Hosmed 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:
Plus
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R R R
Cost 2017: (R4,184) (R3,115) (R700)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: 2018 benefits coming soon. 2017 benefits:
  • Unlimited
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:
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:
  • Unlimited
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • 100% scheme rate
Transplants: 2018 benefits are coming soon!
Co-payments: n/a
  • 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:
  • Sterilization: R13,690 per person
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OUT OF HOSPITAL BENEFITS:
Plus
2017 v 2018 benefits Gap benefits Notes
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • 16 visits per person, and 26 visits per family
  • Applies to GPs, Specialists and Outpatient Facilities


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Childcare:
  • No benefit
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • See GP benefit, above
Pathology: 2018 benefits coming soon. 2017 benefits:
  • R4,360 per person
General radiology: 2018 benefits coming soon. 2017 benefits:
  • R3,210 per person
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • 2 scans per person
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Alternative services: R3,495 per family
  • Remedial and other therapies: R4,430 per family
  • Physiotherapy and Biokinetics: R2,340 per person limited to R3,750 per family
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MATERNITY BENEFITS:
Plus
2017 v 2018 benefits Gap benefits Notes
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • Natural Birth: 2 nights and 3 days
  • Caesar: 3 nights and 4 days
  • Home Births: R6,000 per pregnancy

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Consultations: 2018 benefits coming soon. 2017 benefits:
  • Additional 5 visits per pregnancy at GP or Specialist
  • Antenatal classes: R477 per mother
Scans: 2018 benefits coming soon. 2017 benefits:
  • 3 x 2D scans
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CANCER (ONCOLOGY):
Plus
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • R534,000 per person
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:
Plus
2017 v 2018 benefits Gap benefits Notes
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry: paid by scheme
  • Specialised dentistry: R5,840 per person and R7,360 per family

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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:
Plus
2017 v 2018 benefits Gap benefits Notes
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: R12,600 per person, and R24,060 per family

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Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • R4,800 per person, and R9,400 per family
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • R975 per family, with a maximum of R191 per script
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • R120 per person, limited to R1,440 per family per year
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • 7 days
Biological:
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OPTOMETRY:
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2017 v 2018 benefits Gap benefits Notes
Optometry: 2018 benefits coming soon. 2017 benefits:
  • Benefit available every 24 months
  • Frames: R870 per person
  • Lens: R165 each; Bifocal: R360 each; Multifocal: R660 each
  • Contact lenses: R2,915 per person

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MENTAL HEALTH:
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2017 v 2018 benefits Gap benefits Notes
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs: 21 days per person
  • non-PMBs:R19,800 per family

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Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • R4,100 per person and R8,200 per family
Trauma:
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OTHER BENEFITS:
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2017 v 2018 benefits Gap benefits Notes
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • R13,344 per family
  • No benefit

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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: 2018 benefits are coming soon!
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: 2018 benefits are coming soon!
  • No benefit
Other: 2018 benefits are coming soon!
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WELLNESS/PREVENTATIVE BENEFITS:
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2017 v 2018 benefits Gap benefits Notes
Flu vaccination: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit

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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:
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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