Resolution Supreme 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:
Supreme
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:
Supreme
Benefits Gap benefits
Payout Rate for Specialists:
  • 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
Hospital Choice:
  • Unlimited
Specialised Radiology:
  • R19,787 per family with R1,996 co-payment. In and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits are coming soon!
Transplants:
  • PMB only
Co-payments:
  • No co-payments if performed out of hospital (except for specialised radiology), or if PMB
  • Dental admissions: R2,642 co-payment
  • Specialised radiology: R1,996
  • Hysteroscopy: R2,971 co-payment
  • Arthroscopy, endometrial ablation, laparoscopic procedures, urinary incontinence repair, varicose veins, conservative back, spinal treatment: R3,957 co-payment
  • Joint replacements: R7,550 co-payment
  • Spinal surgery: R8,255 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: 12 days per family
  • Hospice, rehab and step down facility: 21 days per family
Casualty:
  • R1,680 per family
Other: 2018 benefits are coming soon!
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OUT OF HOSPITAL BENEFITS:
Supreme
Benefits Gap benefits
GP consultations:
  • Unlimited
Childcare:
  • No benefit
Specialists consultations:
  • M= 4 consults, M1 =5 consults, M2+ =6 consults, unless PMB
Pathology:
  • Sublimit: M =R3,358; M1 =R4,122; M2+ =R4,979
  • Shared with standard radiology benefit
  • Subject to day-to-day benefit
General radiology:
  • Sublimit: M =R3,358; M1 =R4,122; M2+ =R4,979
  • Shared with pathology benefit
  • Subject to day-to-day benefit
Specialised radiology:
  • R19,787 per family with R1,996 co-payment. In and out of hospital
Supplementary Services: (Physio, etc)
  • Sub limits: M =R3,358; M1 =4,979; M2+ =R6,587
  • Physio sublimit: R1,469 per family
  • Speech therapy and audiology sublimit: R1,680 per family
  • From day-to-day benefit
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MATERNITY BENEFITS:
Supreme
Benefits Gap benefits
Hospital stay:
  • Vaginal birth: 3 days, 2 nights
  • Caesarean birth: 4 days, 3 nights
Consultations:
  • 9 consults, paid by scheme
  • Antenatal classes: no benefit
  • Baby care products: R968 at DSP
Scans:
  • 2 x 2D scans, paid by scheme
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CANCER (ONCOLOGY):
Supreme
Benefits Gap benefits
Overall coverage (in and out of hospital):
  • Unlimited subject to DSP
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DENTISTRY:
Supreme
Benefits Gap benefits
Dentistry:
  • Overall limit: M=R14,936
    Adult dependant= R11,202
    Child dependant (max 3) = R1,562
  • Standard dentistry: from overall limit
  • Specialised dentistry: R14,091 sublimit. Includes crowns, bridges, implants, metal dentures, periodontics
  • No cover for orthognathic surgery
Orthodontics: See above
Maxillo Facial Surgery: 2018 benefits are coming soon!
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MEDICATION:
Supreme
Benefits Gap benefits
Chronic:
  • PMB chronic: paid by scheme
  • non-PMBs: Additional 28 conditions covered
  • R5,790. Thereafter, only PMBs covered.
Acute (presrcibed) medication:
  • From day-to-day benefit
Over-the-counter:
  • From day-to-day benefit
  • Sublimit: M=R2,372
    M1= R4,086
    M2+=R4,462
Birth Control:
  • R1,584 per female, from preventative benefit limit
On Discharge:
  • 7 days supply
Biological:
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OPTOMETRY:
Supreme
Benefits Gap benefits
Optometry:
  • 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
    Benefits Gap benefits
    In-hospital:
    • R31,610 per family
    Out-of-hospital:
    • R1,680 per family from day-to-day benefit
    Trauma:
    • 3 psychologist consults per person
    • R693 per consult
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    OTHER BENEFITS:
    Supreme
    Benefits Gap benefits
    General Appliances:
    • External appliances: R15,805, with sub limits
    • No benefit
    1.1. Hearing Aids: See above
    • No benefit
    1.2. Wheelchairs: See above
    • No benefit
    Dialysis:
    • Unlimited, 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: R131,935 per family
    • Oxygen: R15,805
    • Sleep apnoea: R15,805 for infant younger than 1yr
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    WELLNESS/PREVENTATIVE BENEFITS:
    Supreme
    Benefits Gap benefits
    Flu vaccination:
    • Covered subject to overall R3,957 per family for preventative care benefits
    • 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 R3,957 per family for preventative care benefits
    • No benefit
    Child Immunisation:
    • Covered subject to overall R3,751 per family for preventative care benefits
    • No benefit
    Pap Smear:
    • Covered subject to overall R3,751 per family for preventative care benefits
    • No benefit
    Mammogram:
    • Covered subject to overall R3,751 per family for preventative care benefits. 35yrs+.
    • No benefit
    PAS Test:
    • Covered subject to overall R3,751 per family for preventative care benefits
    • No benefit
    HIV Test:
    • Covered subject to overall R3,751 per family for preventative care benefits
    • No benefit
    Other:
    • HPV vaccine
    • Oral contraceptive: R1,496
    • Subject to overall R3,751 per family for preventative care benefits
    • No benefit
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    PROSTHETICS:
    Supreme
    Benefits Gap benefits
    Overal Limit:
    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