Topmed Network A 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:
Network A
Quick Overview
Main: Adult: Child:
Total Cost pm: R348 R348 R348
Savings (per year): No savings option on this plan
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 for all children
Income band: This plan is only available to households with income in R0-R1,000pm band.
View other income bands
See full benefits below

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view

.

IN HOSPITAL PROCEDURES:
Network A
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:
  • Network
  • R12,800 per family per year for use of a non-network hospital
Specialised Radiology:
  • PMB only per scan
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
  • PMBs only, in State facilities
Co-payments:
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals:
  • PMBs only
Casualty:
  • Unlimited in public hospital
Other:
  • Treatment of immunocompromised and opportunistic infections: R46,872 per family
  • Medical appliances: PMBs only
  • No cover for injuries sustained during strike, picketing, riot or physical struggle
.
.
.
.
OUT OF HOSPITAL BENEFITS:
Network A
Benefits Gap benefits
GP consultations:
  • Network GPs: Basic primary care
  • Non-Network GPs: 3 visits per year, R1,236 per family, for emergencies only
Childcare:
  • No benefit
Specialists consultations:
  • Network: R1,500 per family, including any radiology and pathology requested
Pathology:
  • Basic blood tests covered if requested by GP
General radiology:
  • Basic x-rays covered if requested by GP
Specialised radiology:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
.
.
MATERNITY BENEFITS:
Network A
Benefits Gap benefits
Hospital stay:
  • One confinement per year
  • Home births: covered
Consultations:
  • Pre and postnatal care, from Primary Healthcare Provider
Scans:
  • 1 x 2D scan, paid by scheme
.
.
CANCER (ONCOLOGY):
Network A
Benefits Gap benefits
Overall coverage (in and out of hospital):
  • PMBs only
.
.
DENTISTRY:
Network A
Benefits Gap benefits
Dentistry:
  • Standard dentistry: network provider only. Includes 1 set of plastic dentures per family every 2 years.
  • Specialised dentistry: no benefit
Orthodontics:
  • No benefit
Maxillo Facial Surgery: 2018 benefits are coming soon!
.
.
MEDICATION:
Network A
Benefits Gap benefits
Chronic:
  • PMBs chronic: paid by scheme
Acute (presrcibed) medication:
  • Covered if dispensed by Network GP or pharmacy, according to formulary
Over-the-counter:
  • R216 per family per year, with a maximum of R72 per script
Birth Control:
  • No benefit
On Discharge:
  • No benefit
Biological:
  • No benefit
.
.
OPTOMETRY:
Network A
Benefits Gap benefits
Optometry:
  • One test, one set of lenses, one standard frame OR contacts to the value of R444 per person every 2 years
.
.
MENTAL HEALTH:
Network A
Benefits Gap benefits
In-hospital:
  • PMBs only
Out-of-hospital:
  • PMBs only
Trauma:
.
.
OTHER BENEFITS:
Network A
Benefits Gap benefits
General Appliances:
  • PMBs only
  • No benefit
1.1. Hearing Aids:
  • No benefit
  • No benefit
1.2. Wheelchairs:
  • No benefit
  • No benefit
Dialysis:
  • PMBs only, in State facilities
HIV:
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • No benefit
  • No benefit
Other: 2018 benefits are coming soon!
.
.
WELLNESS/PREVENTATIVE BENEFITS:
Network A
Benefits Gap benefits
Flu vaccination: 2018 benefits are coming soon!
  • No benefit
Pneumonia vaccines: 2018 benefits are coming soon!
  • No benefit
Back Rehabilitation Programme: 2018 benefits are coming soon!
  • No benefit
Biometric Screening: 2018 benefits are coming soon!
  • No benefit
Child Immunisation:
  • Covered
  • No benefit
Pap Smear: 2018 benefits are coming soon!
  • No benefit
Mammogram: 2018 benefits are coming soon!
  • No benefit
PAS Test: 2018 benefits are coming soon!
  • No benefit
HIV Test: 2018 benefits are coming soon!
  • No benefit
Other:
  • No benefit
.
.
PROSTHETICS:
Network A
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