Medimed Max B medical aid plan: 2017

Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB. Pay for all children. Income-limited plan: R10,001-R17,000pm only

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IN HOSPITAL PROCEDURES:

Payout Rate for Specialists:

200% scheme rate

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,050	R3,050	R530
Children:	Pay for all children
Income limit:	R10,001-R17,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
	Main:	Adult:	Child:
(S) Savings:	R14,150	R14,150	R1,590
Extended Fund:	R5,000 pp	R10,000 pf	R

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Medimed Standard B 2017

Hospital Choice:

Unlimited

Specialised Radiology:

4 scans per family, up to R20,000 per family, in and out of hospital

Supplementary Services: (Physio, etc)

R4,000 per family

Transplants:

R200,000 per family
Benefit is shared with Dialysis Benefit

Co-payments:

Alternatives to hospitals:

R15,000 per person

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OUT OF HOSPITAL BENEFITS:

GP consultations:

Paid from day-to-day benefit

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,050	R3,050	R530
Children:	Pay for all children
Income limit:	R10,001-R17,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
	Main:	Adult:	Child:
(S) Savings:	R14,150	R14,150	R1,590
Extended Fund:	R5,000 pp	R10,000 pf	R

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Medimed Standard B 2017

Specialists consultations:

Paid from day-to-day benefit

Pathology:

Paid from day-to-day benefit

General radiology:

Paid from day-to-day benefit

Specialised radiology:

4 scans per family, up to R20,000 per family
In and out-of-hospital
Paid by scheme

Supplementary Services: (Physio, etc)

Paid from day-to-day benefit

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MATERNITY BENEFITS:

Hospital stay:

200% scheme rate for specialists

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,050	R3,050	R530
Children:	Pay for all children
Income limit:	R10,001-R17,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
	Main:	Adult:	Child:
(S) Savings:	R14,150	R14,150	R1,590
Extended Fund:	R5,000 pp	R10,000 pf	R

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Medimed Standard B 2017

Consultations:

2 prenatal consults
1 paediatric consult
Paid by scheme

Scans:

2 x 2D scans
Paid by scheme

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CANCER (ONCOLOGY):

Overall coverage (in and out of hospital):

R400,000 per family

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.

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,050	R3,050	R530
Children:	Pay for all children
Income limit:	R10,001-R17,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
	Main:	Adult:	Child:
(S) Savings:	R14,150	R14,150	R1,590
Extended Fund:	R5,000 pp	R10,000 pf	R

Compare with these plans:

Medimed Standard B 2017

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DENTISTRY:

Dentistry:

Paid from day-to-day benefit
In-hospital (wisdom teeth and children under 12): R11,000 per family paid by scheme

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,050	R3,050	R530
Children:	Pay for all children
Income limit:	R10,001-R17,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
	Main:	Adult:	Child:
(S) Savings:	R14,150	R14,150	R1,590
Extended Fund:	R5,000 pp	R10,000 pf	R

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Medimed Standard B 2017

Orthodontics:

Paid from day-to-day benefit

Maxillo Facial Surgery:

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MEDICATION:

Chronic:

PMB chronic: paid by scheme
Extended chronic conditions: R3,200 per person and R6,400 per family paid by scheme

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,050	R3,050	R530
Children:	Pay for all children
Income limit:	R10,001-R17,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
	Main:	Adult:	Child:
(S) Savings:	R14,150	R14,150	R1,590
Extended Fund:	R5,000 pp	R10,000 pf	R

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Medimed Standard B 2017

Acute (presrcibed) medication:

Paid from day-to-day benefit

Over-the-counter:

R150 per prescription, R1,500 per family
Paid from day-to-day benefit

Birth Control:

On Discharge:

Notes:

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OPTOMETRY:

Optometry:

R3,000 per person and R6,000 per family, every 2 years
Paid from day-to-day benefit

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,050	R3,050	R530
Children:	Pay for all children
Income limit:	R10,001-R17,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
	Main:	Adult:	Child:
(S) Savings:	R14,150	R14,150	R1,590
Extended Fund:	R5,000 pp	R10,000 pf	R

Compare with these plans:

Medimed Standard B 2017

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MENTAL HEALTH:

In-hospital:

R6,000 per person, paid at 100% scheme rate. Thereafter paid at 70% scheme rate up to a limit of R12,000 per family

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,050	R3,050	R530
Children:	Pay for all children
Income limit:	R10,001-R17,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
	Main:	Adult:	Child:
(S) Savings:	R14,150	R14,150	R1,590
Extended Fund:	R5,000 pp	R10,000 pf	R

Compare with these plans:

Medimed Standard B 2017

Out-of-hospital:

Paid from day-to-day benefit

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OTHER BENEFITS:

General Appliances:

Paid from day-to-day benefit

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,050	R3,050	R530
Children:	Pay for all children
Income limit:	R10,001-R17,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
	Main:	Adult:	Child:
(S) Savings:	R14,150	R14,150	R1,590
Extended Fund:	R5,000 pp	R10,000 pf	R

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Medimed Standard B 2017

1.1. Hearing Aids:

See "General Appliances" limit

1.2. Wheelchairs:

See "General Appliances" limit

Dialysis:

R200,000 per family
Benefit is shared with Organ Transplant Benefit

HIV:

Unlimited, subject to protocols

Emergency Transport:

ER 24

International Coverage:

Other:

Oxygen: R6,000 per family, paid at 80% scheme rate

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WELLNESS/PREVENTATIVE BENEFITS:

Flu vaccination:

Covered up to R1,300 per person and R2,600 per family for all preventative care benefits

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,050	R3,050	R530
Children:	Pay for all children
Income limit:	R10,001-R17,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
	Main:	Adult:	Child:
(S) Savings:	R14,150	R14,150	R1,590
Extended Fund:	R5,000 pp	R10,000 pf	R

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Medimed Standard B 2017

Pneumonia vaccines:

Back Rehabilitation Programme:

Biometric Screening:

Covered up to R1,300 per person and R2,600 per family for all preventative care benefits

Child Immunisation:

Pap Smear:

Covered up to R1,300 per person and R2,600 per family for all preventative care benefits

Mammogram:

Covered up to R1,300 per person and R2,600 per family for all preventative care benefits

PAS Test:

Covered up to R1,300 per person and R2,600 per family for all preventative care benefits

HIV Test:

Covered up to R1,300 per person and R2,600 per family for all preventative care benefits

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PROSTHESIS:

Overal Limit:

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,050	R3,050	R530
Children:	Pay for all children
Income limit:	R10,001-R17,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
	Main:	Adult:	Child:
(S) Savings:	R14,150	R14,150	R1,590
Extended Fund:	R5,000 pp	R10,000 pf	R

Compare with these plans:

Medimed Standard B 2017

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