Resolution Supreme 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:
Supreme
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R R R
Cost 2017: (R4,565) (R4,345) (R1,130)
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:
Supreme
2017 v 2018 benefits Gap benefits Notes
Payout Rate for Specialists: 2018 benefits coming soon. 2017 benefits:
  • 220% scheme rate for contracted providers, otherwise100% scheme rate
  • 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:
  • Unlimited
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • R18,755 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:
  • Unlimited
Co-payments: 2018 benefits coming soon. 2017 benefits:
  • Dental admissions: R2,504 co-payment
  • Hysteroscopy: R2,816 co-payment
  • Arthroscopy, endometrial ablation, laparoscopic procedures, urinary incontinence repair, varicose veins, conservative back, spinal treatment: R3,751 co-payment
  • Joint replacements: R7,157 co-payment
  • Spinal surgery: R7,824 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: 12 days per family
  • Hospice, rehab and step down facility: 21 days per family
Casualty: 2018 benefits coming soon. 2017 benefits:
  • R1,592 per family
Other: 2018 benefits are coming soon!
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OUT OF HOSPITAL BENEFITS:
Supreme
2017 v 2018 benefits Gap benefits Notes
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • Paid from limit below
  • Limit shared with GPs, specialists, dentistry and optometry
MainAdultChild
R14,157R10,618R1,481


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Childcare:
  • No benefit
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • M= 4 consults, M1 =5 consults, M2+ =6 consults, subject to limits below
  • Limit shared with GPs, specialists, dentistry and optometry
MainAdultChild
R14,157R10,618R1,481
Pathology: 2018 benefits coming soon. 2017 benefits:
  • Paid from limit below, with these sub limits: M =R3,183; M1 =R3,907; M2+ =R4,719
  • Limit below shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1M2+
R7,424R13,067R14,191
General radiology: 2018 benefits coming soon. 2017 benefits:
  • Paid from limit below, with these sub limits: M =R3,183; M1 =R3,907; M2+ =R4,719
  • Limit below shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1M2+
R7,424R13,067R14,191
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • R18,755 per family with R1,892 co-payment. In and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Paid from limit below, with these sub limits: M =R3,183; M1 =4,719; M2+ =R6,244
  • Physio: R1,392 per family sub-limit
  • Speech therapy and audiology: R1,592 per family sublimit
  • Limit below shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1M2+
R7,424R13,067R14,191
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MATERNITY BENEFITS:
Supreme
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

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Consultations: 2018 benefits coming soon. 2017 benefits:
  • 9 consults, paid by scheme
  • Antenatal classes: no benefit
  • Baby care products: R918 at DSP
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2 x 2D scans, paid by scheme
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CANCER (ONCOLOGY):
Supreme
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • Unlimited subject to DSP
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:
Supreme
2017 v 2018 benefits Gap benefits Notes
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry: covered up to limits below. Sub limits apply
  • Specialised dentistry: R13,356 sublimit per family. Includes crowns, bridges, implants, metal dentures, periodontics
  • Overall dentistry limit shared with GPs, specialists, dentistry and optometry, as below
MainAdultChild
R14,157R10,618R1,481

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Orthodontics: See above
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:
Supreme
2017 v 2018 benefits Gap benefits Notes
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMB chronic: paid by scheme
  • non-PMBs: Additional 28 conditions covered
  • M= R5,488 and M+= R10,964. Thereafter, only PMBs covered.

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Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • Limit below shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1M2+
R7,424R13,067R14,191
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • Paid from limit below, with these sub limits: M =R2,248; M1 =R3,873; M2+ =R4,229
  • Limit below shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1M2+
R7,424R13,067R14,191
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • R1,496 per female, from preventative benefit limit
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • 7 days supply
Biological:
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OPTOMETRY:
Supreme
2017 v 2018 benefits Gap benefits Notes
Optometry: 2018 benefits coming soon. 2017 benefits:
  • Single vision: R2,104 per person incl frame, lenses and consult
  • Bifocal: R2,538 per person incl frame, lenses and consult
  • Multifocal: R3,183 per person incl frame, lenses and consult
  • or, Contact lenses: R2,371 per person
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  • Paid from limit below, every 2 years.
  • Limit shared with GPs, specialists, dentistry and optometry
  • MainAdultChild
    R14,157R10,618R1,481

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    MENTAL HEALTH:
    Supreme
    2017 v 2018 benefits Gap benefits Notes
    In-hospital: 2018 benefits coming soon. 2017 benefits:
    • R29,962 per family

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    Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
    • R1,392 per family, subject to limit below (shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication)
    MM1M2+
    R7,424R13,067R14,191
    Trauma:
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    OTHER BENEFITS:
    Supreme
    2017 v 2018 benefits Gap benefits Notes
    General Appliances: 2018 benefits coming soon. 2017 benefits:
    • R14,981, with sub limits
    • No benefit

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    1.1. Hearing Aids: See above
    • No benefit
    1.2. Wheelchairs: See above
    • No benefit
    Dialysis: 2018 benefits coming soon. 2017 benefits:
    • Unlimited, 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:
    • R2 million per person per emergency incident
    • No benefit
    Other: 2018 benefits coming soon. 2017 benefits:
    • Cochlear implants: R125,057 per family
    • Trauma counselling: 3 psychologist visits per person
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    WELLNESS/PREVENTATIVE BENEFITS:
    Supreme
    2017 v 2018 benefits Gap benefits Notes
    Flu vaccination: 2018 benefits coming soon. 2017 benefits:
    • Covered subject to overall R3,751 per family for preventative care benefits
    • 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 coming soon. 2017 benefits:
    • Covered subject to overall R3,751 per family for preventative care benefits
    • No benefit
    Child Immunisation: 2018 benefits coming soon. 2017 benefits:
    • Covered subject to overall R3,751 per family for preventative care benefits
    • No benefit
    Pap Smear: 2018 benefits coming soon. 2017 benefits:
    • Covered subject to overall R3,751 per family for preventative care benefits
    • No benefit
    Mammogram: 2018 benefits coming soon. 2017 benefits:
    • Covered subject to overall R3,751 per family for preventative care benefits. 35yrs+.
    • No benefit
    PAS Test: 2018 benefits coming soon. 2017 benefits:
    • Covered subject to overall R3,751 per family for preventative care benefits
    • No benefit
    HIV Test: 2018 benefits coming soon. 2017 benefits:
    • Covered subject to overall R3,751 per family for preventative care benefits
    • No benefit
    Other: 2018 benefits coming soon. 2017 benefits:
    • HPV vaccine
    • Oral contraceptive: R1,496
    • Subject to overall R3,751 per family for preventative care benefits
    • 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