Selfmed 80% 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:
Selfmed 80%
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R R R
Cost 2017: (R6,335) (R5,485) (R1,100)
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:
Selfmed 80%
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
  • R12,800 per person per year for use of a non-network hospital
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • R1,100 co-payment
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Unlimited
Transplants: 2018 benefits coming soon. 2017 benefits:
  • Donor costs covered up to limits only if recipient is part of the scheme
Co-payments: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment for consults and clinical procedures
  • 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 are coming soon!
Casualty: 2018 benefits coming soon. 2017 benefits:
  • Benefits shared with GP consults and acute medicine
Other: 2018 benefits are coming soon!
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OUT OF HOSPITAL BENEFITS:
Selfmed 80%
2017 v 2018 benefits Gap benefits Notes
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and limited to M =consults, M1 = 30 consults and M2+ =45 consults
  • Shared with GP and Specialist consults>/li>


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Childcare:
  • No benefit
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and limited to M =consults, M1 = 30 consults and M2+ =45 consults
  • Shared with GP and Specialist consults>/li>
Pathology: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment
General radiology: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • 20% + R1,1000 co-payment
  • Scheme rate applies
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Medical and clinical technology: 20% co-payment
  • Physio, speech therapy, occupational therapy, podiatry, orthotic treatment, hearing aid acoustics, dieticians, chiropractors, osteopaths, homeopaths, naturopaths, herbalists and biokinetics: 20% co-payment and limited to R4,800 per person and R13,600 per family
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MATERNITY BENEFITS:
Selfmed 80%
2017 v 2018 benefits Gap benefits Notes
Hospital stay: 2018 benefits are coming soon!
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Consultations: 2018 benefits coming soon. 2017 benefits:
  • Benefits shared with GP and specialist benefit
  • Antenatal classes: R1,400 shared with scan benefit
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2 x 2D scans
  • Additional scans: shared with antenatal class benefit up to R1,400 in total
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CANCER (ONCOLOGY):
Selfmed 80%
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • R408,500 per family
  • Biological medicine: R157,600
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:
Selfmed 80%
2017 v 2018 benefits Gap benefits Notes
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry: 20% co-payment
  • Specialised dentistry: 20% co-payment and limited to R7,700 per person and R23,600 per family
  • Implants: 20% co-payment and limited to R5,600 per person

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Orthodontics: 2018 benefits are coming soon!
Maxillo Facial Surgery: 2018 benefits coming soon. 2017 benefits:
  • Non-elective: 20% co-payment

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:
Selfmed 80%
2017 v 2018 benefits Gap benefits Notes
Chronic: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and R23,300 per person and R45,400 per family

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Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and R5,800 per person and R17,200 per family
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and R1,500 per family
  • Shared with acute medicine and birth control benefit
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and R1,500 per family
  • Shared with acute medicine and OTC benefit
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • 7 days supply
Biological:
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OPTOMETRY:
Selfmed 80%
2017 v 2018 benefits Gap benefits Notes
Optometry: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment
  • Refractive surgery: No benefit

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MENTAL HEALTH:
Selfmed 80%
2017 v 2018 benefits Gap benefits Notes
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • Covered if part of Case Management Programme

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Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and limited to R8,800
Trauma:
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OTHER BENEFITS:
Selfmed 80%
2017 v 2018 benefits Gap benefits Notes
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and limited to R5,300 per family
  • This may be increased to R15,900 with respect to certain appliances, under case management
  • No benefit

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1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
  • 20% co-payment and limited to R16,200 per family
  • No benefit
1.2. Wheelchairs: 2018 benefits are coming soon!
  • No benefit
Dialysis: 2018 benefits coming soon. 2017 benefits:
  • Unlimited
HIV: 2018 benefits coming soon. 2017 benefits:
  • Covered if part of Disease management Programme
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: 2018 benefits are coming soon!
  • No benefit
Other: 2018 benefits coming soon. 2017 benefits:
  • Cochlear implant: R74,500 per implant
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WELLNESS/PREVENTATIVE BENEFITS:
Selfmed 80%
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 coming soon. 2017 benefits:
  • Covered
  • No benefit
Mammogram: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • 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