Hosmed Essential B 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:
Essential B
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R R R
Cost 2017: (R1,460) (R1,333) (R368)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: 2018 benefits coming soon. 2017 benefits:
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Children:

.

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:
Essential B
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

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Hospital Choice: 2018 benefits coming soon. 2017 benefits:
  • Netcare
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • 2 scans per person, in and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • 100% scheme rate
Transplants: 2018 benefits are coming soon!
Co-payments:
  • 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:
  • No benefit
Casualty: 2018 benefits coming soon. 2017 benefits:
  • See GP benefit, above
Other: 2018 benefits coming soon. 2017 benefits:
  • Pathology and radiology: R5,300 per person
.
.
.
.
OUT OF HOSPITAL BENEFITS:
Essential B
2017 v 2018 benefits Gap benefits Notes
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • Network GP: Unlimited


Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Childcare:
  • No benefit
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • Network: 3 consults per family
Pathology: 2018 benefits coming soon. 2017 benefits:
  • R740 per person
General radiology: 2018 benefits coming soon. 2017 benefits:
  • R740 per person
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • 2 scans per person
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
.
.
MATERNITY BENEFITS:
Essential B
2017 v 2018 benefits Gap benefits Notes
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • Natural Birth: 2 days
  • Caesar: 3 days
  • Home Births: R4,000 per pregnancy

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Consultations: 2018 benefits coming soon. 2017 benefits:
  • Unlimited at Network GP
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2 x 2D scans
.
.
.
.
CANCER (ONCOLOGY):
Essential B
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • PMB level of care
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.
.
.
DENTISTRY:
Essential B
2017 v 2018 benefits Gap benefits Notes
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry: paid by scheme
  • Specialised dentistry: 1 set acrylic/plastic dentures per person every 4 years

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Orthodontics: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Maxillo Facial Surgery: 2018 benefits are coming soon!

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:
Essential B
2017 v 2018 benefits Gap benefits Notes
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMBs chronic: paid by scheme

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • Unlimited if dispensed by network GP
  • R950 per person, and R2,650 per family if obtained from pharmacy
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • R210 per family, with a maximum of R80 per script
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • R55 per person, limited to R660 per family per year
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • 5 days
Biological:
.
.
.
.
OPTOMETRY:
Essential B
2017 v 2018 benefits Gap benefits Notes
Optometry: 2018 benefits coming soon. 2017 benefits:
  • Benefit available every 24 months
  • Frames: R195 per person
  • Lens: R165 each; Bifocal/Multifocal: R360 each
  • Contact lenses: R525 per person

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
.
.
MENTAL HEALTH:
Essential B
2017 v 2018 benefits Gap benefits Notes
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Trauma:
.
.
.
.
OTHER BENEFITS:
Essential B
2017 v 2018 benefits Gap benefits Notes
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • R2,500 per family,PMBs only
  • No benefit

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
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: -
HIV: 2018 benefits coming soon. 2017 benefits:
  • 100% scheme rate
  • 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: -
  • No benefit
Other: -
.
.
WELLNESS/PREVENTATIVE BENEFITS:
Essential B
2017 v 2018 benefits Gap benefits Notes
Flu vaccination: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Pneumonia vaccines: 2018 benefits are coming soon!
  • No benefit
Back Rehabilitation Programme: 2018 benefits are coming soon!
  • No benefit
Biometric Screening: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Child Immunisation: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Pap Smear: 2018 benefits coming soon. 2017 benefits:
  • Covered, 18yrs+
  • No benefit
Mammogram: 2018 benefits coming soon. 2017 benefits:
  • Covered, 40yrs+ every two years
  • No benefit
PAS Test: 2018 benefits coming soon. 2017 benefits:
  • Covered, 40yrs+
  • No benefit
HIV Test: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Other: Colon Cancer blood test for 50yrs+
  • 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:
Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
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