Topmed Comprehensive medical aid plan: 2019

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.

Comprehensive
2018 Costs:
Total Cost pm:

Main member:

R6,672

Adult:

R5,506

Child: (Pay only for first 3)

R1,566
Savings Account:
  • No savings option on this plan
Extended Fund: R9,816 R8,316 R2,172
Self Payment Gap:
R3216 R2412 R804
Above Threshold:
  • Once your savings are depleted, and you have paid the self payment gap, scheme will cover most out of hospital expenses at scheme rate, with sublimits for some benefits.
2019 Costs:
Total Cost pm:

Main member:

R7,306
(%)

Adult:

R6,029

Child: (Pay only for first 3)

R1,715
Savings (per year):
  • No savings option on this plan
Self Payment Gap:
R R R
Need help?
NEW! Are you on this plan?

We can help you determine whether this is still the best plan for you, and offer you some options to consider, if applicable. This is a free, online and personalised service, available to members who do not have a broker. Please click here to start.
In brief (2018): See full benefits below

IN HOSPITAL PROCEDURES:
Comprehensive
Scheme Benefits: Gap Benefits:
Specialists: 2019 Benefits coming soon! 2019 Benefits coming soon!
Hospital Choice: 2019 Benefits coming soon! 2019 Benefits coming soon!
Specialised Radiology:
  • R2,600 co-payment paid by you or your gap cover
  • Gap cover pays co-payments for procedures approved by medical aid
Supplementary Services: (Physio, etc) 2019 Benefits coming soon! 2019 Benefits coming soon!
Transplants: 2019 Benefits coming soon! 2019 Benefits coming soon!
Co-payments: 2019 Benefits coming soon! 2019 Benefits coming soon!
Alternatives to hospitals: 2019 Benefits coming soon! 2019 Benefits coming soon!
Casualty: 2019 Benefits coming soon! 2019 Benefits coming soon!
Other: 2019 Benefits coming soon! 2019 Benefits 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)
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.

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.

.
.
.
.
OUT OF HOSPITAL BENEFITS (non-PMB):
Comprehensive
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: No savings option on this plan
Extended Fund: R9,816 R8,316 R2,172
Self Payment:
(per year, if you use up all your savings)
R3216 R2412 R804
Above Threshold: Once your savings are depleted, and you have paid the self payment gap, scheme will cover most out of hospital expenses at scheme rate, with sublimits for some benefits.
General info: 2019 Benefits coming soon! 2019 Benefits coming soon!
GP consultations: 2019 Benefits coming soon! 2019 Benefits coming soon!
Childcare: 2019 Benefits coming soon!
  • No extra benefit available
Specialists consultations: 2019 Benefits coming soon! 2019 Benefits coming soon!
Pathology: 2019 Benefits coming soon! 2019 Benefits coming soon!
General radiology: 2019 Benefits coming soon! 2019 Benefits coming soon!
Specialised radiology: 2019 Benefits coming soon! 2019 Benefits coming soon!
Supplementary Services: (Physio, etc) 2019 Benefits coming soon! 2019 Benefits coming soon!
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
.
.
MATERNITY BENEFITS:
Comprehensive
Scheme Benefits Gap benefits
Hospital stay: 2019 Benefits coming soon! 2019 Benefits coming soon!
Consultations: 2019 Benefits coming soon! 2019 Benefits coming soon!
Scans: 2019 Benefits coming soon! 2019 Benefits coming soon!
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
.
.
CANCER (ONCOLOGY):
Comprehensive
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital): 2019 Benefits coming soon! 2019 Benefits coming soon!
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
.
.
DENTISTRY:
Comprehensive
Scheme Benefits Gap benefits
Standard Dentistry: 2019 Benefits coming soon!
Specialised Dentistry: 2019 Benefits coming soon! 2019 Benefits coming soon!
In-Hospital Dentistry: 2019 Benefits coming soon!
Orthodontics: 2019 Benefits coming soon!
Maxillo Facial Surgery: 2019 Benefits coming soon! 2019 Benefits coming soon!
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
.
.
MEDICATION:
Comprehensive
Scheme Benefits Gap benefits
Chronic: 2019 Benefits coming soon! 2019 Benefits coming soon!
Acute (presrcibed) medication: 2019 Benefits coming soon! 2019 Benefits coming soon!
Over-the-counter: 2019 Benefits coming soon! 2019 Benefits coming soon!
Birth Control: 2019 Benefits coming soon! 2019 Benefits coming soon!
On Discharge: 2019 Benefits coming soon! 2019 Benefits coming soon!
Biological: 2019 Benefits coming soon! 2019 Benefits coming soon!
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
.
.
OPTOMETRY:
Comprehensive
Scheme Benefits Gap benefits
Optometry: 2019 Benefits coming soon! 2019 Benefits coming soon!
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
.
.
MENTAL HEALTH:
Comprehensive
Scheme Benefits Gap benefits
In-hospital: 2019 Benefits coming soon! 2019 Benefits coming soon!
Out-of-hospital: 2019 Benefits coming soon! 2019 Benefits coming soon!
Trauma: 2019 Benefits coming soon! 2019 Benefits coming soon!
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
.
.
OTHER BENEFITS:
Comprehensive
Scheme Benefits Gap benefits
General Appliances: 2019 Benefits coming soon!
  • No benefit
1.1. Hearing Aids: 2019 Benefits coming soon!
  • No benefit
1.2. Wheelchairs: 2019 Benefits coming soon!
  • No benefit
Dialysis: 2019 Benefits coming soon! 2019 Benefits coming soon!
HIV: 2019 Benefits coming soon!
  • No benefit
Emergency Transport: 2019 Benefits coming soon!
  • No benefit
International Insurance: 2019 Benefits coming soon!
  • No benefit
Other: 2019 Benefits coming soon! 2019 Benefits coming soon!
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
.
.
WELLNESS/PREVENTATIVE BENEFITS:
Comprehensive
Scheme Benefits Gap benefits
Flu vaccination: 2019 Benefits coming soon!
  • No benefit
Pneumonia vaccines: 2019 Benefits coming soon!
  • No benefit
Back Rehabilitation Programme: 2019 Benefits coming soon!
  • No benefit
Biometric Screening: 2019 Benefits coming soon!
  • No benefit
Child Immunisation: 2019 Benefits coming soon!
  • No benefit
Pap Smear: 2019 Benefits coming soon!
  • No benefit
Mammogram: 2019 Benefits coming soon!
  • No benefit
PAS Test: 2019 Benefits coming soon!
  • No benefit
HIV Test: 2019 Benefits coming soon!
  • No benefit
Other: 2019 Benefits coming soon!
  • No benefit
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
.
.
PROSTHETICS:
Comprehensive
Scheme Benefits Gap benefits
Overal Limit: 2019 Benefits coming soon!
  • An additional R40,000 per sublimit, per event
Sub-limits: 2019 Benefits coming soon!
  • An additional R40,000 per sublimit, per event
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.

    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