Selfmed Selfnet 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:
Selfnet
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R R R
Cost 2017: (R1,185) (R1,185) (R418)
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:

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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:
Selfnet
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:
  • 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:
  • R1,000 per family
  • from network provider, and maximum 3 visits per year
Other: 2018 benefits are coming soon!
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OUT OF HOSPITAL BENEFITS:
Selfnet
2017 v 2018 benefits Gap benefits Notes
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • Network GP: Unlimited


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Childcare:
  • No benefit
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • R1,070 per person and R2,140 per family from network specialist, including radiology, pathology and medication
Pathology: 2018 benefits coming soon. 2017 benefits:
  • Unlimited subject to network protocol, formulary and referral ny network GP
General radiology: 2018 benefits coming soon. 2017 benefits:
  • Unlimited subject to network protocol, formulary and referral ny network GP
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
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MATERNITY BENEFITS:
Selfnet
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:
  • Subject to network provider
Scans: 2018 benefits coming soon. 2017 benefits:
  • Subject to network provider
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CANCER (ONCOLOGY):
Selfnet
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • PMBs only
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:
Selfnet
2017 v 2018 benefits Gap benefits Notes
Dentistry:
  • Standard dentistry: subject to protocols and use of network dentist

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    Orthodontics: 2018 benefits are coming soon!
    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:
    Selfnet
    2017 v 2018 benefits Gap benefits Notes
    Chronic: 2018 benefits coming soon. 2017 benefits:
    • PMB chronic: paid by scheme

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    Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
    • Covered if prescribed by Network GP and part of formulary
    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:
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    OPTOMETRY:
    Selfnet
    2017 v 2018 benefits Gap benefits Notes
    Optometry: 2018 benefits coming soon. 2017 benefits:
    • One pre-selected frame and set of lenses or contact lenses to value of R460 per person every two years

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    MENTAL HEALTH:
    Selfnet
    2017 v 2018 benefits Gap benefits Notes
    In-hospital: 2018 benefits coming soon. 2017 benefits:
    • Subject to referral by Network GP

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    Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
    • Subject to referral by Network GP
    Trauma:
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    OTHER BENEFITS:
    Selfnet
    2017 v 2018 benefits Gap benefits Notes
    General Appliances: 2018 benefits coming soon. 2017 benefits:
    • PMBs only
    • No benefit

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    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!
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    WELLNESS/PREVENTATIVE BENEFITS:
    Selfnet
    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 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

    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