Add to compare Type of Medical Aid Plan:
Co-payments:
Your oncologist is part of the ICON network • Your treatment is aligned with ICON’s protocols • You consider using medicines listed on the Medihelp Oncology Reference Price List
In Hospital Benefits Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Upfront Payments to hospitals:
R6 700 for back and neck fusions. R2 800 for endoscopic procedures in hospital. R750 for dentistry. R1 000 for MRI scans.
Casualty / Emergency Visits:
Specialists:
Unlimited 100 % of scheme rate
Other healthcare professionals eg. Physio, Occupational, Dietician:
Unlimited 100 % of scheme rate
Radiology and pathology:
Unlimited 100 % of scheme rate
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
100 % of scheme rate subject to R2 800 co-payment per admission. In doctor's rooms member pays first R900
MRI and CT scans:
Unlimited 100 % of scheme rate subject to R1 000 co-payment
ICU and High Care:
Unlimited 100 % of scheme rate
Dialysis:
Unlimited 100 % of scheme rate
Organ Transplants:
100% of the cost Unlimited
Oncology / Cancer:
100 % of scheme rate DSP ICON
Neck and Back Operations:
100 % of scheme rate subject to R6 700 co-payment per admission
Prosthesis:
All hospital admissions and prostheses are subject to pre-authorisation, protocols and case management. See brochure for full details. Benefits not applicable to wear and tear. PMB's only.
Medical and Surgical Appliances:
Sub-limits apply subject to scheme protocols
Maternity Confinements:
Unlimited 100 % of scheme rate
In Hospital Dentistry:
100 % of scheme rate co payment R750 per admission for impacted wisdom teeth, extensive dental treatment for children younger than 5 years.
Take home Medicine:
100% of scheme rate R330 per admission
Rehabilitation, Hospice and Step-down facilities:
Subect to pre-authorisation and prescribed by a medical doctor
Treatment for Mental Health:
Subject to pre-authorisation and prescribed by a medical doctor R30 350 per beneficiary per year. Maximum R42 100 per family per year.
International Travel Benefit:
Day-to-day benefits GP consultations:
100 % of scheme rate M = R2 450 per year M+1 = R4 100 per year M+2 = R5 050 per year M+3+ = R6 100 per year
Specialist consultations:
100 % of scheme rate included in GP limit M = R2 450 per year M+1 = R4 100 per year M+2 = R5 050 per year M+3+ = R6 100 per yea
Acute medicine:
100% of scheme rate only generic medication 30 % co-payment for voluntary use of original medication M = R3 700 per year M+1 = R6 200 per year M+2 = R7 600 per year M+3+ = R8 150 per year
Over-the-counter (OTC) Medicine:
100% of scheme rate only included in Acute medicine limit M = R3 700 per year M+1 = R6 200 per year M+2 = R7 600 per year M+3+ = R8 150 per year
Optometry benefits:
100% of scheme rate 1 composite examination per beneficiary per 24-month cycle
Basic dentistry:
100 % of Denis rate: 2 routine check ups, fillings, extractions, scale and polish, root canal treatment and plastic dentures
Specialised Dentistry:
Crowns and bridges. No benefit for implants
Orthodontics:
Yes - limited R10 760 per beneficiary
MRI and CT Scans (Out of Hospital):
Unlimited 100% of scheme rate subject to R1 000 co-payment
Radiology and Pathology:
100 % of scheme rate radiology R2 450 per family per year pathology R2 450 per family per year
Pregnancy benefits:
12 pregnancy consultations, 2 2D scans and 2 baby consults under 1 year
Physiotherapy and Occupational Therapy day to day:
100 % of scheme rate subject to GP and specialist limit M = R2 450 M+1 = R4 100 M+2 = R5 050 M+3+ = R6 100
Chronic Conditions Chronic Conditions:
26 Conditions on Chronic Disease List. PMB only
Preventative Care Benefits Preventative Benefits:
One test per beneficiary per year. Blood glucose, cholesterol, BMI and HIV test at Clicks- and Dis-Chem clinics. Mammogram, pap smear and prostate test. Bone density test. Back treatment program. Flu vaccine, Tetanus vaccine, HPV vaccine, standard kids immunisations under 7 years.
Total Contributions Total Contribution Main Member:
Total Contribution Adult:
Total Contribution Child*:
Risk Contributions Risk Contribution Main Member:
Benefit:
Subject to pre-authorisation, DSP (ICON), protocols and registration on the Medihelp Oncology Management Programme - 100% of the cost
How many times per annum do you and your dependants visit a doctor?:
How much do you spend on Acute medication per annum?:
How much do you spend on Chronic medication per annum?:
Will you or any of your dependants require specialised Dentistry:
