Selfmed MedElite 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:
Med Elite
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: 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:
See full benefits below

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IN HOSPITAL PROCEDURES:
Med Elite
Benefits Gap benefits
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
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. In and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • 200% scheme tariff
  • 2018 benefits coming soon. 2017 benefits:
    Transplants: 2018 benefits coming soon. 2017 benefits:
    • Donor costs covered up to limits only if recipient is part of the scheme
    Co-payments:
    • 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:
    • No benefit, unless PMB
    Other: 2018 benefits are coming soon!
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    OUT OF HOSPITAL BENEFITS:
    Med Elite
    Benefits Gap benefits
    GP consultations: 2018 benefits coming soon. 2017 benefits:
    • No benefit
    Childcare:
    • No benefit
    Specialists consultations: 2018 benefits coming soon. 2017 benefits:
    • No benefit, unless PMB
    Pathology: 2018 benefits coming soon. 2017 benefits:
    • No benefit, unless PMB
    General radiology: 2018 benefits coming soon. 2017 benefits:
    • No benefit, unless PMB
    Specialised radiology: 2018 benefits coming soon. 2017 benefits:
    • R1,100 co-payment. In and out of hospital
    Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
    • No benefit, unless PMB
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    MATERNITY BENEFITS:
    Med Elite
    Benefits Gap benefits
    Hospital stay: 2018 benefits are coming soon!
    Consultations: 2018 benefits coming soon. 2017 benefits:
    • Consults: Unlimited
    • Antenatal classes: R1,600 shared with additional scan benefit
    Scans: 2018 benefits coming soon. 2017 benefits:
    • R1,600 per family, shared with antenatal class benefit
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    CANCER (ONCOLOGY):
    Med Elite
    Benefits Gap benefits
    Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
    • R327,100 per family
    • Biological medicine: R157,600
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    DENTISTRY:
    Med Elite
    Benefits Gap benefits
    Dentistry: 2018 benefits coming soon. 2017 benefits:
    • No benefit, unless PMB
    Orthodontics: 2018 benefits coming soon. 2017 benefits:
    • No benefit
    Maxillo Facial Surgery: 2018 benefits coming soon. 2017 benefits:
    • Non-elective: R1,100 co-payment, unless PMB
    • Elective: No benefit
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    MEDICATION:
    Med Elite
    Benefits Gap benefits
    Chronic: 2018 benefits coming soon. 2017 benefits:
    • R29,000 per family
    Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
    • No benefit
    Over-the-counter: 2018 benefits coming soon. 2017 benefits:
    • No benefit
    Birth Control: 2018 benefits coming soon. 2017 benefits:
    • R1,500 per family
    On Discharge: 2018 benefits coming soon. 2017 benefits:
    • 7 days supply
    Biological:
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    OPTOMETRY:
    Med Elite
    Benefits Gap benefits
    Optometry: 2018 benefits coming soon. 2017 benefits:
    • No benefit
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    MENTAL HEALTH:
    Med Elite
    Benefits Gap benefits
    In-hospital: 2018 benefits coming soon. 2017 benefits:
    • Covered if part of Case Management Programme
    Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
    • No benefit
    Trauma:
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    OTHER BENEFITS:
    Med Elite
    Benefits Gap benefits
    General Appliances: 2018 benefits coming soon. 2017 benefits:
    • No benefit
    • No benefit
    1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
    • No benefit
    • No benefit
    1.2. Wheelchairs: 2018 benefits coming soon. 2017 benefits:
    • No benefit
    • 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:
    Med Elite
    Benefits Gap benefits
    Flu vaccination: 2018 benefits are coming soon!
    • No benefit
    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 are coming soon!
    • No benefit
    Mammogram: 2018 benefits are coming soon!
    • No benefit
    PAS Test: 2018 benefits are coming soon!
    • No benefit
    HIV Test: 2018 benefits are coming soon!
    • No benefit
    Other:
    • No benefit
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    PROSTHETICS:
    Med Elite
    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