Hospital Plans with Limited Day to Day Cover - 2012
These hospital plans include Hospital Cover as well as a limited amount for day-to-day cover e.g. consultations and medicines. This can be in the form of a medical savings account and / or a traditional benefit, which will give specific annual limits per provider type i.e. doctors and dentistry. This type of benefit does however not carry forward from year to year like savings does. Any unused benefit falls away at the end of each year.
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IN HOSPITAL BENEFIT |
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100% Scheme Rate |
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Member |
R1,000,000 |
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Member + 1 |
R1,250,000 |
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Member + 2 |
R1,400,000 |
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Member + 3 |
R1,500,000 |
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Member + 4 + |
R1,600,000 |
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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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Psychiatric Treatment |
R6,000 |
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(subject to PMB) |
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Hospice care |
n/a |
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Oncology |
R100,000 |
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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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Only from Mediscor |
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Subject to scheme formulary. |
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(Add. 3 Chronic Disease Conditions) |
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ANNUAL DAY TO DAY BENEFIT |
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(including savings) |
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100% Scheme Rate |
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Income p/m R0 - |
R10,500 |
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Member |
R1,956 |
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Member+Spouse |
R3,816 |
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Member+Spouse+Child 1 |
R4,596 |
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Member+Spouse+Child 2 |
R5,376 |
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Member+Spouse+Child 3 |
R6,156 |
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Member+Child 1 |
R2,736 |
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Income p/m |
R10,501+ |
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Member |
R2,748 |
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Member+Spouse |
R5,352 |
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Member+Spouse+Child 1 |
R6,456 |
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Member+Spouse+Child 2 |
R7,560 |
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Member+Spouse+Child 3 |
R8,664 |
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Member+Child 1 |
R3,852 |
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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 - R10,500 |
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Principal Member |
R 1,084 |
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Spouse/Adult dependant |
R 1,032 |
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Per Child |
R 433 |
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Income p/m |
R10,501 + |
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Principal Member |
R 1,524 |
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Spouse/Adult dependant |
R 1,448 |
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Per Child |
R 611 |
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IN HOSPITAL BENEFIT |
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100% Scheme Rate |
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R1,000,000 per family per annum |
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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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Oncology |
R 115,000 |
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Physical Rehabilitation |
R 34,000 |
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(per family) |
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Take home medicine |
R 250 |
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(per admission) |
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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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only from Pharmacy Direct |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% Scheme Rate |
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Limits per annum: |
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Member |
R 1,400 |
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Member + 1 |
R 2,600 |
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Member + 2 |
R 3,000 |
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Member + 3 |
R 3,300 |
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Member + 4 + |
R 3,600 |
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Network GP Limit: |
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Member |
R 1,400 |
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Member + 1 |
R 2,700 |
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Member + 2 |
R3, 100 |
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Member + 3 |
R3, 400 |
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Member + 4 + |
R3, 800 |
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Plus basic Dentistry |
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and Optometry |
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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 1,159 |
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Spouse/Adult dependant |
R 907 |
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Per Child |
R 369 |
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IN HOSPITAL BENEFIT |
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200% 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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Associated Hospitals to be used |
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(Life and Mediclinics) |
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Annual Sub-limits |
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Surgical Appliances |
R4,250 |
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(eg. support stockings) |
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Mental Health |
R 24,300 |
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Rehabilitation, Private |
R 35, 500 |
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nursing, Hospice and |
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step-down facilities |
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Oncology |
R365,000 |
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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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6 additional conditions limited to |
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R 6,600 per family |
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Only from state hospitals |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% Scheme Rate |
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Limits per annum: |
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Member |
R 1,416 |
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Member+Spouse |
R 2,520 |
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Member+Spouse+Child1 |
R 3,072 |
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Member+Spouse+Child2 |
R 3,624 |
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Member+Spouse+Child3 |
R 4,176 |
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Member+Child 1 |
R 1,968 |
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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 1,179 |
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Spouse/Adult dependant |
R 924 |
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Per Child (Max 3) |
R 458 |
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MOMENTUM ACCESS OPTION
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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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Annual Sub-limits :
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High and Intensive Care |
12 days |
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(per admission) |
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Medical and Surgical |
R 4,250 |
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Appliances (per family) |
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Rehabilitation and Step- |
R 33,500 |
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down facilities |
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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% Scheme Rate |
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27 PMB Chronic Disease Conditions |
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Subject to scheme formulary |
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CareCross, Medicross or Prime Cure. |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% NHRPL Rate |
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CareCross, Medicross or |
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Prime Cure |
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GP's: |
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10 visits per person per annum |
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thereafter R500 co-payment |
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applies. |
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Specialists: |
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3 visits per person limited to |
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5 visits per family per annum |
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Conservative Dentistry: |
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No Limit from 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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Principal Member |
R 1,188 |
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Spouse/Adult Dependant |
R 1,129 |
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Per Child |
R 356 |
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| RESOLUTION HEALTH |
| PROGRESSIVE FLEX |
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IN HOSPITAL BENEFIT |
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150% Scheme Rate |
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No overall annual limit |
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*7 day take home medication |
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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-limts 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 |
R20,600 |
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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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100% NHRPL Rate |
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GP's: |
Member |
4 visits |
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Member + 1 |
7 visits |
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Family |
9 visits |
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Specialists: |
Member |
3 visits |
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Member + 1 |
4 visits |
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Family |
5 visits |
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Conservative & Specialised Dentistry |
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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 |
R1,224 |
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Spouse/Adult dependant |
R1,164 |
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Per Child |
R362 |
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IN HOSPITAL BENEFIT |
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200% 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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Associated Hospitals to be used |
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(Life and Mediclinics) |
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Annual Sub-limits : |
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Surgical Appliances |
R 4,250 |
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(eg. support stockings) |
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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 |
R 365,00 |
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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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6 additional conditions limited to |
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R 6, 300 per family |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% Scheme Rate |
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Limits per annum: |
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Member |
R 1,836 |
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Member+Spouse |
R 3,312 |
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Member+Spouse+Child1 |
R 3,996 |
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Member+Spouse+Child2 |
R 4,680 |
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Member+Spouse+Child3 |
R5,364 |
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Member+Child 1 |
R2,520 |
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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 1,528 |
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Spouse/Adult dependant |
R 1,230 |
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Per Child (Max 3) |
R 571 |
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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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*Oral contraceptives |
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*Emergency Trauma at Out Patients |
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Psychiatric Treatment |
R 18,200 |
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Hospice care |
R 13,700 |
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Oncology (only at DSP) |
R230,000 |
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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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Only from MED-Rite Pharmacies |
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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 2,340 |
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Member +Spouse |
R 4,100 |
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Member +Spouse +Child 1 |
R 4,340 |
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Member +Spouse +Child 2 |
R 4,580 |
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Member +Spouse +Child 3 |
R 4,820 |
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Member +Child 1 |
R 2,580 |
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Unlimied GP Network |
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benefit |
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ANNUAL THRESHOLD BENEFIT |
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Principal Member |
R 9,290 |
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Spouse/Adult dependant |
R 7,070 |
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Per Child (Max 3) |
R 2,380 |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 1,547 |
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Spouse/Adult dependant |
R 1,317 |
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Per Child |
R 466 |
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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: |
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Oncology |
R 250,000 |
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Physical Rehabilitation |
R 34,000 |
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(per family) |
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Take home medicine |
R 320 |
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(per admission) |
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Internal Prosthesis: |
R 30,500 |
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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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Add. 16 Chronic Disease Conditions |
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Annual limit: |
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Single |
R 6,900 |
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Per Family |
R 13,800 |
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| |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
|
| |
100% Scheme Rate |
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| |
Limits per annum: |
|
| |
Member |
R 3,100 |
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| |
Member + 1 |
R 4,700 |
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| |
Member + 2 |
R 5,100 |
|
| |
Member + 3 |
R 5,500 |
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| |
Member + 4 + |
R 5,900 |
|
| |
Network GP Limit: |
|
| |
Member |
R3, 000 |
|
| |
Member + 1 |
R 4, 500 |
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| |
Member + 2 |
R 4, 900 |
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| |
Member + 3 |
R 5,200 |
|
| |
Member + 4 + |
R 5, 600 |
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| |
Plus basic and advanced Dentistry |
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| |
and Optometry |
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| |
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ANNUAL THRESHOLD BENEFIT |
|
| |
Does not apply |
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| |
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| |
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| |
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MONTHLY CONTRIBUTIONS |
|
| |
Principal Member |
R 1,795 |
|
| |
Spouse/Adult dependant |
R 1,533 |
|
| |
Per Child |
R 525 |
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| |
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IN HOSPITAL BENEFIT |
|
| |
200% Scheme Rate |
|
| |
No Overall Annual Limit |
|
| |
Co-payments apply for certain |
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| |
procedures |
|
| |
Annual Sub-limits per person: |
|
| |
Mental Health Benefit |
21 days |
|
| |
Terminal Care Benefit |
R 28,000 |
|
| |
Alcohol and Drug |
21 days |
|
| |
Rehabilitation |
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Internal Prostheses: |
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|
| |
See detailed benefit schedule |
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| |
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CHRONIC MEDICATION BENEFIT |
|
| |
100% Scheme Rate |
|
| |
27 MB Chronic Disease Conditions |
|
| |
Subject to scheme formulary |
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| |
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| |
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| |
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| |
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|
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
|
| |
100% Scheme Rate |
|
| |
Limits per annum: |
|
| |
Member |
R 5,544 |
|
| |
Member+Spouse |
R 9,912 |
|
| |
Member+Spouse+Child1 |
R 12,132 |
|
| |
Member+Spouse+Child2 |
R 14.352 |
|
| |
Member+Spouse+Child3 |
R 16,572 |
|
| |
Member+Child 1 |
R 7,764 |
|
| |
|
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|
| |
Insured Network Benefit |
|
| |
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| |
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| |
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| |
|
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|
| |
|
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|
| |
ANNUAL THRESHOLD BENEFIT |
|
| |
Principal Member |
R 8,200 |
|
| |
Spouse/Adult dependant |
R 6,150 |
|
| |
Per Child (Max 3) |
R 2,690 |
|
| |
|
|
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|
| |
MONTHLY CONTRIBUTIONS |
|
| |
Principal Member |
R 1,850 |
|
| |
Spouse/Adult dependant |
R 1,457 |
|
| |
Per Child (Max 3) |
R 740 |
|
| |
|
|
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As additional Hospital Plans with limited day to day cover 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 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 Hospital Plans with limited day to day cover.
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