Makoti Primary F medical aid plan: 2017

Pay for all children. Income-limited plan: R16,001+pm only

View all plans in this scheme

IN HOSPITAL PROCEDURES:
Payout Rate for Specialists:
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R656 R510 R235
Children: Pay for all children
Income limit: R16,001+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
Hospital Choice:
  • State hospitals
Specialised Radiology:
  • PMBs only, in state hospitals
Supplementary Services: (Physio, etc)
  • PMBs only, in state hospitals
Transplants:
  • PMBs only, in state hospitals
Co-payments: None
Alternatives to hospitals:

.
.

OUT OF HOSPITAL BENEFITS:
GP consultations:
  • Chosen network GP: Unlimited
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R656 R510 R235
Children: Pay for all children
Income limit: R16,001+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Specialists consultations:
  • PMBs only, in state hospitals
Pathology:
  • Basic pathology covered by scheme
General radiology:
  • Basic radiology covered by scheme
Specialised radiology:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

.
.

MATERNITY BENEFITS:
Hospital stay:
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R656 R510 R235
Children: Pay for all children
Income limit: R16,001+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Consultations:
  • Consults: With network GP
Scans:
  • 2 x 2D scans, paid by scheme

.
.

CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):
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):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R656 R510 R235
Children: Pay for all children
Income limit: R16,001+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

.
.

DENTISTRY:
Dentistry:
  • Standard dentistry: consultations, fillings, extractions, and prevention are covered according to protocols
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R656 R510 R235
Children: Pay for all children
Income limit: R16,001+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Orthodontics:
Maxillo Facial Surgery:

.
.

MEDICATION:
Chronic:
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R656 R510 R235
Children: Pay for all children
Income limit: R16,001+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
Acute (presrcibed) medication:
Over-the-counter:
Birth Control:
On Discharge:
Notes:

.
.

OPTOMETRY:
Optometry:
  • R700 per person every two years
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R656 R510 R235
Children: Pay for all children
Income limit: R16,001+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

.
.

MENTAL HEALTH:
In-hospital:
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R656 R510 R235
Children: Pay for all children
Income limit: R16,001+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:


Out-of-hospital:

.
.

OTHER BENEFITS:
General Appliances:
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R656 R510 R235
Children: Pay for all children
Income limit: R16,001+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

1.1. Hearing Aids:
1.2. Wheelchairs:
Dialysis:
HIV:
Emergency Transport:
International Coverage:
Other:

.
.

WELLNESS/PREVENTATIVE BENEFITS:
Flu vaccination:
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R656 R510 R235
Children: Pay for all children
Income limit: R16,001+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Pneumonia vaccines:
Back Rehabilitation Programme:
Biometric Screening:
Child Immunisation:
Pap Smear:
  • Covered
Mammogram:
PAS Test:
HIV Test:

.
.

PROSTHESIS:
Overal Limit:
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R656 R510 R235
Children: Pay for all children
Income limit: R16,001+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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