Resolution Foundation A 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:
Fundation A
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:
  • Unlimited
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

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IN HOSPITAL PROCEDURES:
Fundation A
Benefits Gap benefits
Payout Rate for Specialists:
  • 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:
  • Network or R3,896 co-payment
  • R12,800 per family per year for use of a non-network hospital
Specialised Radiology:
  • PMBs only
Supplementary Services: (Physio, etc) 2018 benefits are coming soon!
Transplants:
  • PMBs only
Co-payments:
    Co-payments might apply, depending on scheme protocols and alternative available treatment
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals:
  • Home nursing: no benefit, unless in lieu of hospitalisation
  • Hospice, rehab and step down facility: no benefit
Casualty:
  • No benefit, unless PMB
Other: 2018 benefits are coming soon!
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OUT OF HOSPITAL BENEFITS:
Fundation A
Benefits Gap benefits
GP consultations:
  • Network GP: Unlimited
Childcare:
  • No benefit
Specialists consultations:
  • No benefit, unless PMB
Pathology:
  • No benefit, unless PMB
General radiology:
  • No benefit, unless PMB
Specialised radiology:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
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MATERNITY BENEFITS:
Fundation A
Benefits Gap benefits
Hospital stay:
  • Vaginal birth: 3 days, 2 nights
  • Caesarean birth: 4 days, 3 nights
  • Elective Caesarean: no benefit
Consultations:
  • Consults by GP or midwife only. Specialists require authorisation
  • Antenatal classes: no benefit
Scans:
  • 2 x 2D scans, paid by scheme
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CANCER (ONCOLOGY):
Fundation A
Benefits Gap benefits
Overall coverage (in and out of hospital):
  • R76,686 per family
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DENTISTRY:
Fundation A
Benefits Gap benefits
Dentistry:
  • Standard dentistry: R1,870 per person and R3,116 per family, with sub limits
  • Specialised dentistry: No benefit
Orthodontics:
  • No benefit
Maxillo Facial Surgery: 2018 benefits are coming soon!
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MEDICATION:
Fundation A
Benefits Gap benefits
Chronic:
  • PMB chronic: paid by scheme
Acute (presrcibed) medication:
  • Limited to network providers and formularies
Over-the-counter:
  • Limited to network providers and formularies
Birth Control:
  • No benefit
On Discharge:
  • 7 days supply
Biological:
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OPTOMETRY:
Fundation A
Benefits Gap benefits
Optometry:
  • Single vision: R1,046 per person incl frame, lenses and consult
  • Bifocal: R1,592per person incl frame, lenses and consult
  • Multifocal: no benefit
  • Contact lenses: no benefit
  • Every 2 years
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MENTAL HEALTH:
Fundation A
Benefits Gap benefits
In-hospital:
  • PMBs only
Out-of-hospital:
  • PMBs only
Trauma:
  • Access to Nurse help line, and Rape Crisis Centre
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OTHER BENEFITS:
Fundation A
Benefits Gap benefits
General Appliances: 2018 benefits are coming soon!
  • No benefit
1.1. Hearing Aids: 2018 benefits are coming soon!
  • No benefit
1.2. Wheelchairs: 2018 benefits are coming soon!
  • No benefit
Dialysis:
  • PMBs only, at network providers
HIV:
  • Covered at network hospitals if on HIV Management Programme
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • No benefit
  • No benefit
Other:
  • Cochlear implants: no benefit
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WELLNESS/PREVENTATIVE BENEFITS:
Fundation A
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:
  • Covered
  • No benefit
Mammogram: 2018 benefits are coming soon!
  • No benefit
PAS Test:
  • Covered
  • No benefit
HIV Test:
  • Covered
  • No benefit
Other:
  • No benefit
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PROSTHETICS:
Fundation A
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