Topmed Network C medical aid plan: 2019

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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.

Network C
2018 Costs:
Total Cost pm:

Main member:

R1,397

Adult:

R1,397

Child: (Pay for all)

R391
Savings Account:
  • No savings option on this plan
2019 Costs:
Total Cost pm:

Main member:

R2,068
(%)

Adult:

R2,068

Child: (Pay for all)

R554
Income band:
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In brief (2018): See full benefits below

IN HOSPITAL PROCEDURES:
Network C
Scheme Benefits: Gap Benefits:
Specialists: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Hospital Choice: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Specialised Radiology:
  • PMB only per scan
  • No benefit
Supplementary Services: (Physio, etc) 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Transplants: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Co-payments: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Alternatives to hospitals: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Casualty: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Other: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
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)
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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.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Network C
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: No savings option on this plan
General info: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
GP consultations: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Childcare: 2019 Benefits coming November 15, 2018
  • No extra benefit available
Specialists consultations: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Pathology: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
General radiology: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Specialised radiology: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Supplementary Services: (Physio, etc) 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
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MATERNITY BENEFITS:
Network C
Scheme Benefits Gap benefits
Hospital stay: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Consultations: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Scans: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
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CANCER (ONCOLOGY):
Network C
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital): 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
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DENTISTRY:
Network C
Scheme Benefits Gap benefits
Standard Dentistry: 2019 Benefits coming November 15, 2018
Specialised Dentistry: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
In-Hospital Dentistry: 2019 Benefits coming November 15, 2018
Orthodontics: 2019 Benefits coming November 15, 2018
Maxillo Facial Surgery: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
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MEDICATION:
Network C
Scheme Benefits Gap benefits
Chronic: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Acute (presrcibed) medication: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Over-the-counter: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Birth Control: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
On Discharge: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Biological: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
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OPTOMETRY:
Network C
Scheme Benefits Gap benefits
Optometry: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
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MENTAL HEALTH:
Network C
Scheme Benefits Gap benefits
In-hospital: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Out-of-hospital: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
Trauma: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
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OTHER BENEFITS:
Network C
Scheme Benefits Gap benefits
General Appliances: 2019 Benefits coming November 15, 2018
  • No benefit
1.1. Hearing Aids: 2019 Benefits coming November 15, 2018
  • No benefit
1.2. Wheelchairs: 2019 Benefits coming November 15, 2018
  • No benefit
Dialysis: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
HIV: 2019 Benefits coming November 15, 2018
  • No benefit
Emergency Transport: 2019 Benefits coming November 15, 2018
  • No benefit
International Insurance: 2019 Benefits coming November 15, 2018
  • No benefit
Other: 2019 Benefits coming November 15, 2018 2019 Benefits coming November 15, 2018
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WELLNESS/PREVENTATIVE BENEFITS:
Network C
Scheme Benefits Gap benefits
Flu vaccination: 2019 Benefits coming November 15, 2018
  • No benefit
Pneumonia vaccines: 2019 Benefits coming November 15, 2018
  • No benefit
Back Rehabilitation Programme: 2019 Benefits coming November 15, 2018
  • No benefit
Biometric Screening: 2019 Benefits coming November 15, 2018
  • No benefit
Child Immunisation: 2019 Benefits coming November 15, 2018
  • No benefit
Pap Smear: 2019 Benefits coming November 15, 2018
  • No benefit
Mammogram: 2019 Benefits coming November 15, 2018
  • No benefit
PAS Test: 2019 Benefits coming November 15, 2018
  • No benefit
HIV Test: 2019 Benefits coming November 15, 2018
  • No benefit
Other: 2019 Benefits coming November 15, 2018
  • No benefit
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PROSTHETICS:
Network C
Scheme Benefits Gap benefits
Overal Limit: 2019 Benefits coming November 15, 2018
  • An additional R40,000 per sublimit, per event
Sub-limits: 2019 Benefits coming November 15, 2018
  • An additional R40,000 per sublimit, per event
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    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