CompCare Mumed ED medical aid plan: 2017

Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits. Pay for all children.

View all plans in this scheme

IN HOSPITAL PROCEDURES:
Payout Rate for Specialists:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,054 R1,600 R572
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R5,376 R3,372 R1,338

Compare with these plans:
Hospital Choice:
  • Netcare Network
Specialised Radiology:
  • R22,000 per family
  • No benefit for screening purposes
Supplementary Services: (Physio, etc)
Transplants:
Co-payments:
  • Excision lesion:R1,000
  • Gastroscopy, colonoscopy, cystoscopy, proctoscopy, nasal/sinus endoscopy, hysteroscopy, flexible sigmoidoscopy, diagnostic laparoscopy, dental: R3,300
  • Adenoidectomy, myringotomy, grommets, tonsillectomy: R2,550
  • Laparoscopic hemicolectomy, laparoscopic inguinal hernia repair, laparoscopic appendicectomy : R4,000
  • Laminectomy and spinal fusion, : R8,000
  • Hysterectomy (except for cancer), laparoscopy, hysteroscopy, endometrial ablation, arthroscopy, functional nasal surgry and septoplasty: R6,150
  • Joint replacements, conservative back and neck treatment - spinal cord injections, laminectomy and spinal fusion, nissen fundoplication (reflux surgery):R15,000
Alternatives to hospitals:
  • Step down nursing facilities, hospice and rehabilitation: Unlimited
  • Private nursing at home from day-to-day benefit limited to 60 days per family

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OUT OF HOSPITAL BENEFITS:
GP consultations:
  • Paid from day-to-day benefit, and then by scheme
  • M= 6 visits, M+1 =8 visits, M+2 =10 visits, M+3+ =11 visits
  • If day-to-day benefit is depleted: 2 additional consults and one ER visit (limited to R1,000) per child younger than 6yrs, paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,054 R1,600 R572
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R5,376 R3,372 R1,338

Compare with these plans:

Specialists consultations:
  • Paid from day-to-day benefit.
Pathology:
  • Paid from day-to-day benefit.
General radiology:
  • Paid from day-to-day benefit.
Specialised radiology:
  • R22,000 per family, in and out of hospital
  • No benefit for screening purposes
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit and R1,800 per person and R2,850 per family

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MATERNITY BENEFITS:
Hospital stay:
  • Normal birth: 2 days
  • Caesarean: 3 days
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,054 R1,600 R572
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R5,376 R3,372 R1,338

Compare with these plans:

Consultations:
  • 12 consults paid by scheme
  • Ante-natal classes: R680 per pregnancy, paid from day-to-day benefit but not from above threshold
Scans:
  • 2 x 2D scans, paid by scheme

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CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):
  • Unlimited, subject to protocols
  • Biological medicine: R124,000 per family with a 25% co-payment on non-PMB medicines

Note: All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,054 R1,600 R572
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R5,376 R3,372 R1,338

Compare with these plans:

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DENTISTRY:
Dentistry:
  • Standard dentistry: paid from day-to-day benefit, thereafter paid by scheme
  • Specialised dentistry: paid from day-to-day benefit, limited to R1,850 per person
  • Implants: no benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,054 R1,600 R572
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R5,376 R3,372 R1,338

Compare with these plans:

Orthodontics:
  • No benefit
Maxillo Facial Surgery:

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MEDICATION:
Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 10 conditions covered from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,054 R1,600 R572
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R5,376 R3,372 R1,338

Compare with these plans:
Acute (presrcibed) medication:
  • Paid from day-to-day benefit
Over-the-counter:
  • One script per day, and R160 per event>
  • R530 per person and R950 per family
Birth Control:
  • R120 per month
On Discharge:
  • 7 days supply
Notes:

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OPTOMETRY:
Optometry:
  • Paid from day-to-day benefit
  • Lenses and frames: R1,450 per person and R4,125 per family every second year
  • Frame: Sub-limit of R730 per person every second year
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,054 R1,600 R572
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R5,376 R3,372 R1,338

Compare with these plans:

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MENTAL HEALTH:
In-hospital:
  • Limited to 21 days per family
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,054 R1,600 R572
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R5,376 R3,372 R1,338

Compare with these plans:


Out-of-hospital:
  • Psychiatry: R3,800 per family from day-to-day benefit
  • Psychologists: R1,500 per family from day-to-day benefit

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OTHER BENEFITS:
General Appliances:
  • R9,975 per family paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,054 R1,600 R572
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R5,376 R3,372 R1,338

Compare with these plans:

1.1. Hearing Aids:
  • See "General Appliances" limit
1.2. Wheelchairs:
  • See "General Appliances" limit
Dialysis:
HIV:
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
Emergency Transport:
International Coverage:
  • International benefit: subject to benefits per individual benefit category. Paid at South African rates
    Other:
    • Oxygen home ventilation: from day-to-day benefit
    • Wound care in lieu of hospitalisation: subject to protocols
    • Trauma: unlimited phone consults with psychologists/social workers and 3 face-to-face sessions per person per year

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    WELLNESS/PREVENTATIVE BENEFITS:
    Flu vaccination:
    • Covered
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,054 R1,600 R572
    Children: Pay for all children
    Day-to-Day Benefit:
    Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-
    Extended Fund: R5,376 R3,372 R1,338

    Compare with these plans:

    Pneumonia vaccines:
    • Covered, as required
    Back Rehabilitation Programme:
    Biometric Screening:
    • Covered
    Child Immunisation:
    • Covered
    Pap Smear:
    • Covered, 18yrs+
    Mammogram:
    • Covered, 35yrs+ every two years
    PAS Test:
    • Covered, 40yrs+
    HIV Test:
    • Covered

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    PROSTHESIS:
    Overal Limit:
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,054 R1,600 R572
    Children: Pay for all children
    Day-to-Day Benefit:
    Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-
    Extended Fund: R5,376 R3,372 R1,338

    Compare with these plans:
    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