Selfmed 80% medical aid plan: 2017

Pay for maximum 3 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: R6,335 R5,485 R1,100
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
Hospital Choice:
  • Network
Specialised Radiology:
  • R1,100 co-payment
Supplementary Services: (Physio, etc)
  • Unlimited
Transplants:
  • Donor costs covered up to limits only if recipient is part of the scheme
Co-payments:
  • 20% co-payment for consults and clinical procedures
Alternatives to hospitals:

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OUT OF HOSPITAL BENEFITS:
GP consultations:
  • 20% co-payment and limited to M =consults, M1 = 30 consults and M2+ =45 consults
  • Shared with GP and Specialist consults>/li>
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,335 R5,485 R1,100
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Specialists consultations:
  • 20% co-payment and limited to M =consults, M1 = 30 consults and M2+ =45 consults
  • Shared with GP and Specialist consults>/li>
Pathology:
  • 20% co-payment
General radiology:
  • 20% co-payment
Specialised radiology:
Supplementary Services: (Physio, etc)
  • Medical and clinical technology: 20% co-payment
  • Physio, speech therapy, occupational therapy, podiatry, orthotic treatment, hearing aid acoustics, dieticians, chiropractors, osteopaths, homeopaths, naturopaths, herbalists and biokinetics: 20% co-payment and limited to R4,800 per person and R13,600 per family

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MATERNITY BENEFITS:
Hospital stay:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,335 R5,485 R1,100
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Consultations:
  • Benefits shared with GP and specialist benefit
  • Antenatal classes: R1,400 shared with scan benefit
Scans:
  • 2 x 2D scans
  • Additional scans: shared with antenatal class benefit up to R1,400 in total

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CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):
  • R408,500 per family
  • Biological medicine: R157,600

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: R6,335 R5,485 R1,100
Children: Pay for maximum 3 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: 20% co-payment
  • Specialised dentistry: 20% co-payment and limited to R7,700 per person and R23,600 per family
  • Implants: 20% co-payment and limited to R5,600 per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,335 R5,485 R1,100
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Orthodontics:
Maxillo Facial Surgery:
  • Non-elective: 20% co-payment

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MEDICATION:
Chronic:
  • 20% co-payment and R23,300 per person and R45,400 per family
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,335 R5,485 R1,100
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
Acute (presrcibed) medication:
  • 20% co-payment and R5,800 per person and R17,200 per family
Over-the-counter:
  • 20% co-payment and R1,500 per family
  • Shared with acute medicine and birth control benefit
Birth Control:
  • 20% co-payment and R1,500 per family
  • Shared with acute medicine and OTC benefit
On Discharge:
  • 7 days supply
Notes:
  • Chronic meds: Must be obtained from DSP. Formularies apply. Otherwise, 40% co-payment

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OPTOMETRY:
Optometry:
  • 20% co-payment
  • Refractive surgery: No benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,335 R5,485 R1,100
Children: Pay for maximum 3 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:
  • Covered if part of Case Management Programme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,335 R5,485 R1,100
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:


Out-of-hospital:
  • 20% co-payment and limited to R8,800

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OTHER BENEFITS:
General Appliances:
  • 20% co-payment and limited to R5,300 per family
  • This may be increased to R15,900 with respect to certain appliances, under case management
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,335 R5,485 R1,100
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

1.1. Hearing Aids:
  • 20% co-payment and limited to R16,200 per family
1.2. Wheelchairs:
Dialysis:
  • Unlimited
HIV:
  • Covered if part of Disease management Programme
Emergency Transport: ER24
International Coverage:
Other:
  • Cochlear implant: R74,500 per implant

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WELLNESS/PREVENTATIVE BENEFITS:
Flu vaccination:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,335 R5,485 R1,100
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Pneumonia vaccines:
Back Rehabilitation Programme:
Biometric Screening:
Child Immunisation:
Pap Smear:
  • Covered
Mammogram:
  • Covered
PAS Test:
HIV Test:

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PROSTHESIS:
Overal Limit:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,335 R5,485 R1,100
Children: Pay for maximum 3 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