Resolution Progressive Flex Plus

Pay for all children.

View all plans in this scheme

IN HOSPITAL PROCEDURES:
Payout Rate for Specialists:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,369 R2,219 R733
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
Hospital Choice:
  • Unlimited
Specialised Radiology:
  • R9,438 per family with R1,892 co-payment. In and out of hospital
Supplementary Services: (Physio, etc)
Transplants:
  • R112,524 per family
Co-payments:
  • Excision nail bed, skin lesions, tympanoplasty:R1,881 co-payment
  • Myringotomy, tonsillectomy, adenoidectomy: R2,193 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: 5 days per family
  • Hospice, rehab and step down facility: 12 days per family

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OUT OF HOSPITAL BENEFITS:
GP consultations:
  • M =4 consults, M1 =7 consults, M2+ =9 consults
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,369 R2,219 R733
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Specialists consultations:
  • M =2 consults, M1+ =3 consults
Pathology:
  • From limit below
  • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1+
R2,268R2,878
General radiology:
  • From limit below
  • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1+
R2,268R2,878
Specialised radiology:
  • R9,438 per family with R1,892 co-payment. In and out of hospital
Supplementary Services: (Physio, etc)
  • From limit below
  • Physio, speech therapy, audiology: from limit below
  • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1+
R2,268R2,878

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MATERNITY BENEFITS:
Hospital stay:
  • Vaginal birth: 3 days, 2 nights
  • Caesarean birth: 4 days, 3 nights
  • Elective Caesarean: no benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,369 R2,219 R733
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Consultations:
  • 3 consults, paid by scheme
  • Antenatal classes: no benefit
  • Baby care products: R601 at DSP
Scans:
  • 2 x 2D scans, paid by scheme

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CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):
  • R261,555 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: R2,369 R2,219 R733
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

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DENTISTRY:
Dentistry:
  • Standard dentistry: R3,116 per person and R5,009 per family, with sub limits
  • Specialised dentistry: R5,310 per family
  • Implants, partial metal dentures and periodontics: no benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,369 R2,219 R733
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Orthodontics:
  • No benefit
Maxillo Facial Surgery:

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MEDICATION:
Chronic:
  • PMB chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,369 R2,219 R733
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
Acute (presrcibed) medication:
  • From limit below
  • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1+
R2,268R2,878
Over-the-counter:
  • From limit below, with following sub limits: M =R623 and M+ =R873
  • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1+
R2,268R2,878
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:
  • Single vision: R1,147 per person incl frame, lenses and consult
  • Bifocal: R1,748 per person incl frame, lenses and consult
  • Multifocal: R2,026 per person incl frame, lenses and consult
  • or, Contact lenses: R1,147 per person
  • Every 2 years
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,369 R2,219 R733
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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: R2,369 R2,219 R733
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:


Out-of-hospital:
  • From limit below
  • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1+
R2,268R2,878

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OTHER BENEFITS:
General Appliances:
  • R3,896 per family, subject to sub limits and PMBs
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,369 R2,219 R733
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

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:
  • R750,000 per person per emergency incident
Other:
  • Cochlear implants: no benefit

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WELLNESS/PREVENTATIVE BENEFITS:
Flu vaccination:
  • Covered subject to overall R2,493 per family for preventative care benefits
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,369 R2,219 R733
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

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:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,369 R2,219 R733
Children: Pay for all children
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