Health Squared - Foundation Medical Aid Plan

Health Squared - Foundation

Affordable, income-based medical aid with unlimited hospitalisation at network providers; limited cover for GP and specialist visits; cover for 29 chronic conditions; 24/7 emergency medical assistance; and free flu and child vaccinations.

In Hospital Benefits

Overall Annual Limit

Unlimited subject to sub-limits 100% (Resolution Rate)

Provider

Network Hospitals, R7000 co-payment for use of non Network hospitals

GP's & Specialists

Professional fees paid at 100% Scheme Tariff Covered at DSP

GP's & Specialists: Unlimited

Radiology & Pathology: Unlimited

Oncology: Unlimited (PMB conditions) & R88 772 per family for non-PMB per annum at ICON Network.

Organ Transplants: Limited to PMBs

Dialysis: PMBs and subject to Network

Internal Prosthesis: Unlimited per family per annum. Subject to prosthesis sub-limits and Scheme Protocols. R 42 136 overall annual limit for non-PMB conditions (per family per annum).

Chronic

26 PMBs

Out of Hospital Benefits

Saving / Day to Day / OHEB

GPs: Unlimited to Network authorisation required after 4th visit
Specialists limits: Subject to PMBs and referral by GP, 2 out of Network visits per year
Basic Optometry & Dentistry (subject to scheme rules)

Pooled Day to Day Benefit

No benefit

Threshhold / Safety Net

Not applicable

Self-Payment Gap Before Threshold

Not applicable

Above Threshold Limits

Not applicable

Maternity Care

Subject to scheme protocols and PMBs
2 x 2D scans, subject to scheme protocols and PMBs
GP/midwife: Pre-authorisation needed

Contributions

Contributions

INCOME BASED:

R0 - R2 730

Member: R1 124

Adult: R1 124

Per Child: R487

 

INCOME BASED:

R2 731- R8 880

Member: R1 669

Adult: R1 669

Per Child: R575

 

INCOME BASED:

R8 881 - R15 580

Member: R2 307

Adult: R2 307

Per Child: R885

 

NCOME BASED:

R15 581 - R18 700

Member: R2 721

Adult: R2 2721

Per Child: R938

 

INCOME BASED:

R18 701+

Member: R3 473

Adult: R3 473

Per Child: R1 191

 

 

 

 


Finding it difficult to make sense of all this? Not to worry, you can:

Finding it difficult to make sense of all this? Not to worry, you can:

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