Makoti Primary C 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.

COSTS and OVERVIEW:
Primary C
Quick Overview
Main: Adult: Child:
Total Cost pm: R R R
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:
Income band: This plan is only available to households with income in pm band.
View other income bands
See full benefits below

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view

.

IN HOSPITAL PROCEDURES:
Primary C
Benefits Gap benefits
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
Hospital Choice: 2018 benefits coming soon. 2017 benefits:
  • State hospitals
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • PMBs only, in state hospitals
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • PMBs only, in state hospitals
Transplants: 2018 benefits coming soon. 2017 benefits:
  • PMBs only, in state hospitals
Co-payments: None
  • 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 are coming soon!
Casualty: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Other: 2018 benefits are coming soon!
.
.
.
.
OUT OF HOSPITAL BENEFITS:
Primary C
Benefits Gap benefits
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • Chosen network GP: Unlimited
Childcare:
  • No benefit
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • PMBs only, in state hospitals
Pathology: 2018 benefits coming soon. 2017 benefits:
  • Basic pathology covered by scheme
General radiology: 2018 benefits coming soon. 2017 benefits:
  • Basic radiology covered by scheme
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
.
.
MATERNITY BENEFITS:
Primary C
Benefits Gap benefits
Hospital stay: 2018 benefits are coming soon!
Consultations: 2018 benefits coming soon. 2017 benefits:
  • Consults: With network GP
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2 x 2D scans, paid by scheme
.
.
CANCER (ONCOLOGY):
Primary C
Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • PMBs only
.
.
DENTISTRY:
Primary C
Benefits Gap benefits
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry: consultations, fillings, extractions, and prevention are covered according to protocols
Orthodontics: 2018 benefits are coming soon!
Maxillo Facial Surgery: 2018 benefits are coming soon!
.
.
MEDICATION:
Primary C
Benefits Gap benefits
Chronic: 2018 benefits coming soon. 2017 benefits:
Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • Paid by scheme according to formulary
Over-the-counter:
Birth Control:
On Discharge:
Biological:
.
.
OPTOMETRY:
Primary C
Benefits Gap benefits
Optometry: 2018 benefits coming soon. 2017 benefits:
  • R700 per person every two years
.
.
MENTAL HEALTH:
Primary C
Benefits Gap benefits
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Trauma:
.
.
OTHER BENEFITS:
Primary C
Benefits Gap benefits
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
  • No benefit
1.1. Hearing Aids: 2018 benefits are coming soon!
  • No benefit
1.2. Wheelchairs: 2018 benefits are coming soon!
  • No benefit
Dialysis: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
HIV: 2018 benefits are coming soon!
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: 2018 benefits are coming soon!
  • No benefit
Other: 2018 benefits are coming soon!
.
.
WELLNESS/PREVENTATIVE BENEFITS:
Primary C
Benefits Gap benefits
Flu vaccination: 2018 benefits are coming soon!
  • No benefit
Pneumonia vaccines: 2018 benefits are coming soon!
  • No benefit
Back Rehabilitation Programme: 2018 benefits are coming soon!
  • No benefit
Biometric Screening: 2018 benefits are coming soon!
  • No benefit
Child Immunisation: 2018 benefits are coming soon!
  • No benefit
Pap Smear: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Mammogram: 2018 benefits are coming soon!
  • No benefit
PAS Test: 2018 benefits are coming soon!
  • No benefit
HIV Test: 2018 benefits are coming soon!
  • No benefit
Other:
  • No benefit
.
.
PROSTHETICS:
Primary C
Benefits Gap benefits
Overal Limit:
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