Selfmed Selfnet 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.

Selfnet
2018 Costs:
Total Cost pm:

Main member:

R

Adult:

R

Child:

R
2019 Costs:
Total Cost pm:

Main member:

R
(%)

Adult:

R

Child:

R
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In brief (2018): See full benefits below

IN HOSPITAL PROCEDURES:
Selfnet
Scheme Benefits: Gap Benefits:
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:
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!
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)

No phone calls!
Our quote will include the right gap cover for this plan

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Selfnet
Scheme Benefits Gap benefits
Main: Adult: Child:
General info:
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • Network GP: Unlimited
Childcare:
  • No extra benefit available
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

No phone calls!
Our quote will include the right gap cover for this plan

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MATERNITY BENEFITS:
Selfnet
Scheme Benefits Gap benefits
Hospital stay: 2018 benefits are coming soon!
Consultations: 2018 benefits coming soon. 2017 benefits:
  • Subject to network provider
Scans: 2018 benefits coming soon. 2017 benefits:
  • Subject to network provider

No phone calls!
Our quote will include the right gap cover for this plan

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CANCER (ONCOLOGY):
Selfnet
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • PMBs only

No phone calls!
Our quote will include the right gap cover for this plan

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DENTISTRY:
Selfnet
Scheme Benefits Gap benefits
Dentistry:
  • Standard dentistry: subject to protocols and use of network dentist
  • Orthodontics: 2018 benefits are coming soon!
    Maxillo Facial Surgery: 2018 benefits are coming soon!

    No phone calls!
    Our quote will include the right gap cover for this plan

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    MEDICATION:
    Selfnet
    Scheme Benefits Gap benefits
    Chronic: 2018 benefits coming soon. 2017 benefits:
    • PMB chronic: paid by scheme
    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:

    No phone calls!
    Our quote will include the right gap cover for this plan

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    OPTOMETRY:
    Selfnet
    Scheme Benefits Gap benefits
    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

    No phone calls!
    Our quote will include the right gap cover for this plan

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    MENTAL HEALTH:
    Selfnet
    Scheme Benefits Gap benefits
    In-hospital: 2018 benefits coming soon. 2017 benefits:
    • Subject to referral by Network GP
    Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
    • Subject to referral by Network GP
    Trauma:

    No phone calls!
    Our quote will include the right gap cover for this plan

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    OTHER BENEFITS:
    Selfnet
    Scheme 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: ER24
    • No benefit
    International Insurance: 2018 benefits are coming soon!
    • No benefit
    Other: 2018 benefits are coming soon!

    No phone calls!
    Our quote will include the right gap cover for this plan

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    WELLNESS/PREVENTATIVE BENEFITS:
    Selfnet
    Scheme 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

    No phone calls!
    Our quote will include the right gap cover for this plan

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    PROSTHETICS:
    Selfnet
    Scheme Benefits Gap benefits
    Overal Limit:
    Sub-limits:

    No phone calls!
    Our quote will include the right gap cover for this plan


      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