Topmed Limited 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:
Limited
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R2,267 R990 R416
Cost 2017: (R2,245) (R600) (R260)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: R1,000,000
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Savings: No savings option on this plan
Children: Pay for all children

.

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:
Limited
2017 v 2018 benefits Gap benefits Notes
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

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Hospital Choice:
  • Network
Specialised Radiology:
  • Subject to Overall Annual Limit and 20% co-payment
Supplementary Services: (Physio, etc)
  • Subject to Overall Annual Limit and 20% co-payment
Transplants:
  • Subject to Overall Annual Limit and 20% co-payment
Co-payments:
  • Hospital account at private hospital: 50% of the first R5,220, then 10% of remainder up to a maximum of R11,280 in total
  • All other accounts: 20% 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:
  • Private nursing and step down facilities and hospice: 21 days per person
Casualty:
  • Subject to Overall Annual Limit and 20% co-payment
Other:
  • Treatment of immunocompromised and opportunistic infections: R46,872 per family
  • Medical appliances: R5,556 per person
.
.
.
.
OUT OF HOSPITAL BENEFITS:
Limited
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • R7,080 per family, including specialists with 20% co-payment, unless PMB


Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Childcare:
  • No benefit
Specialists consultations:
  • See GP benefit, above
Pathology:
  • R5,088 per family, for radiology, pathology and histology
  • 20% co-payment
General radiology:
  • R5,088 per family, for radiology, pathology and histology
  • 20% co-payment
Specialised radiology:
  • 3 scans per family, R15,852
  • 20% co-payment
Supplementary Services: (Physio, etc)
  • Physiotherapist, Chiropractor and Biokineticist: R3,024 per family
  • Audiologist, Dietician, Occupational Therapist, Speech Therapist, Social Worker: R2,400 per family
  • Chiropodist, Homeopath, Naturopath, Osteopath, Podiatrist and Orthoptist: R2,400 per family
  • 20% co-payment
.
.
MATERNITY BENEFITS:
Limited
2017 v 2018 benefits Gap benefits Notes
Hospital stay:
  • Subject to Overall Annual Limit and 20% co-payment

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Consultations:
  • 2 consults
Scans:
  • 2 x 2D scans, paid by scheme
.
.
.
.
CANCER (ONCOLOGY):
Limited
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital):
  • Subject to Overall Annual Limit and 20% co-payment
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.
.
.
DENTISTRY:
Limited
2017 v 2018 benefits Gap benefits Notes
Dentistry:
  • Standard dentistry: R5,040 per family
  • Specialised dentistry: R8,028 per family
  • 20% co-payment

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Orthodontics: See above
Maxillo Facial Surgery: 2018 benefits are coming soon!

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:
Limited
2017 v 2018 benefits Gap benefits Notes
Chronic:
  • PMBs and non-PMBs: R11,508 per family. Thereafter, only PMBs are covered
  • 20% co-payment for non-PMBs

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Acute (presrcibed) medication:
  • R7,860 per family
  • 20% co-payment
Over-the-counter:
Birth Control:
On Discharge:
  • 7 days supply
Biological:
  • No benefit
.
.
.
.
OPTOMETRY:
Limited
2017 v 2018 benefits Gap benefits Notes
Optometry:
  • Test: R468 per person
  • Single vision, incl test: R924 per person
  • Bifocal, incl test: R1,380 per person
  • Multifocal, incl test: R1,848 per person
  • 20% co-payment

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
.
.
MENTAL HEALTH:
Limited
2017 v 2018 benefits Gap benefits Notes
In-hospital:
  • 21 days per person

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Out-of-hospital:
  • R4,488 per family
  • 20% co-payment
Trauma:
.
.
.
.
OTHER BENEFITS:
Limited
2017 v 2018 benefits Gap benefits Notes
General Appliances:
  • R5,364 per person
  • 20% co-payment
  • No benefit

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
1.1. Hearing Aids:
  • R12,828 per person every 2 years
  • 20% co-payment
  • No benefit
1.2. Wheelchairs:
  • See "General Appliances" limit
  • No benefit
Dialysis:
  • Subject to Overall Annual Limit and 20% co-payment
HIV:
  • Subject to Overall Annual Limit and 20% co-payment
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • R10 million per family per year, maximum of 90 days
  • No benefit
Other: 2018 benefits are coming soon!
.
.
WELLNESS/PREVENTATIVE BENEFITS:
Limited
2017 v 2018 benefits Gap benefits Notes
Flu vaccination:
  • Covered
  • No benefit

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Pneumonia vaccines:
  • Covered
  • 60yrs+
  • No benefit
Back Rehabilitation Programme: 2018 benefits are coming soon!
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation:
  • Covered
  • No benefit
Pap Smear:
  • Covered
  • , 15yrs+
  • No benefit
Mammogram:
  • Covered for 40yrs+, every 2 years. Includes sonar.
  • No benefit
PAS Test:
  • Covered, 40yrs+. Frequency dependant on age.
  • No benefit
HIV Test:
  • Covered, 15yrs+
  • No benefit
Other:
  • Bone densitometry: 50yrs+, every 3 years
  • Glaucoma test: 40yrs+
  • Tetanus: as required
  • 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:
Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
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