Selfmed Selfnet Essential 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:
Selfnet Essential
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:
  • PMBs only plus R12,000 per family for Adenoidectomy, tonsillectomy and grommets if performed in day hospital
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

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view

.

IN HOSPITAL PROCEDURES:
Selfnet Essential
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:
  • PMBs only
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Transplants: 2018 benefits coming soon. 2017 benefits:
  • Heart, lung, bone-marrow, kidney and liver transplants only. 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!
.
.
.
.
OUT OF HOSPITAL BENEFITS:
Selfnet Essential
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:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
.
.
MATERNITY BENEFITS:
Selfnet Essential
Benefits Gap benefits
Hospital stay: 2018 benefits are coming soon!
Consultations: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Scans: 2018 benefits coming soon. 2017 benefits:
  • No benefit
.
.
CANCER (ONCOLOGY):
Selfnet Essential
Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • PMBs only
.
.
DENTISTRY:
Selfnet Essential
Benefits Gap benefits
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Orthodontics: 2018 benefits are coming soon!
Maxillo Facial Surgery: 2018 benefits are coming soon!
.
.
MEDICATION:
Selfnet Essential
Benefits Gap benefits
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMB chronic: paid by scheme
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:
  • No benefit
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • 7 days supply
Biological:
.
.
OPTOMETRY:
Selfnet Essential
Benefits Gap benefits
Optometry: 2018 benefits coming soon. 2017 benefits:
  • No benefit
.
.
MENTAL HEALTH:
Selfnet Essential
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:
  • Subject to referral by Network GP
Trauma:
.
.
OTHER BENEFITS:
Selfnet Essential
Benefits Gap benefits
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
  • No benefit
1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • 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 are coming soon!
.
.
WELLNESS/PREVENTATIVE BENEFITS:
Selfnet Essential
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
.
.
PROSTHETICS:
Selfnet Essential
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