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. R41 350 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

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 630

Member: R1 081

Adult: R1 081

Per Child: R468

 

INCOME BASED: R2 631- R8 550

Member: R1 553

Adult: R1 553

Per Child: R535

 

INCOME BASED: R8 551 - R15 000

Member: R2 146

Adult: R2 146

Per Child: R823

 

INCOME BASED: R15 001 - R18 000

Member: R2 474

Adult: R2 474

Per Child: R853

 

INCOME BASED: R18 000+

Member: R3 157

Adult: R3 157

Per Child: R1 083

 

 

 

 


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