Cape Medical Select medical aid plan: 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

COSTS and OVERVIEW:
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Quick Overview
Main: Adult: Child:
Total Cost pm: R R R
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: 2018 benefits coming soon. 2017 benefits:
  • Unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Children:
See full benefits below

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IN HOSPITAL PROCEDURES:
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Benefits Gap benefits
Payout Rate for Specialists: 2018 benefits coming soon. 2017 benefits:
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice: 2018 benefits coming soon. 2017 benefits:
  • Unlimited for non PMBs
  • PMBs: State or simialar facility, nominated by scheme
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • R10,220 per person with a R1,500 co-payment in and out of hospital
  • Thereafter, from day-to-day benefit
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • 100% scheme rate
Transplants: 2018 benefits coming soon. 2017 benefits:
  • PMB level of care
Co-payments: 2018 benefits coming soon. 2017 benefits:
  • Arthroscopy, appendectomy, inguinal hernia repair, gynaecological procedures, urology procedures, umbilical hernia repair, incisional hernia repair, ventral hernia repair, colectomy, colonoscopy, gastroscopy, hysteroscopy, sympathectomy, vaginal hysterectomy, cystoscopy: R1,000 co-payment
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals: 2018 benefits coming soon. 2017 benefits:
  • Hospice and registered nurses: up to 15 days per person
Casualty: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Other: n/a
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OUT OF HOSPITAL BENEFITS:
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Benefits Gap benefits
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Childcare:
  • No benefit
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Pathology: 2018 benefits coming soon. 2017 benefits:
  • Covered if Lancet or Pathcare is used
General radiology: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • R10,220 per person with a R1,500 co-payment in and out of hospital
  • Thereafter, from day-to-day benefit
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
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MATERNITY BENEFITS:
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Benefits Gap benefits
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • 200% scheme rate
  • Elective caesarean: no benefit
Consultations: 2018 benefits coming soon. 2017 benefits:
  • Consults: R2,450 per family, including scans. Paid by scheme.
  • Thereafter, from day-to-day benefit
Scans: 2018 benefits coming soon. 2017 benefits:
  • R2,450 per family, including scans
  • Thereafter, from day-to-day benefit
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CANCER (ONCOLOGY):
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Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • PMBs only, at state or similar facilities
  • Subject to SAOC Tier 1 and Tier 2 guidelines
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DENTISTRY:
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Benefits Gap benefits
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry: from day-to-day benefit
  • Specialised dentistry: from day-to-day benefit
Orthodontics: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Maxillo Facial Surgery: 2018 benefits coming soon. 2017 benefits:
  • 120% scheme rate
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MEDICATION:
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Benefits Gap benefits
Chronic: 2018 benefits coming soon. 2017 benefits:
  • No. of chronic conditions covered: 27 CDLs and PMBs
Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Biological:
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OPTOMETRY:
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Benefits Gap benefits
Optometry: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
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MENTAL HEALTH:
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Benefits Gap benefits
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit, unless PMB
Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit, unless PMB
Trauma:
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OTHER BENEFITS:
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Benefits Gap benefits
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
  • No benefit
1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
  • See "General Appliances" limit
  • No benefit
1.2. Wheelchairs: 2018 benefits coming soon. 2017 benefits:
  • See "General Appliances" limit
  • No benefit
Dialysis: 2018 benefits coming soon. 2017 benefits:
  • PMB level of care criteria
HIV: 2018 benefits will be posted soon!
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: 2018 benefits will be posted soon!
  • No benefit
Other: 2018 benefits will be posted soon!
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WELLNESS/PREVENTATIVE BENEFITS:
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Benefits Gap benefits
Flu vaccination: 2018 benefits will be posted soon!
  • No benefit
Pneumonia vaccines: 2018 benefits will be posted soon!
  • No benefit
Back Rehabilitation Programme: 2018 benefits will be posted soon!
  • No benefit
Biometric Screening: 2018 benefits will be posted soon!
  • No benefit
Child Immunisation: 2018 benefits will be posted soon!
  • No benefit
Pap Smear: 2018 benefits will be posted soon!
  • No benefit
Mammogram: 2018 benefits coming soon. 2017 benefits:
  • R1,320 with R300 co-payment, for women 49yrs+, once every two years
  • No benefit
PAS Test: 2018 benefits will be posted soon!
  • No benefit
HIV Test: 2018 benefits will be posted soon!
  • No benefit
Other:
  • No benefit
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PROSTHETICS:
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Benefits Gap benefits
Overal Limit:
Sub-limits:

    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised