Resolution Hospital 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:
Hospital
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R R R
Cost 2017: (R1,565) (R1,335) (R585)
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:
Hospital
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:
  • Network or R3,896 co-payment
  • R12,800 per person per year for use of a non-network hospital
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • R7,502 per family with R1,892 co-payment. In and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits are coming soon!
Transplants: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Co-payments: 2018 benefits coming soon. 2017 benefits:
  • Excision nail bed, skin lesions, tympanoplasty:R1,881 co-payment
  • Myringotomy, tonsillectomy, adenoidectomy: R2,193 co-payment
  • Dental admissions, circumcision, colonoscopy, sigmoidoscopy, proctoscopy, cystoscopy, gastroscopy: R2,504 co-payment
  • Hysteroscopy: R2,816 co-payment
  • Arthroscopy, endometrial ablation, laparoscopic procedures, urinary incontinence repair, varicose veins, conservative back, spinal treatment, hernia repair, hysterectomy: R3,751 co-payment
  • Nasal surgery: R5,632 co-payment
  • Joint replacements, rotator cuff surgery: R7,157 co-payment
  • Spinal surgery: R7,824 co-payment
  • Reflux surgery: R10,752 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: 2018 benefits coming soon. 2017 benefits:
  • Home nursing: no benefit, unless in lieu of hospitalisation
  • Hospice, rehab and step down facility: 10 days per family
Casualty: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Other: 2018 benefits are coming soon!
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OUT OF HOSPITAL BENEFITS:
Hospital
2017 v 2018 benefits Gap benefits Notes
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • No benefit


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Childcare:
  • No benefit
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Pathology: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
General radiology: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • R7,502 per family with R1,892 co-payment. In and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
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MATERNITY BENEFITS:
Hospital
2017 v 2018 benefits Gap benefits Notes
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • Vaginal birth: 3 days, 2 nights
  • Caesarean birth: 4 days, 3 nights
  • Elective Caesarean: no benefit

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Consultations: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
  • Antenatal classes: no benefit
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2 x 2D scans, paid by scheme
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CANCER (ONCOLOGY):
Hospital
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • R170,693 per family
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:
Hospital
2017 v 2018 benefits Gap benefits Notes
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry:No benefit
  • Specialised dentistry: No benefit
  • Impacted wisdom teeth: R4,375 per family with R2,505 co-payment, in hospital

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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:
Hospital
2017 v 2018 benefits Gap benefits Notes
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMB chronic: paid by scheme

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Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • No benefit
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • 7 days supply
Biological:
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OPTOMETRY:
Hospital
2017 v 2018 benefits Gap benefits Notes
Optometry: 2018 benefits coming soon. 2017 benefits:
  • No benefit

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MENTAL HEALTH:
Hospital
2017 v 2018 benefits Gap benefits Notes
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only

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Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Trauma:
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OTHER BENEFITS:
Hospital
2017 v 2018 benefits Gap benefits Notes
General Appliances: 2018 benefits are coming soon!
  • No benefit

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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, at network providers
HIV: 2018 benefits coming soon. 2017 benefits:
  • Covered at network hospitals if on HIV Management Programme
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: 2018 benefits coming soon. 2017 benefits:
  • R750,000 per person per emergency incident
  • No benefit
Other: 2018 benefits coming soon. 2017 benefits:
  • Cochlear implants: no benefit
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WELLNESS/PREVENTATIVE BENEFITS:
Hospital
2017 v 2018 benefits Gap benefits Notes
Flu vaccination: 2018 benefits are coming soon!
  • 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 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

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