Medimed Essential C medical aid plan: 2018

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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.

Essential C
2018 Costs:
Total Cost pm:

Main member:

R

Adult:

R

Child:

R
2019 Costs:
Total Cost pm:

Main member:

R
(%)

Adult:

R

Child:

R
Income band:
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In brief (2018): See full benefits below

IN HOSPITAL PROCEDURES:
Essential C
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:
  • Network, or a 20% co-payment applies
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • 3 scans per family, up to R10,000 per family, in and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • R2,000 per person
Transplants: 2018 benefits coming soon. 2017 benefits:
  • R50,000 per family
  • Benefit is shared with Dialysis and Oncology Benefit
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:
  • R6,000 per person
Casualty:
  • Paid from day-to-day benefit
  • Other: 2018 benefits are coming soon!
    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)

    No phone calls!
    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):
    Essential C
    Scheme Benefits Gap benefits
    Main: Adult: Child:
    General info:
    GP consultations: 2018 benefits coming soon. 2017 benefits:
    • Network GPs: Unlimited, paid by scheme
    • Non-network GPs: 6 consults per person, paid from day-to-day benefit
    Childcare:
    • No extra benefit available
    Specialists consultations: 2018 benefits coming soon. 2017 benefits:
    • R3,000 per person and R6,000 per family
    • Paid by scheme
    Pathology: 2018 benefits coming soon. 2017 benefits:
    • Unlimited
    • Paid by scheme
    General radiology: 2018 benefits coming soon. 2017 benefits:
    • Unlimited
    • Paid by scheme
    Specialised radiology: 2018 benefits coming soon. 2017 benefits:
    • 3 scans per family, up to R10,000 per family, in and out of hospital.
    • Paid by scheme
    Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

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

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    MATERNITY BENEFITS:
    Essential C
    Scheme Benefits Gap benefits
    Hospital stay: 2018 benefits coming soon. 2017 benefits:
    • Covered
    Consultations: 2018 benefits coming soon. 2017 benefits:
    • No additional benefits (see out-of-hospital GP and Specialist benefit)
    Scans: 2018 benefits coming soon. 2017 benefits:
    • No additional benefits (see out-of-hospital radiology benefit)

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

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    CANCER (ONCOLOGY):
    Essential C
    Scheme Benefits Gap benefits
    Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
    • R50,000 per family, shared with dialysis and organ transplants benefit

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

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    DENTISTRY:
    Essential C
    Scheme Benefits Gap benefits
    Dentistry: 2018 benefits coming soon. 2017 benefits:
    • R3,200 per person and R5,500 per family
    • One set of plastic dentures every two years
    • In-hospital (wisdom teeth and children under 12): R7,000 per family
    • Paid by scheme
    Orthodontics: See above
    Maxillo Facial Surgery: See above

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

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    MEDICATION:
    Essential C
    Scheme Benefits Gap benefits
    Chronic: 2018 benefits coming soon. 2017 benefits:
    • PMB chronic: paid by scheme on authorisation
    Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
    • Unlimited if prescribed by GP according to formulary
    • Paid by scheme
    Over-the-counter: 2018 benefits coming soon. 2017 benefits:
    • R100 per prescription, and R400 per family
    • Paid from day-to-day benefit
    Birth Control:
    On Discharge: 2018 benefits coming soon. 2017 benefits:
    • See "Acute Medicine" benefit
    Biological:

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

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    OPTOMETRY:
    Essential C
    Scheme Benefits Gap benefits
    Optometry: 2018 benefits coming soon. 2017 benefits:
    • Eye test: R235 per person every 2 years at network provider
    • Frames: R200 per person every two years
    • Lenses: R140 per person for single vision or R310 per person for bi/multifocals every 2 years
    • Contact Lenses: R650 per person, every 2 years as an alternative to glasses
    • Paid by scheme

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

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    MENTAL HEALTH:
    Essential C
    Scheme Benefits Gap benefits
    In-hospital: 2018 benefits coming soon. 2017 benefits:
    • R4,000 per person
    Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
    • R3,000 per person and R6,000 per family, shared with out-of-hospital specialist benefit
    Trauma:

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

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    OTHER BENEFITS:
    Essential C
    Scheme Benefits Gap benefits
    General Appliances: 2018 benefits coming soon. 2017 benefits:
    • Paid from day-to-day benefit
    • No benefit
    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 coming soon. 2017 benefits:
    • R50,000 per family, shared with organ transplant and oncology benefits
    HIV: 2018 benefits coming soon. 2017 benefits:
    • Unlimited, subject to protocols
    • No benefit
    Emergency Transport: ER 24
    • No benefit
    International Insurance: 2018 benefits are coming soon!
    • 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:
    Essential C
    Scheme 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 are coming soon!
    • 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

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

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    PROSTHETICS:
    Essential C
    Scheme Benefits Gap benefits
    Overal Limit:
    Sub-limits:

    No phone calls!
    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