Selfmed Selfsure 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:
Selfsure
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R R R
Cost 2017: (R2,456) (R2,451) (R836)
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:
Selfsure
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:
  • R1,600 co-payment. In and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • 100% 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:
    • Combined with GP and Acute medicine benefit
    Other: 2018 benefits coming soon. 2017 benefits:
    • Joint replacements: no benefit, unless PMBs
    • Spinal surgery: no benefit, unless PMBs
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    OUT OF HOSPITAL BENEFITS:
    Selfsure
    2017 v 2018 benefits Gap benefits Notes
    GP consultations: 2018 benefits coming soon. 2017 benefits:
    • Paid from day-to-day benefit


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    Childcare:
    • No benefit
    Specialists consultations: 2018 benefits coming soon. 2017 benefits:
    • Paid from day-to-day benefit
    Pathology: 2018 benefits coming soon. 2017 benefits:
    • R4,900 per person or R6,900 per family
    • Shared with radiology, pathology, standard dentistry, physio and biokinetics
    General radiology: 2018 benefits coming soon. 2017 benefits:
    • R4,900 per person or R6,900 per family
    • Shared with radiology, pathology, standard dentistry, physio and biokinetics
    Specialised radiology: 2018 benefits coming soon. 2017 benefits:
    • R1,600 co-payment. In and out of hospital
    Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
      Physio and biokinetics:
    • R4,900 per person or R6,900 per family. Shared with radiology, pathology, standard dentistry, physio and biokinetics
    • Otherwise, from day-to-day benefits
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    MATERNITY BENEFITS:
    Selfsure
    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:
    • Consults: Unlimited
    • Antenatal classes: R1,600 shared with additional scan benefit
    Scans: 2018 benefits coming soon. 2017 benefits:
    • 2 x 2D scans
    • Additional scans: shared with antenatal class benefit
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    CANCER (ONCOLOGY):
    Selfsure
    2017 v 2018 benefits Gap benefits Notes
    Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
    • R242,400 per family
    • Biological medicine: No benefit
    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:
    Selfsure
    2017 v 2018 benefits Gap benefits Notes
    Dentistry: 2018 benefits coming soon. 2017 benefits:
    • Standard dentistry: R4,900 per person or R6,900 per family. Shared with radiology, pathology, standard dentistry, physio and biokinetics
    • Specialised dentistry: from day-to-day limit

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    Orthodontics: 2018 benefits are coming soon!
    Maxillo Facial Surgery: 2018 benefits coming soon. 2017 benefits:
    • Non-elective: R1,100 co-payment, unless PMB
    • Elective: R1,100 co-payment, and subject to day-to-day 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

    MEDICATION:
    Selfsure
    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:
    • Paid from day-to-day benefit
    Over-the-counter: 2018 benefits coming soon. 2017 benefits:
    • Paid from day-to-day 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:
    Selfsure
    2017 v 2018 benefits Gap benefits Notes
    Optometry: 2018 benefits coming soon. 2017 benefits:
    • R2,600 per person and R5,100 per family
    • Refractive surgery: No benefit

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    MENTAL HEALTH:
    Selfsure
    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:
    • No benefit
    Trauma:
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    OTHER BENEFITS:
    Selfsure
    2017 v 2018 benefits Gap benefits Notes
    General Appliances: 2018 benefits coming soon. 2017 benefits:
    • R4,300 per family
    • This may be increased to R12,900 with respect to certain appliances, under case management
    • No benefit

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    1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
    • No benefit
    • No benefit
    1.2. Wheelchairs: See above
    • 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: R30,200 per implant
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    WELLNESS/PREVENTATIVE BENEFITS:
    Selfsure
    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