Spectramed Cyan B 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:
Cyan B
Quick Overview
Main: Adult: Child:
Total Cost pm: R2,647 R2,572 R1,061
Savings: R4,128 R4,008 R1,656
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:
Income band: This plan is only available to households with income in R8,001+pm band.
View other income bands
See full benefits below

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IN HOSPITAL PROCEDURES:
Cyan B
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-payment and limited to R4,700 per family
Supplementary Services: (Physio, etc)
  • Physio: R2,900 per family
Transplants:
  • R200,000 per family
Co-payments:
  • Dental in-hospital, hysterectomy: R2,500 co-payment
  • Gastroscopy, Colonoscopy: R1,500 co-payment if in hospital
  • Sigmoidoscopy: R1,500 co-payment
  • Reflux surgery: R3,000 co-payment
  • Laparoscopy, hysteroscopy, endometrial ablation: R2,500 co-payment
  • Procedural arthroscopy: R2,000 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:
  • No benefit
Casualty:
  • Paid from day-to-day benefit
Other:
  • Diagnostic arthroscopy: no benefit
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OUT OF HOSPITAL BENEFITS:
Cyan B
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:
  • R4,500 per family with a R1,500 co-payment
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
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MATERNITY BENEFITS:
Cyan B
Benefits Gap benefits
Hospital stay:
  • R12,500 unless at DSP
  • Caesarean: R10,500 limit if not authorised
  • Home births: R5,800
Consultations:
  • 10 prenatal consults with midwife
  • 3 postnatal consults with midwife
  • Antenatal classes: R500 per family
  • Otherwise, from day-to-day benefit
Scans:
  • 2x 2D scans paid by scheme
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CANCER (ONCOLOGY):
Cyan B
Benefits Gap benefits
Overall coverage (in and out of hospital):
  • Chemo and radiotherapy: R120,000 per family
  • Biological and target therapies: R105,000 per family with 30% co-payment
  • DSP oncologist only
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DENTISTRY:
Cyan B
Benefits Gap benefits
Dentistry:
  • Paid from day-to-day benefit
Orthodontics:
  • Paid from day-to-day benefit
Maxillo Facial Surgery: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
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MEDICATION:
Cyan B
Benefits Gap benefits
Chronic:
  • PMB chronic: paid by scheme
  • non-PMB: 3 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:
  • No benefit
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OPTOMETRY:
Cyan B
Benefits Gap benefits
Optometry:
  • M =R750; M1 =R1,100; M2 =R1,350; M3 =R1,650; M4+ =R2,000
  • Frame sublimit: R440
  • Paid from day-to-day benefit
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MENTAL HEALTH:
Cyan B
Benefits Gap benefits
In-hospital:
  • R7,000 per family, at DSP only
Out-of-hospital:
  • Paid from day-to-day benefit
Trauma:
  • No benefit
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OTHER BENEFITS:
Cyan B
Benefits Gap benefits
General Appliances:
  • Subject to authorisation, from day-to-day benefit
  • No benefit
1.1. Hearing Aids: 2018 benefits are coming soon!
  • No benefit
1.2. Wheelchairs: 2018 benefits are coming soon!
  • 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:
Cyan B
Benefits Gap benefits
Flu vaccination:
  • Covered, with overall R1,100 per familylimit, shared with most preventative benefits
  • 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 R1,100 per familylimit, shared with most preventative benefits
  • No benefit
Child Immunisation: 2018 benefits are coming soon!
  • No benefit
Pap Smear:
  • Covered, with overall R1,100 per familylimit, shared with most preventative benefits
  • No benefit
Mammogram: 2018 benefits are coming soon!
  • No benefit
PAS Test: 2018 benefits are coming soon!
  • No benefit
HIV Test:
  • Covered, with overall R1,100 per familylimit, shared with most preventative benefits
  • No benefit
Other:
  • No benefit
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PROSTHETICS:
Cyan B
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