User login

You are here

Home

Resolution Health MILLENNIUM 2018

Add to compare
Type of Medical Aid Plan: 
Threshold
Medical Aid Year: 
2018
Day to day Benefits: 

Stated benefits.

Co-payments: 
Various co-payments applicable.
In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
100% of Scheme Rate.
Hospitals: 

Any Hospital.

Upfront Payments to hospitals: 

CO-PAYMENTS

Arthroscopy: R3 957

Circumcision: R2 642

Colonoscopy, sigmoidoscopy, proctoscopy: R2 642

Conservative back / spinal treatment: R3 957

Cystoscopy: R2 642

Dental admissions: R2 642

Excision nailbed: R1 984

Gastroscopy: R2 642

Endometrial ablation: R3 957

Hernia repair: R3 957

Hysterectomy: R3 957

Hysteroscopy: R2 971

Joint replacements: R7 550

Laparoscopic procedures: R3 957

Nasal surgery (including endoscopy): R5 942

Reflux surgery: R11 343

Rotator cuff surgery: R7 550

Skin lesions: R1 984

Spinal surgery: R8 255

Urinary incontinence repair: R3 957

Varicose veins: R3 957

Casualty / Emergency Visits: 
Subject to Medical Savings Account & Above Threshold Benefit.
Specialists: 
Clinical medical specialist fees, including consultations and procedures. Non-Contracted Providers at 100% of Scheme Rate. Contracted Providers up to 150% of Contracted Rate.
Other healthcare professionals eg. Physio, Occupational, Dietician: 
100% of Scheme Rate.
Radiology and pathology: 
100% of Scheme Rate.
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
100% of Scheme Rate.
MRI and CT scans: 
CT, MRI, PET and Nuclear Medicine scans, R15 828 per family per annum. Subject to Scheme Protocols. Co-payment of R1 996 per incident (in-and-out of hospital). Pre-authorisation required. 100% of Scheme Rate.
ICU and High Care: 
100% of Scheme Rate.
Dialysis: 
Covered at Network Providers. Subject to Scheme Protocols and PMBs. Pre-authorisation required.
Organ Transplants: 
Unlimited, subject to PMBs and Scheme Protocols.
Oncology / Cancer: 
Oncologist, Chemotherapy, Radiotherapy & Oncology-related blood tests. Unlimited (subject to ICON protocols and option specific medicine formularies), subject to Scheme Protocols and DSP Network, pre-authorisation required.
Neck and Back Operations: 
Conservative back / spinal treatment. Co-Payment R3 957.
Joint Replacements: 
Co-Payment R7 750.
Prosthesis: 

Prosthesis sub-limits.

Overall option limit: R62 825.

Knee: R47 697.

Hip: R43 276

Shoulder / Elbow / Ankle: R55 303.

External fixator: R62 825.

SPINAL FUSION:

1 Level CERVICAL - R22 250 & LUMBAR DORSAL - R27 841.

2 Level CERVICAL - R34 499 & LUMBAR DORSAL - R42 664.

3 Level CERVICAL - R47 686 & LUMBAR DORSAL - R50 376.

4 Or more Levels CERVICAL - R62 825 & LUMBAR DORSAL - R62 825.

CORONORY STENTS: 1 Stent - R23 706. 2 Stents - R38 856. Total - R62 825.

Pelvic floor - R7 828.

Hernia mesh - R7 828.

Intraocular lens (left) - R3 629. Intraocular lens (right) - R3 629.

Medical and Surgical Appliances: 
External medical appliances, R11871 per family PA, subject to sub-limits: Back supports R4480. CPAP Machine(3y cycle) R9100. Glucometers(3y cycle) R1057. Hearing aids(annual, 3y lifespan/appliance) R11871. Nebulisers(3y cycle) R992. Wheelchairs R6593.
Maternity Confinements: 
Normal delivery: 3 days & 2 nights. Caesarean Section (clinically indicated only): 4 days & 3 nights. Elective Caesarean Section: No benefit. Neonatal Intensive Care: Subject to Scheme Protocols.
In Hospital Dentistry: 
Surgery, dental hospitalisation, anaesthetics & associated costs. Impacted wisdom teeth & extensive procedures in children <5. Multiple hospital admissions are not covered. Co-payment will apply to all admissions. Pre-auth required for Maxillo procedures
Take home Medicine: 
Maximum of 7 days’ supply.
Rehabilitation, Hospice and Step-down facilities: 
18 Days per family per annum. 100% of Scheme Rate.
Treatment for Mental Health: 
Psychiatric disorders, Limited to Network Providers and subject to PMBs and Scheme Protocols. Non PMBs limited to R19 787 per family per annum.
HIV / AIDS: 
Primary care including Voluntary Counselling, Testing & Treatment. Hospitalisation if member is registered on the HIV Management Programme, at Network hospitals. Subject to Scheme Protocols & PMBs. If not registered limited to Provincial Facility.
Ambulance Service: 
Limited to Netcare 911, 100% of Scheme Rate.
International Travel Benefit: 
Limited to emergency medical cover up to R2 million per beneficiary per incident.
Day-to-day benefits
GP consultations: 

Subject to Medical Savings Account and Above Threshold Benefit.

Non-Contracted Providers up to 100% of Scheme Rate. Contracted Providers up to 100% of Contracted Rate.

Chronic Disease List (CDL) Prescribed Minimum Benefit (PMB) consultations covered separately.

Subject to Disease Management Protocols. Pre-authorisation required.

Specialist consultations: 

Non-Contracted Providers up to 100% of Scheme Rate.

Contracted Providers at 100% of Contracted Rate (up to 150% of Scheme Rate).

Subject to Medical Savings Account and Above Threshold Benefit.

Additional visits subject to Prescribed Minimum Benefits and pre-authorisation.

Consultations outside Networks may incur a co-payment.

Room procedures (require pre-authorisation, limited to Scheme Protocols).

Acute medicine: 

Subject to Medical Savings Account, Above Threshold Benefit and sub-limits of:

M R6 223.

M+1 R8 585.

M+2+ R10 205.

Acute medication subject to relevant plan formulary.

Reference and Generic Reference Pricing may apply.

Benefit protocols apply.

Use preferred provider pharmacies.

Over-the-counter (OTC) Medicine: 

Subject to Medical Savings Account, Above Threshold Benefit and a sub-limit on Schedule 0-2 drugs of:

M R1 844.

M+1 R2 572.

M+2 R3 030.

Optometry benefits: 
Subject to Medical Savings Account, Above Threshold Benefit and a sub-limit of R2 795 per beneficiary.
Basic dentistry: 
Subject to Scheme Protocols, MSA, ATB and sub-limits of: M R6 223. M+1 R8 585. M+2+ R10 205.
Specialised Dentistry: 
Subject to Scheme Protocols, MSA, ATB and sub-limits of: M R6 223. M+1 R8 585. M+2+ R10 205. Crowns, Bridges included. Partial metal dentures, 1 Per jaw per beneficiary every 3 years.
Orthodontics: 

Orthodontics (Fixed braces). Subject to MSA.

1 per lifetime for beneficiaries under the age of 18 years.

Benefits on pre-authorisation will be applied to cases assessed as treatment mandatory, as per orthodontic indices.

Limited to individuals younger than 18 years of age.

Orthognathic surgery is not covered.

MRI and CT Scans (Out of Hospital): 
CT, MRI, PET and Nuclear Medicine scans, R15 828 per family per annum. Subject to Scheme Protocols. Co-payment of R1 996 per incident (in-and-out of hospital). Pre-authorisation required. 100% of Scheme Rate.
Radiology and Pathology: 
Subject to Medical Savings. Account 100% of Scheme Rate.
Pregnancy benefits: 
Antenatal care. Maternity programme (registration required). Baby care products at a DSP, R858. 9 Consultations (Midwife, GP or Specialist), Antenatal classes & Postnatal midwife visits Subject to MSA and ATB. 2 2D Scans.
Physiotherapy and Occupational Therapy day to day: 
Subject to Medical Savings. Account 100% of Scheme Rate.
Chronic Conditions
Provider: 
Should be obtained from a Designated Service Provider.
Chronic Conditions: 

25 CDL conditions + HIV, BPH and HRT. • Addison’s Disease • Asthma • Benign Prostatic Hypertrophy • Bipolar Affective Mood Disorders • Bronchiectasis • Cardiac Dysrhythmia (Arrhythmia) • Cardiac Failure • Cardiomyopathy • Chronic Obstructive Pulmonary Disorders (COPD) • Chronic Renal Failure / Disease • Crohn’s Disease • Diabetes Insipidus • Diabetes Mellitus Type 1 & 2 • Epilepsy • Glaucoma • Haemophilia • HIV • Hormone Replacement Therapy • Hyperlipidaemia • Hypertension • Hypothyroidism • Ischaemic Heart Disease (Coronary Artery Disease) • Multiple Sclerosis • Parkinson’s Disease • Rheumatoid Arthritis • Schizophrenia • Systemic Lupus Erythematosis • Ulcerative Colitis ADDITIONAL CHRONIC CONDITIONS: • ADHD • Allergic Rhinitis • Angina Pectoris • Ankylosing Spondylitis • Arthritis • Cerebrovascular Accident (Stroke) • Cushing’s Syndrome • Delusional Disorder • Eczema • Gastro-Oesophageal Reflux Disease (GORD) • Gout • Hyperthyroidism • Idiopathic Thrombocytopenic Purpura • Interstitial Fibrosis of the Lung • Major Depression • Meniere’s Syndrome • Motor Neuron Disease • Myasthenia Gravis • Osteoporosis • Paget’s Disease • Peripheral Vascular Disease • Pituitary Adenoma • Psoriasis • Scleroderma • Urinary Incontinence

Additional Chronic Conditions: 
M R2 795, M+ R5 602. Benefits subject to stated sub-limits and thereafter to PMBs CDLs.
Preventative Care Benefits
Preventative Benefits: 

Preventative care limit: R2 630 per family per annum. Scheme Rate applies.

Blood pressure, Blood sugar, Cholesterol, Body Mass Index, R124 per beneficiary over the age of 18 years. Only at pharmacy.

HIV test, 1 Test per beneficiary per annum.

Mammogram (screening), 1 Examination per female beneficiary per annum over the age of 35 years.

Pap smears, 1 Test per beneficiary per annum. PSA testing, 1 Test per beneficiary per annum over the age of 45 years.

Vaccinations, Flu, 1 Dose flu vaccination per beneficiary per annum. R1 978 benefit for childhood immunisations as recommended by the Department of Health up to 18 months.

HPV vaccine (cervical cancer prevention), 1 course (3 doses per registered schedule) per female beneficiary per life between 9 and 46 years.

Nurse helpline (including Rape Crises Centre) Advice and information regarding any emergency medical condition. Call 086 111 2162.

Oral contraception R1 584 per female beneficiary per annum (R132 per month).

Total Contributions
Total Contribution Main Member: 
4660.00
Total Contribution Adult: 
4990.00
Total Contribution Child*: 
1085.00
MILLENNIUM
Annual Medical Savings Account
Annual Medical Savings Main Member: 
11184.00
Annual Medical Savings Adult: 
9576.00
Annual Medical Savings Child*: 
2604.00
Monthly Medical Savings
Savings Child*: 
217.00
Savings Adult: 
798.00
Savings Main Member: 
932.00
Annual Threshold Amounts
Annual Threshold Main Member: 
14604.00
Annual Threshold Adult: 
12350.00
Annual Threshold Child*: 
3272.00
Above Threshold Benefit Limits
Above Threshold Benefit Main Member: 
5849.00
Above Threshold Benefit Adult: 
4988.00
Above Threshold Benefit Child*: 
817.00
Risk Contributions
Risk Contribution Main Member: 
3728.00
Risk Contribution Adult: 
3192.00
Risk Contribution Child: 
868.00
How many times per annum do you and your dependants visit a doctor?: 
20
How much do you spend on Acute medication per annum?: 
More than R 5000
How much do you spend on Chronic medication per annum?: 
More than R 5000
Will you or any of your dependants require specialised Dentistry: 
Yes
Medical Aid Plan Name Term: 
Any