Resolution Hospital 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:
Hospital
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:
See full benefits below

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IN HOSPITAL PROCEDURES:
Hospital
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:
  • Unlimited
  • R12,800 per family per year for use of a non-network hospital
Specialised Radiology:
  • R7,915 per family with R1,996 co-payment. In and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits are coming soon!
Transplants:
  • State hospitals only
Co-payments:
  • No co-payments if performed out of hospital (except for specialised radiology), or if PMB
  • Specialised radiology: R1,996
  • Excision nail bed, skin lesions, tympanoplasty:R1,984 co-payment
  • Myringotomy, tonsillectomy, adenoidectomy: R2,313 co-payment
  • Dental admissions, circumcision, colonoscopy, sigmoidoscopy, proctoscopy, cystoscopy, gastroscopy: R2,642 co-payment
  • Hysteroscopy: R2,971 co-payment
  • Arthroscopy, endometrial ablation, laparoscopic procedures, urinary incontinence repair, varicose veins, conservative back or spinal treatment, hernia repair, hysterectomy: R3,957 co-payment
  • Nasal surgery: R5,942 co-payment
  • Joint replacements, rotator cuff surgery: R7,550 co-payment
  • Spinal surgery: R8,255 co-payment
  • Reflux surgery: R11,343 co-payment
  • 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: in lieu of hospitalisation
  • Hospice, rehab and step down facility: 10 days per family
Casualty:
  • No benefit, unless PMB
Other: 2018 benefits are coming soon!
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OUT OF HOSPITAL BENEFITS:
Hospital
Benefits Gap benefits
GP consultations:
  • 2 consults per person, unlimited for PMBs
Childcare:
  • No benefit
Specialists consultations:
  • No benefit, unless PMB
Pathology:
  • No benefit, unless PMB
General radiology:
  • No benefit, unless PMB
Specialised radiology:
  • R7,915 per family with R1,996 co-payment. In and out of hospital
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
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MATERNITY BENEFITS:
Hospital
Benefits Gap benefits
Hospital stay:
  • Vaginal birth: 3 days, 2 nights
  • Caesarean birth: 4 days, 3 nights
  • Elective Caesarean: no benefit
Consultations:
  • PMBs only
  • Antenatal classes: no benefit
Scans:
  • 2 x 2D scans, paid by scheme
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CANCER (ONCOLOGY):
Hospital
Benefits Gap benefits
Overall coverage (in and out of hospital):
  • R180,081 per family
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DENTISTRY:
Hospital
Benefits Gap benefits
Dentistry:
  • Standard dentistry:No benefit
  • Specialised dentistry: No benefit
  • Impacted wisdom teeth: R4,616 per family with R2,642 co-payment, in hospital
Orthodontics:
  • No benefit
Maxillo Facial Surgery: 2018 benefits are coming soon!
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MEDICATION:
Hospital
Benefits Gap benefits
Chronic:
  • PMB chronic: paid by scheme
Acute (presrcibed) medication:
  • No benefit
Over-the-counter:
  • No benefit
Birth Control:
  • R1,000, subject to R2,493 sublimit for preventative benefits
On Discharge:
  • 7 days supply
Biological:
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OPTOMETRY:
Hospital
Benefits Gap benefits
Optometry:
  • No benefit
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MENTAL HEALTH:
Hospital
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:
Hospital
Benefits Gap benefits
General Appliances:
  • External: R4,122 per family, subject to PMBs and various sub-limits per appliance
    • No benefit
    1.1. Hearing Aids: See above, every 3 years
    • No benefit
    1.2. Wheelchairs: See above, every 3 years
    • No benefit
    Dialysis:
    • PMBs only, at network providers
    HIV:
    • Covered if on HIV Management Programme
    • No benefit
    Emergency Transport:
    • No benefit
    International Insurance:
    • Available, contact scheme
    • No benefit
    Other:
    • Cochlear implants: no benefit
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    WELLNESS/PREVENTATIVE BENEFITS:
    Hospital
    Benefits Gap benefits
    Flu vaccination:
    • Covered, with a R2,493 limit for all preventative benefits
    • 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:
    • Covered, with a R2,493 limit for all preventative benefits, and a sublimit of R1,875
    • No benefit
    Pap Smear:
    • Covered for 45yrs+, with a R2,493 limit for all preventative benefits
    • No benefit
    Mammogram: 2018 benefits are coming soon!
    • No benefit
    PAS Test:
    • Covered for 45yrs+, with a R2,493 limit for all preventative benefits
    • No benefit
    HIV Test: 2018 benefits are coming soon!
    • No benefit
    Other:
    • No benefit
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    PROSTHETICS:
    Hospital
    Benefits Gap benefits
    Overal Limit:
    • Various sublimits apply, speak to scheme
    Sub-limits:
    • R37,685 per family

      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