Commed Deluxe medical aid plan: 2017

Comprehensive cover with savings, self-payment gap and limited above threshold benefits that cover most out-of-hospital benefits (with limits). Pay for all children.

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IN HOSPITAL PROCEDURES:
Payout Rate for Specialists:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R5,802 R4,742 R1,158
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive cover with savings, self-payment gap and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
Main: Adult: Child:
(S) Savings: R10,440 R8,532 R2,088
(SP) Self Payment: R7,830 R6,399 R1,566
Threshold (S+SP): R18,270 R14,931 R3,654
Above Threshold: 2,610 2,133 522

Compare with these plans:
Hospital Choice:
  • Unlimited
Specialised Radiology:
  • R10,000 per person with a R2,000 co-payment
Supplementary Services: (Physio, etc)
Transplants:
Co-payments:
  • Arthroscopy: R2,000 co-payment
  • Circumcision (elective): R1,000 co-payment
  • Colonoscopy, sigmoidoscopy, proctoscopy: R1500 co-payment
  • Cystoscopy: R1,000 co-payment
  • Dental admissions: R1,000 co-payment
  • Gastroscopy: R1,500 co-payment
  • Hernia repair: R1,500 co-payment
  • Hysterectomy: R2,500 co-payment
  • Hysteroscopy: R2,500 co-payment
  • Joint Replacements: R5,000 co-payment
  • Laparoscopic procedures: R2,500 co-payment
  • Myringotomy: R1,000 co-payment
  • Nasal Surgery: R1,500 co-payment
  • Reflux surgery: R2,500 co-payment
  • Skin lesions: R1,000 co-payment
  • Spinal surgery: R5,000 co-payment
  • Urinary incontinence repair: R3,000 co-payment
  • Varicose veins: R3,000 co-payment
Alternatives to hospitals:
  • Physical rehabilitation, sub-acute facilities, nursing services, hospice: 14 days per person

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OUT OF HOSPITAL BENEFITS:
GP consultations:
  • 14 consults per person and 28 consults per family
  • Paid from day-to-day benefit
  • Shared with Specialist benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R5,802 R4,742 R1,158
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive cover with savings, self-payment gap and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
Main: Adult: Child:
(S) Savings: R10,440 R8,532 R2,088
(SP) Self Payment: R7,830 R6,399 R1,566
Threshold (S+SP): R18,270 R14,931 R3,654
Above Threshold: 2,610 2,133 522

Compare with these plans:

Specialists consultations:
  • 14 consults per person and 28 consults per family. Paid from day-to-day benefit
  • Shared with GP benefit
Pathology:
  • R2,860 per person and R8,480 per family
  • Paid from day-to-day benefit
General radiology:
  • R2,900 per person and R8,500 per family
  • Paid from day-to-day benefit
Specialised radiology:
  • Paid from day-to-day benefit
Supplementary Services: (Physio, etc)
  • R4,000 per person and R8,000 per family
  • Paid from day-to-day benefit but not from threshold

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MATERNITY BENEFITS:
Hospital stay:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R5,802 R4,742 R1,158
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive cover with savings, self-payment gap and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
Main: Adult: Child:
(S) Savings: R10,440 R8,532 R2,088
(SP) Self Payment: R7,830 R6,399 R1,566
Threshold (S+SP): R18,270 R14,931 R3,654
Above Threshold: 2,610 2,133 522

Compare with these plans:

Consultations:
  • Paid from day-to-day benefit
Scans:
  • 2 x 2D scans

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CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):
  • R400,000 per person at DSP

Note: 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.
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R5,802 R4,742 R1,158
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive cover with savings, self-payment gap and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
Main: Adult: Child:
(S) Savings: R10,440 R8,532 R2,088
(SP) Self Payment: R7,830 R6,399 R1,566
Threshold (S+SP): R18,270 R14,931 R3,654
Above Threshold: 2,610 2,133 522

Compare with these plans:

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DENTISTRY:
Dentistry:
  • Standard: R2,900 per person and R6,900 per family. From day-to-day benefit
  • Specialised: R4,755 per person and R8,550 per family. From day-to-day benefit but not from threshold
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R5,802 R4,742 R1,158
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive cover with savings, self-payment gap and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
Main: Adult: Child:
(S) Savings: R10,440 R8,532 R2,088
(SP) Self Payment: R7,830 R6,399 R1,566
Threshold (S+SP): R18,270 R14,931 R3,654
Above Threshold: 2,610 2,133 522

Compare with these plans:

Orthodontics:
Maxillo Facial Surgery:

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MEDICATION:
Chronic:
  • No. of chronic conditions covered by scheme: 27 CDLs and PMBs
  • Overall limit for chronic paid by scheme:R4,500 per person and R8,000 per family. Once depleted, only CDL and PMBs will continue to be covered by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R5,802 R4,742 R1,158
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive cover with savings, self-payment gap and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
Main: Adult: Child:
(S) Savings: R10,440 R8,532 R2,088
(SP) Self Payment: R7,830 R6,399 R1,566
Threshold (S+SP): R18,270 R14,931 R3,654
Above Threshold: 2,610 2,133 522

Compare with these plans:
Acute (presrcibed) medication:
  • R3,500 per person and R9,000 per family
  • Paid from day-to-day benefit
Over-the-counter:
  • R1,750 per family
  • Paid from day-to-day benefit
Birth Control:
On Discharge:
Notes:

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OPTOMETRY:
Optometry:
  • R2,250 per person every two years
  • Paid from day-to-day benefit, but not from threshold
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R5,802 R4,742 R1,158
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive cover with savings, self-payment gap and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
Main: Adult: Child:
(S) Savings: R10,440 R8,532 R2,088
(SP) Self Payment: R7,830 R6,399 R1,566
Threshold (S+SP): R18,270 R14,931 R3,654
Above Threshold: 2,610 2,133 522

Compare with these plans:

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MENTAL HEALTH:
In-hospital:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R5,802 R4,742 R1,158
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive cover with savings, self-payment gap and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
Main: Adult: Child:
(S) Savings: R10,440 R8,532 R2,088
(SP) Self Payment: R7,830 R6,399 R1,566
Threshold (S+SP): R18,270 R14,931 R3,654
Above Threshold: 2,610 2,133 522

Compare with these plans:


Out-of-hospital:

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OTHER BENEFITS:
General Appliances:
  • R15,000 per family
  • Stoma care: from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R5,802 R4,742 R1,158
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive cover with savings, self-payment gap and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
Main: Adult: Child:
(S) Savings: R10,440 R8,532 R2,088
(SP) Self Payment: R7,830 R6,399 R1,566
Threshold (S+SP): R18,270 R14,931 R3,654
Above Threshold: 2,610 2,133 522

Compare with these plans:

1.1. Hearing Aids:
  • Paid from day-to-day benefit every 2 years
1.2. Wheelchairs:
  • Every 3 years, subject to above limit
Dialysis:
HIV:
Emergency Transport: ER24
International Coverage:
  • Emergency cover in SADC countries
Other:

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WELLNESS/PREVENTATIVE BENEFITS:
Flu vaccination:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R5,802 R4,742 R1,158
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive cover with savings, self-payment gap and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
Main: Adult: Child:
(S) Savings: R10,440 R8,532 R2,088
(SP) Self Payment: R7,830 R6,399 R1,566
Threshold (S+SP): R18,270 R14,931 R3,654
Above Threshold: 2,610 2,133 522

Compare with these plans:

Pneumonia vaccines:
Back Rehabilitation Programme:
Biometric Screening:
Child Immunisation:
Pap Smear:
Mammogram:
  • Covered for 49yrs+, every 2 years.
  • Limited to R2,500 and with R500 co-payment
PAS Test:
HIV Test:

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PROSTHESIS:
Overal Limit:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R5,802 R4,742 R1,158
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive cover with savings, self-payment gap and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
Main: Adult: Child:
(S) Savings: R10,440 R8,532 R2,088
(SP) Self Payment: R7,830 R6,399 R1,566
Threshold (S+SP): R18,270 R14,931 R3,654
Above Threshold: 2,610 2,133 522

Compare with these plans:
Sub-limits:

    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