Selfmed MedXXI 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: R1,599 R1,592 R818
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:
  • R1,600 co-payment. In and out of hospital
Supplementary Services: (Physio, etc)
  • 100% scheme tariff
    Transplants:
    • Donor costs covered up to limits only if recipient is part of the scheme
    Co-payments:
    Alternatives to hospitals:

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    OUT OF HOSPITAL BENEFITS:
    GP consultations:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,599 R1,592 R818
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    Specialists consultations:
    • Some day procedures covered
    Pathology:
    • No benefit, unless PMB
    General radiology:
    • No benefit, unless PMB
    Specialised radiology:
    • R1,600 co-payment. In and out of hospital
    Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    MATERNITY BENEFITS:
    Hospital stay:
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,599 R1,592 R818
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    Consultations:
    • 2 consults per year
    • Antenatal classes: R1,600 shared with scan benefit
    Scans:
    • R1,600 per family, shared with antenatal class benefit

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    CANCER (ONCOLOGY):
    Overall coverage (in and out of hospital):
    • R176,600 per family
    • Biological medicine: No benefit

    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: R1,599 R1,592 R818
    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:
    • No benefit, unless PMB
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,599 R1,592 R818
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    Orthodontics:
    • No benefit
    Maxillo Facial Surgery:
    • R1,100 co-payment, unless PMB

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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: R1,599 R1,592 R818
    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:
    • No benefit
    Over-the-counter:
    • No benefit
    Birth Control:
    • R1,500 per family
    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:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,599 R1,592 R818
    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: R1,599 R1,592 R818
    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:
    • No benefit

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    OTHER BENEFITS:
    General Appliances:
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,599 R1,592 R818
    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:
    • No benefit
    1.2. Wheelchairs:
    • No benefit
    Dialysis:
    • Unlimited
    HIV:
    • Covered if part of Disease management Programme
    Emergency Transport: ER24
    International Coverage:
    Other:
    • Cochlear implant: R30,200 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: R1,599 R1,592 R818
    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: R1,599 R1,592 R818
    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