Genesis Private 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.

Private
2018 Costs:
Total Cost pm:

Main member:

R

Adult:

R

Child:

R
2019 Costs:
Total Cost pm:

Main member:

R
(%)

Adult:

R

Child:

R
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In brief (2018): See full benefits below

IN HOSPITAL PROCEDURES:
Private
Scheme Benefits: Gap Benefits:
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
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
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)

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Our quote will include the right gap cover for this plan

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Private
Scheme Benefits Gap benefits
Main: Adult: Child:
General info:
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, no benefit
Childcare:
  • No extra benefit available
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Pathology: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
General radiology: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
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:
  • No benefit, unless PMB

No phone calls!
Our quote will include the right gap cover for this plan

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MATERNITY BENEFITS:
Private
Scheme Benefits Gap benefits
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • 100% scheme rate
Consultations: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Scans: 2018 benefits coming soon. 2017 benefits:
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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CANCER (ONCOLOGY):
Private
Scheme Benefits Gap benefits
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

No phone calls!
Our quote will include the right gap cover for this plan

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DENTISTRY:
Private
Scheme Benefits Gap benefits
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
Orthodontics: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Maxillo Facial Surgery: 2018 benefits coming soon. 2017 benefits:
  • Paid by scheme if due to major trauma or accident at 200% Scheme Tariff

No phone calls!
Our quote will include the right gap cover for this plan

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MEDICATION:
Private
Scheme Benefits Gap benefits
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMBs chronic: paid by scheme
Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • No benefit
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Biological:

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Our quote will include the right gap cover for this plan

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OPTOMETRY:
Private
Scheme Benefits Gap benefits
Optometry: 2018 benefits coming soon. 2017 benefits:
  • No benefit

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Our quote will include the right gap cover for this plan

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MENTAL HEALTH:
Private
Scheme Benefits Gap benefits
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
Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Trauma:

No phone calls!
Our quote will include the right gap cover for this plan

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OTHER BENEFITS:
Private
Scheme Benefits Gap benefits
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
1.2. Wheelchairs: 2018 benefits coming soon. 2017 benefits:
  • No 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: ER24
  • No benefit
International Insurance: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
Other: 2018 benefits are coming soon!

No phone calls!
Our quote will include the right gap cover for this plan

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WELLNESS/PREVENTATIVE BENEFITS:
Private
Scheme Benefits Gap benefits
Flu vaccination: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
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

No phone calls!
Our quote will include the right gap cover for this plan

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PROSTHETICS:
Private
Scheme Benefits Gap benefits
Overal Limit:
Sub-limits:

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Our quote will include the right gap cover for this plan


    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