Spectramed Azure C 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:
Azure C
Quick Overview
Main: Adult: Child:
Total Cost pm: R4,034 R2,892 R1,417
Savings: R8,472 R6,072 R2,976
Extended Fund: RM=R7,100
M1=R8,600
M2=R9,900
M3=R11,300
M4=R12,700
"Benefit Booster"		 R R
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit:
  • Unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Children: Pay less for 2nd and 3rd child
Income band: This plan is only available to households with income in R11,501+pm band.
View other income bands
See full benefits below

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IN HOSPITAL PROCEDURES:
Azure C
Benefits Gap benefits
Payout Rate for Specialists:
  • 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:
  • Unlimited, but all PMBs subject to Designated Service Provider only or a 30% co-payment
  • DSPs include Netcare and Lifecare hospitals, among others
Specialised Radiology:
  • R1,500 co-paymentand limited to R15,700 per family
Supplementary Services: (Physio, etc)
  • Physio: R5,800 per family
Transplants:
  • R500,000 per family
Co-payments:
  • Dental in-hospital: R2,000 co-payment
  • Gastroscopy, Colonoscopy: R1,500 co-payment if in hospital
  • Sigmoidoscopy: R1,500 co-payment
  • Hysterectomy: R1,500 co-payment
  • Laparoscopy, hysteroscopy, endometrial ablation: R2,000 co-payment
  • Arthroscopy: R1,000 co-payment
  • Reflux surgery: R2,000 co-payment
  • Joint replacement and spinal surgery: R4,500 co-payment
  • Non-surgical admissions: R1,000 co-payment
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals:
  • Nursing and hospice: R8,600 per family
Casualty:
  • Paid from day-to-day benefit
Other: 2018 benefits are coming soon!
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OUT OF HOSPITAL BENEFITS:
Azure C
Benefits Gap benefits
GP consultations:
  • Gastroscopies, colonoscopies, plantar wart removal, removal of ingrown toenail, varicose vein injection/drainage: paid by scheme at 200% scheme rate
  • Otherwise, from day-to-day benefit
Childcare:
  • No benefit
Specialists consultations:
  • Paid from day-to-day benefit
Pathology:
  • Paid from day-to-day benefit
General radiology:
  • Paid from day-to-day benefit
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • R14,600 per family with a R1,500 co-payment
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
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MATERNITY BENEFITS:
Azure C
Benefits Gap benefits
Hospital stay:
  • DSP only
  • Caesarean: R10,500 limit if not authorised
  • Home births: R11,000
Consultations:
  • 10 prenatal consults with midwife
  • 3 postnatal consults with midwife
  • Antenatal classes: R525 per family
  • Otherwise, from day-to-day benefit
Scans:
  • 3x 2D scans paid by scheme
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CANCER (ONCOLOGY):
Azure C
Benefits Gap benefits
Overall coverage (in and out of hospital):
  • Chemo and radiotherapy: R520,000 per family
  • Biological and target therapies: R212,000 per family with 25% co-payment
  • DSP oncologist only
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DENTISTRY:
Azure C
Benefits Gap benefits
Dentistry:
  • Standard dentistry: from day-to-day benefit
  • Specialised dentistry: paid by scheme subject to Benefit Booster benefit, up to M =R5,250; M1 =R6,600; M2 =R7,850; M3 =R9,250; M4+ =R10,600 with further sub-limits
Orthodontics:
  • See above
Maxillo Facial Surgery:
  • See above
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MEDICATION:
Azure C
Benefits Gap benefits
Chronic:
  • PMB chronic: paid by scheme. Must be obtained from DSP or 40% co-payment applies.
  • non-PMB: 7 more conditions, paid by scheme
Acute (presrcibed) medication:
  • Paid from day-to-day benefit
Over-the-counter:
  • Paid from day-to-day benefit
Birth Control:
  • Paid from day-to-day benefit
On Discharge:
  • 5 days supply
Biological:
  • R40,000 per family with a 30% co-payment
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OPTOMETRY:
Azure C
Benefits Gap benefits
Optometry:
  • R2,400 per person every 2 years
  • Frame sublimit: R1,100
  • Paid from day-to-day benefit
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MENTAL HEALTH:
Azure C
Benefits Gap benefits
In-hospital:
  • R18,500 per family
Out-of-hospital:
  • R5,500 per family, subject to Benefit Booster benefit and PMBs
Trauma:
  • No benefit
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OTHER BENEFITS:
Azure C
Benefits Gap benefits
General Appliances:
  • Subject to authorisation, from day-to-day benefit
  • No benefit
1.1. Hearing Aids:
  • No benefit
  • No benefit
1.2. Wheelchairs:
  • No benefit
  • No benefit
Dialysis:
  • DSP only, or a 30% co-payment
HIV:
  • Includes post exposure prophylaxis and mother-to-child transmission
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • No benefit
  • No benefit
Other: 2018 benefits are coming soon!
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WELLNESS/PREVENTATIVE BENEFITS:
Azure C
Benefits Gap benefits
Flu vaccination:
  • Covered, with overall R1,500 per familylimit, shared with most preventative benefits and subject to further sublimits
  • No benefit
Pneumonia vaccines: 2018 benefits are coming soon!
  • No benefit
Back Rehabilitation Programme: 2018 benefits are coming soon!
  • No benefit
Biometric Screening:
  • Covered, with overall R1,500 per familylimit, shared with most preventative benefits and subject to further sublimits
  • No benefit
Child Immunisation: 2018 benefits are coming soon!
  • No benefit
Pap Smear:
  • Covered, with overall R1,500 per familylimit, shared with most preventative benefits and subject to further sublimits
  • No benefit
Mammogram:
  • Covered, with overall R1,500 per familylimit, shared with most preventative benefits and subject to further sublimits
  • 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:
Azure C
Benefits Gap benefits
Overal Limit:
Sub-limits:
  • An additional R40,000 per sublimit, per event

    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