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.

COSTS and OVERVIEW:
Progressive Flex
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:
Progressive Flex
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 R4,110 co-payment
  • R12,800 per family per year for use of a non-network hospital
Specialised Radiology:
  • R9,957 per family with R1,996 co-payment. In and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits are coming soon!
Transplants:
  • R118,713 per family for PMB conditions
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: 5 days per family
  • Rehab and step down facility: 12 days per family
  • Hospice: 15 days for oncology patients
Casualty:
  • R1,680 per family
Other: 2018 benefits are coming soon!
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OUT OF HOSPITAL BENEFITS:
Progressive Flex
Benefits Gap benefits
GP consultations:
  • M =4 consults, M1 =7 consults, M2+ =9 consults, unless PMB
Childcare:
  • No benefit
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
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MATERNITY BENEFITS:
Progressive Flex
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
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CANCER (ONCOLOGY):
Progressive Flex
Benefits Gap benefits
Overall coverage (in and out of hospital):
  • R275,914 per family
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DENTISTRY:
Progressive Flex
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:
  • No benefit
Maxillo Facial Surgery: 2018 benefits are coming soon!
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MEDICATION:
Progressive Flex
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:
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OPTOMETRY:
Progressive Flex
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
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MENTAL HEALTH:
Progressive Flex
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
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OTHER BENEFITS:
Progressive Flex
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:
  • No benefit
International Insurance:
  • Available, contact scheme
  • No benefit
Other:
  • Cochlear implants: no benefit
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WELLNESS/PREVENTATIVE BENEFITS:
Progressive Flex
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
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PROSTHETICS:
Progressive Flex
Benefits Gap benefits
Overal Limit:
  • Various sublimits apply, speak to scheme
  • Joint replacements and spinal procedures: PMB only
Sub-limits:
  • R56,537 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