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| | 56% recommend | | 56% recommend | | 56% recommend | | 56% recommend | | 56% recommend | |
| | From 61 Reviews | | From 61 Reviews | | From 61 Reviews | | From 61 Reviews | | From 61 Reviews | |
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| | R753 | | R529 | | R1011 | | R1677 | | R593 | |
| | R1309 | | R964 | | R1974 | | R3307 | | R1081 | |
| | R1483 | | R1149 | | R2283 | | R3737 | | R1288 | |
| | R1657 | | R1334 | | R2592 | | R4167 | | R1495 | |
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Hospital Plan
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Network Option
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Comprehensive Plan
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Comprehensive Plan
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Network Option
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| | The Hospital Plan that offers extensive cover on hospitalisation. | | The Fundamental Plan is a primary healthcare plan. | | The Progressive Plan with generous in- and out-of-hospital benefits. | | The Prestige Plan that provides cover for members who want or need extensive cover. | | The Fundamental Plan is a primary healthcare plan. | |
| | | | | | | | | | R5001 | |
| | | | R5000 | | | | | | R8000 | |
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| | Unlimited | | Capped. Limited to Prescribed Minumum Benefits's at Designated Service Providers only | | Limited to R210000 for single and R420000 for family | | Unlimited | | Capped. Limited to Prescribed Minumum Benefits's at Designated Service Providers only | |
| | Yes | | No | | Yes | | Yes | | No | |
| | 100% | | 100% | | 100% | | 100% | | 100% | |
| | • Hosptial at 100% of National Health Reference Price List
• Specialists at 150% of National Health Reference Price List | | • Hosptial at 100% of National Health Reference Price List
• Specialists at 100% of National Health Reference Price List | | • Hosptial at 100% of National Health Reference Price List
• Specialists at 100% of National Health Reference Price List | | • Hosptial at 100% of National Health Reference Price List
• Specialists at 200% of National Health Reference Price List | | • Hosptial at 100% of National Health Reference Price List
• Specialists at 100% of National Health Reference Price List | |
| | Yes | | Yes | | Yes | | Yes | | Yes | |
| | See Scheme Details | | See Scheme Details | | See Scheme Details | | See Scheme Details | | See Scheme Details | |
| | • Oncology Limited to R157500 per beneficiary covered at the oncology network of doctors, subject to SAOC Protocols Tier 2.
• Organ transplant R78000, subject to PMB | | • Oncology Limited to R157500 per beneficiary covered at the oncology network of doctors, subject to SAOC Protocols Tier 1
• Organ transplant Limited to liver, kidney and heart only where these are provided at Provincial Hospitals | | • Oncology Limited to R210000 per beneficiary covered at the oncology network of doctors, subject to SAOC Protocols Tier 1
• Organ transplant Limited to a Provincial Hospital and subject to scheme Protocols | | • Oncology Limited to R262000 per beneficiary covered at the oncology network of doctors, subject to SAOC Protocols Tier 2
• Organ transplant R260000 | | • Oncology Limited to R157500 per beneficiary covered at the oncology network of doctors, subject to SAOC Protocols Tier 1
• Organ transplant Limited to liver, kidney and heart only where these are provided at Provincial Hospitals | |
| | •100% of National Health Reference Price List (In hospital)
•Radiology R7250 per family | | Limited to Network Hospitals or Designated Service Providers | | •100% of National Health Reference Price List (In hospital)
•Radiology R5750 per family | | •100% of National Health Reference Price List (In hospital)
•Radiology R7850 per family | | Limited to Network Hospitals or Designated Service Providers | |
| | •Pre-auth required
•Admission protocols apply
•Impacted teeth removals only
•General anaesthetic benefits are available for very young children for extensive dental treatment
•Multiple hospital admissions are not covered | | No benefit | | • Pre-auth required
• Admission protocols apply
• Impacted teeth removals only
• General anaesthetic benefits are available for very young children for extensive dental treatment
• Multiple hospital admissions are not covered | | Pre-auth required
• Certain Maxillo Facial procedures are covered in-hospital
• General anaesthetic benefits are available for very young children for extensive dental treatment
• Multiple hospital admissions are not covered | | No benefit | |
| | 100% of National Health Reference Price List | | 100% of National Health Reference Price List | | 100% of National Health Reference Price List | | 100% of National Health Reference Price List | | 100% of National Health Reference Price List | |
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| | 25 chronic diseases covered | | 25 chronic diseases covered | | 25 chronic diseases covered | | 25 chronic diseases covered | | 25 chronic diseases covered | |
| | • Limited to Provincial facilities
• Additional chronic medicines, No benefit | | • Subject to registration and approval by CareCross and limited to their Formulary
• Additional chronic medicines, No benefit | | • Subject to Progressive formulary, reference pricing may apply
• Additional chronic Limited to MCA Provider Tariff Subject to Protocols | |
• Subject to Prestige formulary, reference pricing may apply
• Additional chronic included
• Limited to total chronic medication benefit: M= R3675, M+=R7350 | | • Subject to registration and approval by CareCross and limited to their Formulary
• Additional chronic medicines, No benefit | |
| | No benefit | | No benefit | | Limited to R85 per script per day
• M = R525
• M1 = R525
• M2+ = R840 | | Limited to R85 per script per day
• M = R525
• M1 = R525
• M2+ = R840 | | No benefit | |
| | No benefit | | As dispensed by CareCross GP subject to CareCross acute Formulary | | Subject to Formulary
• M = R785
• M1 = R1050
• M2+ = R1310 | | Subject to Formulary
• M = R2100
• M1 = R3150
• M2+ = R4200 | | As dispensed by CareCross GP subject to CareCross acute Formulary | |
| | 7 days supply | | 7 days supply | | 7 days supply | | 7 days supply | | 7 days supply | |
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No Benefit
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Network Provider
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Comprehensive cover with sublimits
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Comprehensive cover with sublimits
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Network Provider
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| | | | | | • 1 Adult: R576
• 2 Adults: R1152
• 2 Adults 1 Child: R1440
• 2 Adults 2 Children: R1728
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| | No benefit | | Unlimited at Carecross | | 100% of National Health Reference Price List
• M = R850
• M1 = R1500
• M2+ = R1900 | | 100% of National Health Reference Price List
• M = R1800
• M1 = R2600
• M2+ = R3400 | | Unlimited at Carecross | |
| | No benefit | | Unlimited at Carecross | | 100% of National Health Reference Price List
• M = R500
• M1 = R750
• M2+ = R1250 | | 100% of National Health Reference Price List
• M = R1500
• M1 = R1750
• M2+ = R2250 | | Unlimited at Carecross | |
| | No benefit | | No benefit | | 100% of National Health Reference Price List
• R420 per family
• Subject to overall annual limit | | 100% of National Health Reference Price List
• R945 per family
• Subject to overall annual limit | | No benefit | |
| | •Limited to Prescribed Minumum Benefits
•Subject to Scheme Protocols | | Subject to CareCross Protocols | | 100% of National Health Reference Price List
• M = R785
• M1 = R1050
• M2+ = R1310 | | 100% of National Health Reference Price List
• M = R2100
• M1 = R2600
• M2+ = R3150 | | Subject to CareCross Protocols | |
| | No benefit | | • Examination 1 consultation per Beneficiary
• Spectacles Standard frame as per CareCross Protocals
• Contact lenses Lenses will be limited to a white mono or bifocal prescription as per CareCross Protocals | | • Examination 1 consultation per Beneficiary per Benefit Cycle (24 Months)
• Spectacles One pair of single vision spectacles inclusive of a frame and consultation per beneficiary, to the total value of R700
• or One pair of bifocal spectacles inclusive of a frame and consultation per beneficiary, to the total value of R950
• or One pair of multifocal spectacles inclusive of a frame and consultation per beneficiary, to the total value of R1200
• Contact lenses Limited to MCA | | • Examination1 Consultation per Beneficiary per Benefit Cycle (24 Months)
• Spectacles Frame benefit limited to R600
• One pair of either single vision spectacle lenses, bifocal lenses or multifocal lenses, per beneficiary per Benefit Cycle (24 months)
• Contact lens materials benefit limited to R1330 per benefi ciary per Benefit Cycle | | • Examination 1 consultation per Beneficiary
• Spectacles Standard frame as per CareCross Protocals
• Contact lenses Lenses will be limited to a white mono or bifocal prescription as per CareCross Protocals | |
| | No benefit except surgery | | Conservative dentistry
• Consultations: 2 annual checkups per beneficiary
• Fillings: Where such fillings are clinically indicated
• Oral Hygiene: 2 annual scale and polish treatments per beneficiary
Specialised dentistry
• No benefit | | Conservative dentistry
• Consultations: 2 annual checkups per beneficiary
• Fillings: Once per tooth in a 3-year period
• Oral Hygiene: 2 annual scale and polish treatments per beneficiary
• Plastic Dentures: One set of plastic dentures (an upper and a lower) per beneficiary in a 4-year period
Specialised dentistry
• Crowns, Partial metal frame dentures, Orthodontics limited to Medical Savings Account
• Implants, Periodontics No Benefit
Surgery
• In the dental chair: Covered at the Resolution Dental Tariff | | Conservative dentistry
• Consultations 2 annual checkups per beneficiary
• Fillings: Once per tooth in a 3-year period
• Oral Hygiene: 2 annual scale and polish treatments per beneficiary
• One set of plastic dentures per beneficiary in a 4-year period
Specialised dentistry
• 2 Crowns per family per year. Benefits for crowns will be granted once per tooth in a 5-year period
• One partial metal frame dentures (not full metal denture) per beneficiary in a 5-year period
• Orthodontics on cases assessed as treatment mandatory. Limited to individuals younger than 18 years, surgery not covered
• Periodontics is limited to conservative, non-surgical therapy only
Surgery
• Surgery in the dental chair: Covered at the Resolution Dental Tariff | | Conservative dentistry
• Consultations: 2 annual checkups per beneficiary
• Fillings: Where such fillings are clinically indicated
• Oral Hygiene: 2 annual scale and polish treatments per beneficiary
Specialised dentistry
• No benefit | |
| | •Limited to Prescribed Minumum Benefits
•Subject to Scheme Protocols | | • Limited to Provincial facilities
• Subject to Scheme Protocols | | • 100% of National Health Reference Price List
• R525 per family
• Subject to overall annual limit | | • 100% of National Health Reference Price List
• R1050 per family
• Subject to overall annual limit | | • Limited to Provincial facilities
• Subject to Scheme Protocols | |
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| | •Maternity Confinements (Normal Vaginal Delivery) (Excl. Specialist and GP fee) R15000
•Confinements (Caesarean Section if clinically appropriate) (Excl. Specialist and GP fee) R18800
•Neonatal Intensive Care Limited to Scheme Protocols
•Maternity programme included | | •Maternity Confinements (Normal Vaginal Delivery) (Excl. Specialist and GP fee) R15000
•Confinements (Caesarean Section if clinically appropriate) (Excl. Specialist and GP fee) R18800
•Neonatal Intensive Care Limited to Scheme Protocols
•Maternity programme included | | •Maternity Confinements (Normal Vaginal Delivery) (Excl. Specialist and GP fee) R15000
•Confinements (Caesarean Section if clinically appropriate) (Excl. Specialist and GP fee) R18800
•Neonatal Intensive Care Limited to Scheme Protocols
•Maternity programme included | | •Maternity Confinements (Normal Vaginal Delivery) (Excl. Specialist and GP fee) R15000
•Confinements (Caesarean Section if clinically appropriate) (Excl. Specialist and GP fee) R18800
•Neonatal Intensive Care Limited to Scheme Protocols
•Maternity programme included | | •Maternity Confinements (Normal Vaginal Delivery) (Excl. Specialist and GP fee) R15000
•Confinements (Caesarean Section if clinically appropriate) (Excl. Specialist and GP fee) R18800
•Neonatal Intensive Care Limited to Scheme Protocols
•Maternity programme included | |
| | No benefit | | No benefit | | 100% of National Health Reference Price List R2625 | | 100% of National Health Reference Price List R6300 | | No benefit | |
| | •Appliances no benefit
•Prosthesis R42000 | | • Appliances no benefit
• Prosthesis R28850 | | • Appliances 100% of National Health Reference Price List, R2600
• Prosthesis R42000 | | • Appliances 100% of National Health Reference Price List, R9900
• Prosthesis R42000 | | • Appliances no benefit
• Prosthesis R28850 | |
| | •Travel Insurance of R500000 over 90days
•Preventative Care Program | | No benefit | | •Travel Insurance of R500000 over 90days
•Preventative Care Program | | •Travel Insurance of R500000 over 90days
•Preventative Care Program | | No benefit | |
| | Yes | | Yes | | Yes | | Yes | | Yes | |
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