Resolution Progressive Flex 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.

Progressive Flex
2018 Costs:
Total Cost pm:

Main member:

R

Adult:

R

Child:

R
2019 Costs:
Total Cost pm:

Main member:

R
(%)

Adult:

R

Child:

R
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In brief (2018): See full benefits below

IN HOSPITAL PROCEDURES:
Progressive Flex
Scheme Benefits: Gap Benefits:
Specialists:
  • 100% scheme rate
  • You or gap cover pay the balance, if any
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • Recommended for this plan: Plan Blue, R295pm per family where no member is older than 64yrs (otherwise, R435pm per family)
Hospital Choice:
  • Network or R4,110 co-payment
  • No benefit
Specialised Radiology:
  • Limited to R9,957 per family with R1,996 co-payment paid by you or your gap cover
  • In and out of hospital
  • Co-payment paid
  • Sublimit increased as necessary, for approved procedures
  • No benefit for exclusions
  • Out of hospital, co-payment and sublimit increase is for MRI and CT scans only
Supplementary Services: (Physio, etc) TBC
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals, for non-PMB treatment
  • No benefit for out-of-hospital services
Transplants:
  • R118,713 per family for PMB conditions
  • No extra benefit available (PMB benefits are paid in full by medical aid)
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
  • Co-payments paid by you or your gap cover
  • Gap cover pays co-payments for procedures approved by medical aid
Alternatives to hospitals:
  • Home nursing: 5 days per family
  • Rehab and step down facility: 12 days per family
  • Hospice: 15 days for oncology patients
Casualty:
  • R1,680 per family
  • Pays up to R20,000 per person per year for emergency medical treatment not paid for by medical aid
Other:
  • N/A
  • N/A
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):
Progressive Flex
Scheme Benefits Gap benefits
Main: Adult: Child:
General info:
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
GP consultations:
  • M =4 consults, M1 =7 consults, M2+ =9 consults, unless PMB
Childcare:
  • No extra benefit available
Specialists consultations:
  • M =2 consults, M1+ =3 consults, unless PMB
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
  • R9,957 per family with R1,996 co-payment. In and out of hospital
Supplementary Services: (Physio, etc)
  • 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:
Progressive Flex
Scheme Benefits Gap benefits
Hospital stay:
  • Vaginal birth: 3 days, 2 nights
  • Caesarean birth: 4 days, 3 nights
  • Elective Caesarean: no benefit
Consultations:
  • 9 consults, including 3 consults at specialist
  • Antenatal classes: no benefit
  • Baby care products: R634 at DSP pharmacies
Scans:
  • 3 x 2D scans, paid by scheme

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

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CANCER (ONCOLOGY):
Progressive Flex
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • R275,914 per family

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

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DENTISTRY:
Progressive Flex
Scheme Benefits Gap benefits
Dentistry:
  • Standard dentistry: R3,287 per person and R5,284 per family, with sub limits
  • Specialised dentistry: from day to day benefit, with a R5,602 per family sublimit, for crowns and bridges
  • Implants, partial metal dentures and periodontics: no benefit
Orthodontics:
  • You pay this out of pocket
  • No extra benefit available
Maxillo Facial Surgery: 2018 benefits are coming soon!
  • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)

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

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MEDICATION:
Progressive Flex
Scheme Benefits Gap benefits
Chronic:
  • PMB chronic: paid by scheme
  • non-PMB: 10 conditions covered
  • Overall sublimit: R2,795 per person, with PMBs unlimited thereafter
Acute (presrcibed) medication: TBC
Over-the-counter:
  • From day to day benefit with a sublimit of M=R657 and M+1=R921
Birth Control:
  • R1,584 per female, from preventative benefit limit
On Discharge:
  • 7 days supply
Biological:

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

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OPTOMETRY:
Progressive Flex
Scheme Benefits Gap benefits
Optometry:
  • Single vision: R1,210 per person incl frame, lenses and consult
  • Bifocal: R1,844 per person incl frame, lenses and consult
  • Multifocal: R2,137 per person incl frame, lenses and consult
  • or, Contact lenses: R1,210 per person
  • Every 2 years
  • Pays shortfalls and co-payments for any non-PMB in-hospital treatment approved by scheme. (PMBs are paid in full by scheme if you use DSP)

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

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MENTAL HEALTH:
Progressive Flex
Scheme Benefits Gap benefits
In-hospital:
  • PMBs only
Out-of-hospital:
  • From day-to-day benefit
Trauma:
  • Access to Nurse help line, and Rape Crisis Centre

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

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OTHER BENEFITS:
Progressive Flex
Scheme Benefits Gap benefits
General Appliances:
  • External: PMBs only. R4,110 per family, subject to sub limits
  • No benefit
1.1. Hearing Aids: See above
  • No benefit
1.2. Wheelchairs: See above
  • No benefit
Dialysis:
  • PMBs only, at network providers
HIV:
  • Covered at network hospitals if on HIV Management Programme
  • No benefit
Emergency Transport: Netcare 911
  • No benefit
International Insurance:
  • Available, contact scheme
  • No benefit
Other:
  • Cochlear implants: no benefit

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

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WELLNESS/PREVENTATIVE BENEFITS:
Progressive Flex
Scheme Benefits Gap benefits
Flu vaccination:
  • Covered
  • No benefit
Pneumonia vaccines: 2018 benefits are coming soon!
  • No benefit
Back Rehabilitation Programme: 2018 benefits are coming soon!
  • No benefit
Biometric Screening:
  • Covered subject to overall R2,630 per family for tests for blood pressure, blood sugar, cholestrol, BMI
  • No benefit
Child Immunisation:
  • R1,978
  • No benefit
Pap Smear:
  • Covered
  • No benefit
Mammogram:
  • Covered, 40yrs+
  • No benefit
PAS Test:
  • Covered, 45yrs+
  • No benefit
HIV Test:
  • Covered
  • No benefit
Other: 2018 benefits coming soon. 2017 benefits:
  • HPV vaccine
  • Oral contraceptive: R1,496
  • Subject to overall R2,493 per family for preventative care benefits
  • No benefit

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

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PROSTHETICS:
Progressive Flex
Scheme Benefits Gap benefits
Overal Limit:
  • R56,537 per family
Sub-limits:
  • Various sublimits apply, speak to scheme
  • Joint replacements and spinal procedures: PMB only

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