Resolution Supreme medical aid plan: 2017

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: R4,565 R4,345 R1,130
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:
  • R18,755 per family with R1,892 co-payment. In and out of hospital
Supplementary Services: (Physio, etc)
Transplants:
  • Unlimited
Co-payments:
  • Dental admissions: R2,504 co-payment
  • Hysteroscopy: R2,816 co-payment
  • Arthroscopy, endometrial ablation, laparoscopic procedures, urinary incontinence repair, varicose veins, conservative back, spinal treatment: R3,751 co-payment
  • Joint replacements: R7,157 co-payment
  • Spinal surgery: R7,824 co-payment
Alternatives to hospitals:
  • Home nursing: 12 days per family
  • Hospice, rehab and step down facility: 21 days per family

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OUT OF HOSPITAL BENEFITS:
GP consultations:
  • Paid from limit below
  • Limit shared with GPs, specialists, dentistry and optometry
MainAdultChild
R14,157R10,618R1,481
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,565 R4,345 R1,130
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Specialists consultations:
  • M= 4 consults, M1 =5 consults, M2+ =6 consults, subject to limits below
  • Limit shared with GPs, specialists, dentistry and optometry
MainAdultChild
R14,157R10,618R1,481
Pathology:
  • Paid from limit below, with these sub limits: M =R3,183; M1 =R3,907; M2+ =R4,719
  • Limit below shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1M2+
R7,424R13,067R14,191
General radiology:
  • Paid from limit below, with these sub limits: M =R3,183; M1 =R3,907; M2+ =R4,719
  • Limit below shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1M2+
R7,424R13,067R14,191
Specialised radiology:
  • R18,755 per family with R1,892 co-payment. In and out of hospital
Supplementary Services: (Physio, etc)
  • Paid from limit below, with these sub limits: M =R3,183; M1 =4,719; M2+ =R6,244
  • Physio: R1,392 per family sub-limit
  • Speech therapy and audiology: R1,592 per family sublimit
  • Limit below shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1M2+
R7,424R13,067R14,191

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MATERNITY BENEFITS:
Hospital stay:
  • Vaginal birth: 3 days, 2 nights
  • Caesarean birth: 4 days, 3 nights
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,565 R4,345 R1,130
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Consultations:
  • 9 consults, paid by scheme
  • Antenatal classes: no benefit
  • Baby care products: R918 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.
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,565 R4,345 R1,130
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: covered up to limits below. Sub limits apply
  • Specialised dentistry: R13,356 sublimit per family. Includes crowns, bridges, implants, metal dentures, periodontics
  • Overall dentistry limit shared with GPs, specialists, dentistry and optometry, as below
MainAdultChild
R14,157R10,618R1,481
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,565 R4,345 R1,130
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Orthodontics: See above
Maxillo Facial Surgery:

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MEDICATION:
Chronic:
  • PMB chronic: paid by scheme
  • non-PMBs: Additional 28 conditions covered
  • M= R5,488 and M+= R10,964. Thereafter, only PMBs covered.
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,565 R4,345 R1,130
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
Acute (presrcibed) medication:
  • Limit below shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1M2+
R7,424R13,067R14,191
Over-the-counter:
  • Paid from limit below, with these sub limits: M =R2,248; M1 =R3,873; M2+ =R4,229
  • Limit below shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1M2+
R7,424R13,067R14,191
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: R2,104 per person incl frame, lenses and consult
  • Bifocal: R2,538 per person incl frame, lenses and consult
  • Multifocal: R3,183 per person incl frame, lenses and consult
  • or, Contact lenses: R2,371 per person
"
  • Paid from limit below, every 2 years.
  • Limit shared with GPs, specialists, dentistry and optometry
    • MainAdultChild
    R14,157R10,618R1,481
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,565 R4,345 R1,130
    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:
    • R29,962 per family
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,565 R4,345 R1,130
    Children: Pay for all children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:


    Out-of-hospital:
    • R1,392 per family, subject to limit below (shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication)
    MM1M2+
    R7,424R13,067R14,191

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    OTHER BENEFITS:
    General Appliances:
    • R14,981, with sub limits
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,565 R4,345 R1,130
    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:
    • Unlimited, 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: R125,057 per family
    • Trauma counselling: 3 psychologist visits per person

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    WELLNESS/PREVENTATIVE BENEFITS:
    Flu vaccination:
    • Covered subject to overall R3,751 per family for preventative care benefits
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,565 R4,345 R1,130
    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 R3,751 per family for preventative care benefits
    Child Immunisation:
    • Covered subject to overall R3,751 per family for preventative care benefits
    Pap Smear:
    • Covered subject to overall R3,751 per family for preventative care benefits
    Mammogram:
    • Covered subject to overall R3,751 per family for preventative care benefits. 35yrs+.
    PAS Test:
    • Covered subject to overall R3,751 per family for preventative care benefits
    HIV Test:
    • Covered subject to overall R3,751 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: R4,565 R4,345 R1,130
    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