A Comparison of Hospital Plans - 2012
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% Scheme Rate |
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No Overall Annual Limit |
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Network Hospitals to be used |
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Certain procedures only covered at |
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Network Day Clinics |
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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 20,000 |
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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% Scheme Rate |
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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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R2,300 per person from |
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Network providers |
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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 - R6,250 |
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Principal Member |
R 465 |
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Spouse /Adult |
R 465 |
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dependant |
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Per Child (Max 3) |
R117 |
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Income p/m: |
R6,251 - R8,300 |
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Principal Member |
R 579 |
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Spouse /Adult |
R 579 |
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dependant |
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Per Child (Max 3) |
R 144 |
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Income p/m: |
R8,301+ |
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Principal Member |
R 894 |
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Spouse /Adult |
R 894 |
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dependant |
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Per Child (Max 3) |
R 202 |
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IN HOSPITAL BENEFIT |
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100% Scheme Rate |
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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 |
R1,050,000 |
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Member + 4 + |
R1,300,000 |
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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 per person: |
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Psychiatric Treatment |
21 days |
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(subject to PMB) |
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Hospice Care |
n/a |
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Oncology |
Unlimited |
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(subject to PMB) |
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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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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 767 |
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Spouse/Adult dependant |
R692 |
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Per Child |
R 271 |
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IN HOSPITAL BENEFIT |
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100% Scheme Rate |
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No overall annual limit |
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Network hospitals to be used |
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R4,500 co-payment on voluntary |
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non-network admissions |
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Co-payments are due for |
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certain procedures |
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(eg. R3,165 Anthroscopy) |
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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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Psychiatric Treatment & Ocology PMB |
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Hospital Care - R13,700 |
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Internal Prosthesis - PMB |
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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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Only from MED-Rite Pharmacies |
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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 819 |
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Spouse/Adult dependant |
R 612 |
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Per Child |
R 275 |
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IN HOSPITAL BENEFIT |
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100% Scheme Rate |
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No Overall Annual Limit |
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*7 days Take Home Medicine |
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*R950 co-payment except for |
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Emergencies, MVA's and maternity |
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Associated Hospitals to be used |
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(Life and Mediclinics) |
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Annual Sub-limits :
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Medical & Surgical |
R 4,250 |
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Appliances (per family) |
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Mental Health |
R 24,300 |
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Rehabilitation, Private |
R 33, 500 |
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nursing, Hospice and |
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step-down facilities |
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Oncology |
R265,000 |
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thereafter 20% co-pay |
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Internal Prostheses: |
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see detailed benefits |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 Chronic Disease Conditions |
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Subject to scheme formulary |
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Only from state hospitals |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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Does not apply |
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For more savings, please enquire |
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about the Health Saver |
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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 842 |
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Spouse/Adult dependant |
R 637 |
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Per Child (Max 3) |
R 298 |
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| DISCOVERY HEALTH |
| ESSENTIAL DELTA CORE |
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IN HOSPITAL BENEFIT |
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100% Scheme Rate |
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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 28,000 |
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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% Scheme Rate |
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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 844 |
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Spouse/Adult dependant |
R 633 |
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Per Child (Max 3) |
R 339 |
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IN HOSPITAL BENEFIT |
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100% Scheme Rate |
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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 28,000 |
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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% Scheme Rate |
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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 892 |
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Spouse/Adult dependant |
R 669 |
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Per Child (Max 3) |
R 356 |
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| RESOLUTION HEALTH |
| HOSPITAL PLAN |
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IN HOSPITAL BENEFIT |
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100% Scheme 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 Casualty Annual Limit |
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R1,200 per family |
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Annual Sub-limits per person: |
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Prosthesis |
R45,000 |
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(subject to prosthesis sub- |
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limits) |
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Hospice,Rehab & Step down |
R17,700 |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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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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Principal Member |
R 899 |
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Spouse/Adult dependant |
R 718 |
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Per Child |
R 285 |
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IN HOSPITAL BENEFIT |
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100% Scheme Rate |
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No Overall Annual Limit |
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*7 days Take Home Medicine |
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*R950 co-payment except for |
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Emergencies, MVA's and maternity |
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Associated Hospitals to be used |
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(Life and Mediclinics) |
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Annual Sub-limits :
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Medical & Surgical |
R 4,250 |
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Appliances (per family) |
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Mental Health |
R 24,300 |
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Rehabilitation, Private |
R 33, 500 |
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nursing, Hospice and |
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step-down facilities |
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Oncology |
R265,000 |
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thereafter 20% co-pay |
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Internal Prostheses: |
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see detailed benefits |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 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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For more savings, please enquire |
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about the Health Saver |
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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 1,079 |
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Spouse/Adult dependant |
R 851 |
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Per Child (Max 3) |
R 381 |
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IN HOSPITAL BENEFIT |
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100% Scheme 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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(e.g R1,700 Anthroscopy) |
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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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Oncology & Organ |
R 170,000 |
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| |
Transplant |
|
|
| |
Psychiatric Treatment |
R 18,200 |
|
| |
Hospice care |
R 13,700 |
|
| |
Oncology (only at DSP) |
R180,000 |
|
| |
Internal Prosthesis: |
|
|
| |
See detailed benefits |
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
|
| |
CHRONIC MEDICATION BENEFIT |
|
| |
100% Medicine Price |
|
| |
27 PMB Chronic Disease Conditions |
|
| |
Only from MED-Rite Pharmacies |
|
| |
|
|
|
| |
|
|
|
| |
|
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|
| |
|
|
|
| |
|
|
|
|
|
|
|
|
| |
ANNUAL DAY TO DAY BENEFIT (including savings) |
|
| |
Does not apply |
|
| |
|
|
| |
|
|
| |
|
|
| |
|
|
| |
|
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| |
|
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| |
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| |
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|
| |
|
|
| |
|
|
| |
|
|
| |
|
|
|
|
| |
ANNUAL THRESHOLD BENEFIT |
|
| |
Does not apply |
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
MONTHLY CONTRIBUTIONS |
|
| |
Member |
R 1,166 |
|
| |
Spouse/Adult dependant |
R 988 |
|
| |
Per Child |
R 408 |
|
| |
|
|
|
|
|
| |
|
|
| |
IN HOSPITAL BENEFIT |
|
| |
200% Scheme Rate |
|
| |
No Overall Annual Limit |
|
| |
Annual Sub-limits per person: |
|
| |
Mental Health Benefit |
21 days |
|
| |
Terminal Care Benefit |
R 28,000 |
|
| |
Alcohol and Drug |
21 days |
|
| |
Rehabilitation |
|
|
| |
Internal Prostheses: |
|
|
| |
See detailed benefit schedule |
|
| |
|
|
|
| |
|
|
|
| |
|
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| |
|
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| |
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| |
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| |
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| |
|
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|
| |
|
|
|
| |
|
|
|
| |
|
|
|
|
|
|
|
|
| |
CHRONIC MEDICATION BENEFIT |
|
| |
100% Scheme Rate |
|
| |
27 PMB Chronic Disease Conditions |
|
| |
Subject to scheme formulary |
|
| |
|
|
| |
|
|
| |
|
|
| |
|
|
|
| |
ANNUAL DAY TO DAY BENEFIT
(including savings) |
|
| |
No Benefit |
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
|
| |
ANNUAL THRESHOLD BENEFIT |
|
| |
Does not apply |
|
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
| |
MONTHLY CONTRIBUTIONS |
|
| |
Principal Member |
R 1,229 |
|
| |
Spouse/Adult dependant |
R 967 |
|
| |
Per Child (Max 3) |
R 491 |
|
| |
|
|
|
|
|
|
| |
IN HOSPITAL BENEFIT |
|
| |
200% Sceme Rate |
|
| |
No Overall Annual Limit |
|
| |
Co-payments apply for certain |
|
| |
procedures |
|
| |
Take home medicine limited to |
|
| |
R300 per admission |
|
| |
Annual Sub-limits per family: |
|
| |
|
|
| |
Psychiatric treatment R30,000 |
|
| |
(subject to PMB) |
|
| |
Hospice Care R45,000 |
|
| |
Oncology PMB |
|
| |
Internal Prosthesis R27,000 |
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
|
| |
CHRONIC MEDICATION BENEFIT |
|
| |
100% Medicine Price |
|
| |
27 PMB Chronic Disease Conditions |
|
| |
Subject to scheme formulary |
|
| |
Only from Medshield pharmacy |
|
| |
network |
|
|
| |
|
|
| |
|
|
|
|
|
|
|
|
| |
ANNUAL DAY TO DAY BENEFIT (including savings) |
|
| |
|
|
|
| |
Does not apply |
|
| |
|
|
|
| |
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
|
| |
ANNUAL THRESHOLD BENEFIT |
|
| |
|
|
|
| |
does not apply |
|
| |
|
|
|
| |
MONTHLY CONTRIBUTIONS |
|
| |
Member |
R 1,290 |
|
| |
Spouse/Adult dependant |
R 1,086 |
|
| |
1st Child only |
R 603 |
|
| |
|
|
|
|
|
|
|
| |
|
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 0866 200 320 . 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 21 712-8866 at any point in your decision making process for further information on these Hospital Plans.
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