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Per Child |
R 360 |
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IN HOSPITAL BENEFIT |
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Private Provider Rates |
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No overall Annual limit |
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Advanced Network Hospitals |
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to be used |
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Co-payments apply for certain |
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procedures |
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Annual Sub-limits per person: |
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Rehabilitation Benefit |
R 45,000 |
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Jaw Surgery |
R 15,000 |
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Wisdom Teeth Removal |
R 5,500 |
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Oncology Medicines |
R200,000 |
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Internal Prostheses: |
R 27,000 |
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CHRONIC MEDICATION BENEFIT |
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100% Medicine Price |
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27 PMB Chronic Disease Conditions |
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Subject to Basic formulary |
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Only from Oxygen Pharmacy |
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Network |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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Does not apply |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 1,071 |
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Spouse/Adult dependant |
R 903 |
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1st Child Only |
R 500 |
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IN HOSPITAL BENEFIT |
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200% MSR |
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No Overall Annual Limit |
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Annual Sub-limits per person: |
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Mental Health Benefit |
21 days |
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Terminal Care Benefit |
R 23,400 |
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Alcohol and Drug |
21 days |
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Rehabilitation |
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Internal Prostheses: |
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See detailed benefit schedule |
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CHRONIC MEDICATION BENEFIT |
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100% MSR |
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27 PMB Chronic Disease Conditions |
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Subject to scheme formulary |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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No Benefit |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 1,045 |
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Spouse/Adult dependant |
R 823 |
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Per Child (Max 3) |
R 418 |
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IN HOSPITAL BENEFIT |
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100% MSR |
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Member |
R 500,000 |
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Member + 1 |
R 700,000 |
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Member + 2 |
R 850,000 |
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Member + 3 |
R 1050,000 |
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Member + 4 + |
R 1300,000 |
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* 3 days Take Home Medicine |
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* Co-payments apply for certain |
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procedures |
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Annual Sub-limits: |
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Physiotherapy |
R 2,400 |
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Psychiatric treatment |
21 days |
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Dialysis (per treatment) |
R 1,800 |
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Internal Prosthesis: |
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See detailed benefit schedule. |
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CHRONIC MEDICATION BENEFIT |
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100% MSR |
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27 PMB Chronic Disease Conditions |
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Only from Mediscor |
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Subject to scheme formulary. |
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ANNUAL DAY TO DAY BENEFIT |
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(including savings) |
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Does not apply |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 652 |
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Spouse/Adult dependant |
R 588 |
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Per Child |
R 230 |
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IN HOSPITAL BENEFIT |
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100% MSR |
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No Overall Annual Limit |
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Network Hospitals to be used |
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Annual Sub-limits per person: |
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Mental Health Benefit |
21 days |
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Terminal Care Benefit |
R 23,400 |
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Alcohol and Drug |
21 days |
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Rehabilitation |
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Internal Prostheses: |
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See detailed benefit schedule |
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CHRONIC MEDICATION BENEFIT |
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100% MSR |
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27 PMB Chronic Disease Conditions |
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Subject to scheme formulary |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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No Benefit |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 718 |
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Spouse/Adult dependant |
R 538 |
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Per Child (Max 3) |
R 288 |
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As additional standard Hospital Plans become 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 021 712 6626. Alternatively, if you would like us to confirm some of the finer details or 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 21 712-6686 at any point in your decision making process for further information on these Hospital Plans.
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