Selfmed Selfnet 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: R1,185 R1,185 R418
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Hospital Choice:
  • Network
Specialised Radiology:
Supplementary Services: (Physio, etc)
Transplants:
  • Heart, lung, bone-marrow, kidney and liver transplants only. 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:
  • Network GP: Unlimited
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,185 R1,185 R418
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Specialists consultations:
  • R1,070 per person and R2,140 per family from network specialist, including radiology, pathology and medication
Pathology:
  • Unlimited subject to network protocol, formulary and referral ny network GP
General radiology:
  • Unlimited subject to network protocol, formulary and referral ny network GP
Specialised radiology:
  • No benefit, unless PMB
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: R1,185 R1,185 R418
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Consultations:
  • Subject to network provider
Scans:
  • Subject to network provider

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CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):
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: R1,185 R1,185 R418
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: subject to protocols and use of network dentist
    		•
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,185 R1,185 R418
    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:

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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: R1,185 R1,185 R418
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    Acute (presrcibed) medication:
    • Covered if prescribed by Network GP and part of formulary
    Over-the-counter:
    • No benefit
    Birth Control:
    • No 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:
    • One pre-selected frame and set of lenses or contact lenses to value of R460 per person every two years
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,185 R1,185 R418
    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:
    • Subject to referral by Network GP
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,185 R1,185 R418
    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:
    • Subject to referral by Network GP

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    OTHER BENEFITS:
    General Appliances:
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,185 R1,185 R418
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    1.1. Hearing Aids:
    • No benefit
    1.2. Wheelchairs:
    Dialysis:
    • Unlimited
    HIV:
    • Covered if part of Disease management Programme
    Emergency Transport: ER24
    International Coverage:
    Other:

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    WELLNESS/PREVENTATIVE BENEFITS:
    Flu vaccination:
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,185 R1,185 R418
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    Pneumonia vaccines:
    Back Rehabilitation Programme:
    Biometric Screening:
    Child Immunisation:
    Pap Smear:
    Mammogram:
    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: R1,185 R1,185 R418
    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