Medimed Standard D 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 R9,000 per family) or out of pocket, unless PMB. Pay for all children. Income-limited plan: R17,001+pm only

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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: R2,230 R2,230 R470
Children: Pay for all children
Income limit: R17,001+ (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 R9,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R11,190 R11,190 R1,410
Extended Fund: R4,500 pp R9,000 pf R

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Hospital Choice:
  • Unlimited
Specialised Radiology:
  • 3 scans per family, up to R15,000 per family, in and out of hospital
Supplementary Services: (Physio, etc)
  • R3,000 per family
Transplants:
  • R100,000 per family
  • Benefit is shared with Dialysis Benefit
Co-payments:
Alternatives to hospitals:
  • R10,000 per person

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OUT OF HOSPITAL BENEFITS:
GP consultations:
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,230 R2,230 R470
Children: Pay for all children
Income limit: R17,001+ (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 R9,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R11,190 R11,190 R1,410
Extended Fund: R4,500 pp R9,000 pf R

Compare with these plans:

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:
  • 3 scans per family, up to R15,000 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:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,230 R2,230 R470
Children: Pay for all children
Income limit: R17,001+ (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 R9,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R11,190 R11,190 R1,410
Extended Fund: R4,500 pp R9,000 pf R

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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):
  • R200,000 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.
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,230 R2,230 R470
Children: Pay for all children
Income limit: R17,001+ (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 R9,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R11,190 R11,190 R1,410
Extended Fund: R4,500 pp R9,000 pf R

Compare with these plans:

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DENTISTRY:
Dentistry:
  • Paid from day-to-day benefit
  • In-hospital (wisdom teeth and children under 12): R9,000 per family paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,230 R2,230 R470
Children: Pay for all children
Income limit: R17,001+ (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 R9,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R11,190 R11,190 R1,410
Extended Fund: R4,500 pp R9,000 pf R

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Orthodontics:
  • Paid from day-to-day benefit
Maxillo Facial Surgery:

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MEDICATION:
Chronic:
  • PMB chronic: paid by scheme
  • Extended chronic conditions: R1,600 per person and R3,200 per family paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,230 R2,230 R470
Children: Pay for all children
Income limit: R17,001+ (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 R9,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R11,190 R11,190 R1,410
Extended Fund: R4,500 pp R9,000 pf R

Compare with these plans:
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:
  • R2,500 per person and R5,000 per family, every 2 years
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,230 R2,230 R470
Children: Pay for all children
Income limit: R17,001+ (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 R9,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R11,190 R11,190 R1,410
Extended Fund: R4,500 pp R9,000 pf R

Compare with these plans:

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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
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,230 R2,230 R470
Children: Pay for all children
Income limit: R17,001+ (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 R9,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R11,190 R11,190 R1,410
Extended Fund: R4,500 pp R9,000 pf R

Compare with these plans:


Out-of-hospital:
  • Paid from day-to-day benefit

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OTHER BENEFITS:
General Appliances:
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,230 R2,230 R470
Children: Pay for all children
Income limit: R17,001+ (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 R9,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R11,190 R11,190 R1,410
Extended Fund: R4,500 pp R9,000 pf R

Compare with these plans:

1.1. Hearing Aids:
  • See "General Appliances" limit
1.2. Wheelchairs:
  • See "General Appliances" limit
Dialysis:
  • R100,000 per family
  • Benefit is shared with Organ Transplant Benefit
HIV:
  • Unlimited, subject to protocols
Emergency Transport: ER 24
International Coverage:
Other:

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WELLNESS/PREVENTATIVE BENEFITS:
Flu vaccination:
  • Covered up to R1,200 per person and R2,400 per family for all preventative care benefits
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,230 R2,230 R470
Children: Pay for all children
Income limit: R17,001+ (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 R9,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R11,190 R11,190 R1,410
Extended Fund: R4,500 pp R9,000 pf R

Compare with these plans:

Pneumonia vaccines:
Back Rehabilitation Programme:
Biometric Screening:
  • Covered up to R1,200 per person and R2,400 per family for all preventative care benefits
Child Immunisation:
Pap Smear:
  • Covered up to R1,200 per person and R2,400 per family for all preventative care benefits
Mammogram:
  • Covered up to R1,200 per person and R2,400 per family for all preventative care benefits
PAS Test:
  • Covered up to R1,200 per person and R2,400 per family for all preventative care benefits
HIV Test:
  • Covered up to R1,200 per person and R2,400 per family for all preventative care benefits

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PROSTHESIS:
Overal Limit:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,230 R2,230 R470
Children: Pay for all children
Income limit: R17,001+ (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 R9,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R11,190 R11,190 R1,410
Extended Fund: R4,500 pp R9,000 pf R

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