Genesis Private Plus medical aid plan: 2017 vs 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:
Private Plus
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R R R
Cost 2017: (R1,900) (R1,900) (R365)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: 2018 benefits coming soon. 2017 benefits:
  • R550,000 per person for admissions related to cancer, stroke, motor-neuron disease and organ transplant
  • Further sub-limits apply: 2018 benefits coming soon. 2017 benefits:
    • Cancer: R210,000
    • Stroke: R80,000 for in-hospital rehabilitation
    • Immunosuppressant medication: R84,000 per person per year
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Children:

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Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family


IN HOSPITAL PROCEDURES:
Private Plus
2017 v 2018 benefits Gap benefits Notes
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

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Hospital Choice: 2018 benefits coming soon. 2017 benefits:
  • Unlimited
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • Scans related to conservative treatment of back and neck covered up to 50% scheme rate, and limited to R6,000 per person
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • 100% scheme rate
Transplants: 2018 benefits coming soon. 2017 benefits:
  • Limited to R550,000 per person for admissions related to cancer, stroke, motor-neuron disease and organ transplant
  • Cost of immunosuppressants: R84,000
Co-payments: 2018 benefits coming soon. 2017 benefits:
  • External medical appliances: 25% of cost copayment
  • 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: 100% of cost
  • Home care visits: R200 per day
  • Home visits by medical practitioner: 100% scheme rate
Casualty: 2018 benefits coming soon. 2017 benefits:
  • Emergency pre-hospital treatment paid by scheme
Other: 2018 benefits coming soon. 2017 benefits:
  • Colonoscopy: R4,000
  • Gastroscopy: R2,750
  • Haemodialysis: R300,000 per family
  • Internal appliances: R30,000 per person
  • External medical appliances: scheme pays 75% of cost, up to R16,500 per family when used in treatment of fractures
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OUT OF HOSPITAL BENEFITS:
Private Plus
2017 v 2018 benefits Gap benefits Notes
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • Surgical procedures in doctor's rooms: covered for qualifying procedures that would otherwise necessitate admission to hospital
  • Otherwise, paid from day-to-day benefit


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Childcare:
  • No benefit
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Pathology: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
General radiology: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • Scheme pays 50% of scheme rate, limited to R6,000 per person
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
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MATERNITY BENEFITS:
Private Plus
2017 v 2018 benefits Gap benefits Notes
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • 100% scheme rate

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Consultations: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Scans: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
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CANCER (ONCOLOGY):
Private Plus
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • Oncologist consults, chemotherapy, radiotherapy, MRI/CT/PET and bone scans, pathology and materials: R210,000 per person
  • Subject to overall limit of R550,000 for cancer, stroke, motor-neuron disease and organ transplant
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.
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DENTISTRY:
Private Plus
2017 v 2018 benefits Gap benefits Notes
Dentistry: R25,000 per person. Includes: 2018 benefits coming soon. 2017 benefits:
  • Consultations, fillings, extractions, plain x-rays, root canals, wisdom tooth removal
  • Crowns, dentures or bridges: Sub-limit of R3,200
  • In-hospital removal of wisdom teeth: R9,000 per case
  • In-hospital: extractions and fillings for children under 9yrs. Once per lifetime, limited to R9,000

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Orthodontics: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Maxillo Facial Surgery: 2018 benefits coming soon. 2017 benefits:
  • paid by scheme if due to major trauma or accident at 200% Scheme Tarifff

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

MEDICATION:
Private Plus
2017 v 2018 benefits Gap benefits Notes
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: paid from day-to-day benefit

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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:
Private Plus
2017 v 2018 benefits Gap benefits Notes
Optometry: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit

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MENTAL HEALTH:
Private Plus
2017 v 2018 benefits Gap benefits Notes
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • 3 days per person in hospital and 18 days in registered health establishment
  • Limited to R36,000 per person

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Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Trauma:
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OTHER BENEFITS:
Private Plus
2017 v 2018 benefits Gap benefits Notes
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
  • No benefit

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1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
  • No benefit
1.2. Wheelchairs: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
  • No benefit
Dialysis: 2018 benefits are coming soon!
HIV: 2018 benefits coming soon. 2017 benefits:
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
Other: 2018 benefits are coming soon!
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WELLNESS/PREVENTATIVE BENEFITS:
Private Plus
2017 v 2018 benefits Gap benefits Notes
Flu vaccination: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit

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Pneumonia vaccines: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
Back Rehabilitation Programme: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
Biometric Screening: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
Child Immunisation: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
Pap Smear: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
Mammogram: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
PAS Test: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
HIV Test: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
Other: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

2017 v 2018 benefits Gap benefits Notes
Overal Limit:
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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