CompCare Symmetry ED medical aid plan: 2017

Scheme offers extended fund for claims once savings are depleted, and also pays for: specialised radiology, GPs, medical appliances and preventative benefits. Limits apply. All else paid from savings, fund or out of pocket. 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: R2,598 R2,022 R732
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers extended fund for claims once savings are depleted, and also pays for: specialised radiology, GPs, medical appliances and preventative benefits. Limits apply. All else paid from savings, fund or out of pocket.
Main: Adult: Child:
(S) Savings: R3,118 R2,426 R878
Extended Fund: R3,118 R2,426 R878

Compare with these plans:
Hospital Choice:
  • Netcare Network
Specialised Radiology:
  • R25,000 per family with first R1,500 paid out of savings
  • 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, arthroscopy, diagnostic laparoscopy, dental, laparoscopic inguinal hernia repair, laparoscopic appendicectomy: R2,000
  • Adenoidectomy, myringotomy, grommets, tonsillectomy: R2,550
  • Laparoscopic hemicolectomy : R3,000
  • laminectomy and spinal fusion: R4,000
  • Hysterectomy (except for cancer), laparoscopy, hysteroscopy, endometrial ablation, 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):R12,600
  • Specialised radiology: R1,500 co-payment
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
  • Paid from day-to-day benefit
  • 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: R2,598 R2,022 R732
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers extended fund for claims once savings are depleted, and also pays for: specialised radiology, GPs, medical appliances and preventative benefits. Limits apply. All else paid from savings, fund or out of pocket.
Main: Adult: Child:
(S) Savings: R3,118 R2,426 R878
Extended Fund: R3,118 R2,426 R878

Compare with these plans:

Specialists consultations:
  • Paid from day-to-day benefit
Pathology:
  • Paid from day-to-day benefit and R30,000 per family for in and out of hospital
General radiology:
  • Paid from day-to-day benefit
Specialised radiology:
  • R25,000 per family with first R1,500 paid out of savings
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit and R2,800 per person

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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: R2,598 R2,022 R732
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers extended fund for claims once savings are depleted, and also pays for: specialised radiology, GPs, medical appliances and preventative benefits. Limits apply. All else paid from savings, fund or out of pocket.
Main: Adult: Child:
(S) Savings: R3,118 R2,426 R878
Extended Fund: R3,118 R2,426 R878

Compare with these plans:

Consultations:
  • 12 consults paid by scheme
  • Ante-natal classes: R870 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: R2,598 R2,022 R732
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers extended fund for claims once savings are depleted, and also pays for: specialised radiology, GPs, medical appliances and preventative benefits. Limits apply. All else paid from savings, fund or out of pocket.
Main: Adult: Child:
(S) Savings: R3,118 R2,426 R878
Extended Fund: R3,118 R2,426 R878

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 R7,000 per person
  • Implants: no benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,598 R2,022 R732
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers extended fund for claims once savings are depleted, and also pays for: specialised radiology, GPs, medical appliances and preventative benefits. Limits apply. All else paid from savings, fund or out of pocket.
Main: Adult: Child:
(S) Savings: R3,118 R2,426 R878
Extended Fund: R3,118 R2,426 R878

Compare with these plans:

Orthodontics:
  • R17,500 per person, per lifetime
Maxillo Facial Surgery:

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MEDICATION:
Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 20 conditions covered
  • non-PMBs limited to R4,100 per person and R6,160 per family from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,598 R2,022 R732
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers extended fund for claims once savings are depleted, and also pays for: specialised radiology, GPs, medical appliances and preventative benefits. Limits apply. All else paid from savings, fund or out of pocket.
Main: Adult: Child:
(S) Savings: R3,118 R2,426 R878
Extended Fund: R3,118 R2,426 R878

Compare with these plans:
Acute (presrcibed) medication:
  • Paid from day-to-day benefit
Over-the-counter:
  • One script per day, and R170 per event>
  • R650 per person and R1,050 per family
Birth Control:
  • R120 per month
On Discharge:
  • 7 days supply
Notes:

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OPTOMETRY:
Optometry:
  • Radial keratotomy and excimer laser: R4,200 per eye. Paid by scheme
  • Otherwise, from day-to-day benefit
  • Lenses and frames: R1,875 per person every second year
  • Frame: Sub-limit of R990 per person every second year
  • Not covered by above-threshold benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,598 R2,022 R732
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers extended fund for claims once savings are depleted, and also pays for: specialised radiology, GPs, medical appliances and preventative benefits. Limits apply. All else paid from savings, fund or out of pocket.
Main: Adult: Child:
(S) Savings: R3,118 R2,426 R878
Extended Fund: R3,118 R2,426 R878

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: R2,598 R2,022 R732
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers extended fund for claims once savings are depleted, and also pays for: specialised radiology, GPs, medical appliances and preventative benefits. Limits apply. All else paid from savings, fund or out of pocket.
Main: Adult: Child:
(S) Savings: R3,118 R2,426 R878
Extended Fund: R3,118 R2,426 R878

Compare with these plans:


Out-of-hospital:
  • Psychiatry: R5,800 per family from day-to-day benefit
  • Psychologists: R1,710 per family from day-to-day benefit
  • Not payable from above-threshold benefit

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OTHER BENEFITS:
General Appliances:
  • R11,025 per family paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,598 R2,022 R732
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers extended fund for claims once savings are depleted, and also pays for: specialised radiology, GPs, medical appliances and preventative benefits. Limits apply. All else paid from savings, fund or out of pocket.
Main: Adult: Child:
(S) Savings: R3,118 R2,426 R878
Extended Fund: R3,118 R2,426 R878

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: R2,598 R2,022 R732
    Children: Pay for all children
    Day-to-Day Benefit:
    Scheme offers extended fund for claims once savings are depleted, and also pays for: specialised radiology, GPs, medical appliances and preventative benefits. Limits apply. All else paid from savings, fund or out of pocket.
    Main: Adult: Child:
    (S) Savings: R3,118 R2,426 R878
    Extended Fund: R3,118 R2,426 R878

    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: R2,598 R2,022 R732
    Children: Pay for all children
    Day-to-Day Benefit:
    Scheme offers extended fund for claims once savings are depleted, and also pays for: specialised radiology, GPs, medical appliances and preventative benefits. Limits apply. All else paid from savings, fund or out of pocket.
    Main: Adult: Child:
    (S) Savings: R3,118 R2,426 R878
    Extended Fund: R3,118 R2,426 R878

    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