Resolution Millenium Select medical aid plan: 2017

Pay for all children.

IN HOSPITAL PROCEDURES:

Payout Rate for Specialists:

150% scheme rate for contracted providers, otherwise 100% scheme rate

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,819	R3,271	R890
Children:	Pay for all children
Day-to-Day Benefit:

	Main:	Adult:	Child:
(S) Savings:	R9,180	R7,848	R2,124
(SP) Self Payment:	R4,391	R3,409	R849
Threshold (S+SP):	R13.571	R11,257	R2,973
Above Threshold:	5,544	4,728	774

Compare with these plans:

Resolution Millennium 2017

Hospital Choice:

Network or R3,896 co-payment

Specialised Radiology:

R15,003 per family with R1,892 co-payment. In and out of hospital

Supplementary Services: (Physio, etc)

Transplants:

Unlimited

Co-payments:

Excision nail bed, skin lesions:R1,881 co-payment
Dental admissions, circumcision, colonoscopy, sigmoidoscopy, proctoscopy, cystoscopy, gastroscopy: R2,504 co-payment
Hysteroscopy: R2,816 co-payment
Arthroscopy, endometrial ablation, laparoscopic procedures, urinary incontinence repair, varicose veins, conservative back, spinal treatment, hernia repair, hysterectomy: R3,751 co-payment
Nasal surgery: R5,632 co-payment
Joint replacements, rotator cuff surgery: R7,157 co-payment
Spinal surgery: R7,824 co-payment
Reflux surgery: R10,752 co-payment

Alternatives to hospitals:

Home nursing: 10 days per family
Hospice, rehab and step down facility: 18 days per family

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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:	R3,819	R3,271	R890
Children:	Pay for all children
Day-to-Day Benefit:

	Main:	Adult:	Child:
(S) Savings:	R9,180	R7,848	R2,124
(SP) Self Payment:	R4,391	R3,409	R849
Threshold (S+SP):	R13.571	R11,257	R2,973
Above Threshold:	5,544	4,728	774

Compare with these plans:

Resolution Millennium 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:

R15,003 per family with R1,892 co-payment. In and out of hospital

Supplementary Services: (Physio, etc)

Paid from day-to-day benefit

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MATERNITY BENEFITS:

Hospital stay:

Vaginal birth: 3 days, 2 nights
Caesarean birth: 4 days, 3 nights
Elective Caesarean: no benefit

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,819	R3,271	R890
Children:	Pay for all children
Day-to-Day Benefit:

	Main:	Adult:	Child:
(S) Savings:	R9,180	R7,848	R2,124
(SP) Self Payment:	R4,391	R3,409	R849
Threshold (S+SP):	R13.571	R11,257	R2,973
Above Threshold:	5,544	4,728	774

Compare with these plans:

Resolution Millennium 2017

Consultations:

9 consults, from day-to-day benefit
Antenatal classes: from day-to-day benefit
Baby care products: R813 at DSP

Scans:

2 x 2D scans, paid by scheme

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CANCER (ONCOLOGY):

Overall coverage (in and out of hospital):

Unlimited subject to 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.

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,819	R3,271	R890
Children:	Pay for all children
Day-to-Day Benefit:

	Main:	Adult:	Child:
(S) Savings:	R9,180	R7,848	R2,124
(SP) Self Payment:	R4,391	R3,409	R849
Threshold (S+SP):	R13.571	R11,257	R2,973
Above Threshold:	5,544	4,728	774

Compare with these plans:

Resolution Millennium 2017

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DENTISTRY:

Dentistry:

Standard dentistry:

Paid from day-to-day benefit, subject to sub limits below

Main	Adult	Child
R5,899	R8,137	R9,673

Advanced dentistry:

Paid from day-to-day benefit, subject to sub limits below
Implants and periodontics: no benefit

Main	Adult	Child
R5,899	R8,137	R9,673

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,819	R3,271	R890
Children:	Pay for all children
Day-to-Day Benefit:

	Main:	Adult:	Child:
(S) Savings:	R9,180	R7,848	R2,124
(SP) Self Payment:	R4,391	R3,409	R849
Threshold (S+SP):	R13.571	R11,257	R2,973
Above Threshold:	5,544	4,728	774

Compare with these plans:

Resolution Millennium 2017

Orthodontics:

Paid from day-to-day benefit

Maxillo Facial Surgery:

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MEDICATION:

Chronic:

PMB chronic: paid by scheme
non-PMBs: Additional 10 conditions covered
M= R2,649 and M+= R5,310. Thereafter, only PMBs covered.

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,819	R3,271	R890
Children:	Pay for all children
Day-to-Day Benefit:

	Main:	Adult:	Child:
(S) Savings:	R9,180	R7,848	R2,124
(SP) Self Payment:	R4,391	R3,409	R849
Threshold (S+SP):	R13.571	R11,257	R2,973
Above Threshold:	5,544	4,728	774

Compare with these plans:

Resolution Millennium 2017

Acute (presrcibed) medication:

Paid from day-to-day benefit, subject to sub limits below

M	M1	M2+
R5,899	R8,137	R9,673

Over-the-counter:

Shared with acute medicine limit, subject to sub limits below

M	M1	M2+
R1,748	R2,438	R2,872

Birth Control:

R1,496 per female, from preventative benefit limit

On Discharge:

7 days supply

Notes:

Chronic meds: Must be obtained from DSP. Formularies apply. Reference and GRP pricing apply

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OPTOMETRY:

Optometry:

R2,649 per person, subject to day-to-day benefit
Every 2 years

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,819	R3,271	R890
Children:	Pay for all children
Day-to-Day Benefit:

	Main:	Adult:	Child:
(S) Savings:	R9,180	R7,848	R2,124
(SP) Self Payment:	R4,391	R3,409	R849
Threshold (S+SP):	R13.571	R11,257	R2,973
Above Threshold:	5,544	4,728	774

Compare with these plans:

Resolution Millennium 2017

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MENTAL HEALTH:

In-hospital:

R18,755 per family

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,819	R3,271	R890
Children:	Pay for all children
Day-to-Day Benefit:

	Main:	Adult:	Child:
(S) Savings:	R9,180	R7,848	R2,124
(SP) Self Payment:	R4,391	R3,409	R849
Threshold (S+SP):	R13.571	R11,257	R2,973
Above Threshold:	5,544	4,728	774

Compare with these plans:

Resolution Millennium 2017

Out-of-hospital:

Paid from day-to-day benefit

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OTHER BENEFITS:

General Appliances:

R11,252, with sub limits

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,819	R3,271	R890
Children:	Pay for all children
Day-to-Day Benefit:

	Main:	Adult:	Child:
(S) Savings:	R9,180	R7,848	R2,124
(SP) Self Payment:	R4,391	R3,409	R849
Threshold (S+SP):	R13.571	R11,257	R2,973
Above Threshold:	5,544	4,728	774

Compare with these plans:

Resolution Millennium 2017

1.1. Hearing Aids:

See above

1.2. Wheelchairs:

See above

Dialysis:

PMBs only, at network providers

HIV:

Covered at network hospitals if on HIV Management Programme

Emergency Transport:

Netcare 911

International Coverage:

R2 million per person per emergency incident

Other:

Cochlear implants: R75,016 per family

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WELLNESS/PREVENTATIVE BENEFITS:

Flu vaccination:

Covered subject to overall R2,493 per family for preventative care benefits

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Total Cost:	R3,819	R3,271	R890
Children:	Pay for all children
Day-to-Day Benefit:

	Main:	Adult:	Child:
(S) Savings:	R9,180	R7,848	R2,124
(SP) Self Payment:	R4,391	R3,409	R849
Threshold (S+SP):	R13.571	R11,257	R2,973
Above Threshold:	5,544	4,728	774

Compare with these plans:

Resolution Millennium 2017

Pneumonia vaccines:

Back Rehabilitation Programme:

Biometric Screening:

Covered subject to overall R2,493 per family for preventative care benefits

Child Immunisation:

R1,875 subject to overall R2,493 per family for preventative care benefits

Pap Smear:

Covered subject to overall R2,493 per family for preventative care benefits

Mammogram:

Covered subject to overall R2,493 per family for preventative care benefits

PAS Test:

Covered subject to overall R2,493 per family for preventative care benefits

HIV Test:

Covered subject to overall R2,493 per family for 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:	R3,819	R3,271	R890
Children:	Pay for all children
Day-to-Day Benefit:

	Main:	Adult:	Child:
(S) Savings:	R9,180	R7,848	R2,124
(SP) Self Payment:	R4,391	R3,409	R849
Threshold (S+SP):	R13.571	R11,257	R2,973
Above Threshold:	5,544	4,728	774

Compare with these plans:

Resolution Millennium 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