CompCare 2015 Product PDF

Product summary
2015
CompCare
CompCare Medical Scheme offers a

wide range of options to take care of
most peoples healthcare needs. The
options offer a wide range of benefits
at affordable prices.
The Mumed option is an affordable

plan with traditional benefits for young
members and families who want the
freedom to see a healthcare provider of
choice when necessary.
Mumed
Pinnacle
The
Pinnacle
option
offers
comprehensive cover for the discerning
achiever, with exceptional hospital
and superior day-to-day benefits
comprising a combination of savings
account, traditional risk cover and very
competitive above threshold benefits.
The Excess Direct option, a traditional

type of option which requires members
to contribute 20% of the cost of any out
of hospital healthcare services, whilst a
sliding scale co-payment is applied for
hospital accounts with a limit of R10 000
per admission.
Excess Direct
Dynamix
The Dynamix option is an attractive

new generation plan that offers
comprehensive private hospital cover,
a savings account and traditional risk
benefits with above threshold benefits
for day-to-day healthcare expenses.
The Axis option is a premium

comprehensive private hospital benefit
plan with post-operative rehabilitation
benefits for complete peace of mind.
Axis
Symmetry
Product overview
The Symmetry Option provides

unlimited cover in a private hospital of
your choice and comprehensive day-today benefits and traditional risk cover,
for complete peace of mind.
The NetworX option is an affordable

healthcare plan with exceptional value
for students and low-income employees
in the corporate sector, and offers
essential cover within the Universal
Healthcare Provider Network.
NetworX
CompCare Wellness has implemented overall benefit and limit enhancements of 6% across all
options for 2015 whilst limiting contribution increases to 8.9% on all options.
CompCare is financially strong with a solvency level of 38%, considerably higher than the 25%
minimum required by the Council for Medical Schemes.
Those who are new to the Scheme will find that CompCare is sensitive to both healthcare and
budgetary needs with no less than eight benefit options to choose from as well as efficiency
discounted options for those that may prefer using designated service providers in return for a
more affordable contribution rate.
CompCare has introduced a few exciting new benefits:

Utilisation of Universal Network Providers (GP, dental, optometrists) will earn you 10% of the
payment amount into your AFB++ account
A referral by your Universal Network provider GP to a specialist will earn you 10% to your
AFB++ account
CompCare has always been concerned about individuals health so look at the new Newborn
to Adult and Emotional Wellness benefits.
We trust that this summary will provide you with relevant information on the benefit options that
we offer, that will not only help you to stay well, but also cover your health costs when in need.
2015 benefits
BENEFIT SCHEDULE
PINNACLE
DYNAMIX
SYMMETRY
MUMED
EXCESS DIRECT
AXIS
NETWORX
100% of AT - Treatment
subject to preauthorisation, case
management and
Scheme protocols
Access to Private
Hospitals is covered up
to the Overall Annual
Limit at 100% of cost
and there after unlimited
through Public Hospital
facilities. Co-payment
applies to the Hospital
Account at Private
Hospital Facilities. 50%
of the first R4 650 per
incident for the members
account thereafter 10%
of the remainder, up to a
maximum co-payment of
R10 000
management and
Scheme protocols
management and
Scheme protocols in a
Preferred
Hospital Network
Hospitalisation
Hospitalisation (private
hospitals and
nursing homes)
100% of AT Treatment subject to

pre-authorisation,
case management and
Scheme protocols
management and
Scheme protocols
management and
Scheme protocols
Efficiency Discount
Members will receive a

discount on contributions discount on contributions discount on contributions discount on contributions
if Netcare Hospitals are
selected as their preferred selected as their preferred selected as their preferred selected as their preferred
provider for in-hospitals
treatment and if chronic
medicines are obtained
from a Dischem Pharmacy from a Dischem Pharmacy from a Dischem Pharmacy from a Dischem Pharmacy
(including Dischem
(including Dischem
(including Dischem
(including Dischem
Courier Pharmacy)
Courier Pharmacy)
Courier Pharmacy)
Courier Pharmacy)
N/A
Efficiency Discount
with Network
N/A
N/A
N/A
All day-to-day benefits

paid from an Annual
Flexi Benefit at a provider
within the Universal
Network of Service
Providers
N/A
N/A
N/A
Overall Annual Limit

(OAL)
Unlimited
Unlimited
Unlimited
R1.5 million p/f
R500 000 per incident

per year.
Unlimited
R1 million p/f
All Specialised
Radiology including
MRI, CT and PET Scans
100% of AT. Unlimited.

100% of AT. Unlimited.
100% of AT. Limited to
Pre-authorisation required 100% of AT. Limited to
Pre-authorisation
R13 100 p.a. unless
R15 170 p.a. unless
for all MRI and CT
required for all MRI
otherwise pre-authorised. otherwise pre-authorised.
Scans. High Resolution
and CT Scans. High
Pre-authorisation required Pre-authorisation required
CT Scans/PET Scans
Resolution CT Scans/PET
for all MRI and CT
for all MRI and CT
subject to special medical
Scans subject to special
motivation and premedical motivation and
CT Scans/PET Scans
CT Scans/PET Scans
authorisation. No benefit
pre-authorisation. No
subject to special medical subject to special medical
for unauthorised scans.
benefit for unauthorised
motivation and premotivation and preNo benefit for screening
scans. No benefit for
authorisation. No benefit authorisation. No benefit
purposes. The first R2
screening purposes. The
250 paid from available
first R2250 paid from
No benefit for screening
MSA.
available MSA.
purposes
purposes
Accumulates to
Accumulates to threshold
threshold
20% co-payment and

Individual Benefits apply
except MRI and CT scans
where the co-payment is
R1 000 per scan

discount on contributions
discount on contributions
selected as their preferred
if Public Hospitals are
selected as their preferred
provider for in-hospital
treatment and related
from a Dischem Pharmacy
services
(including Dischem
Courier Pharmacy)
100% AT. Subject to

100% of AT. Limited to}
protocols and DSP.
R15 170 p.a. PrePre-authorisation required
authorisation required
for all MRI and CT
for all MRI and CT
CT Scans/PET Scans
CT Scans/PET Scans
subject to special medical subject to special medical
motivation and premotivation and preauthorisation. No benefit authorisation. No benefit
purposes. Subject to OAL
purposes
BENEFIT SCHEDULE
PINNACLE
DYNAMIX
SYMMETRY
MUMED
EXCESS DIRECT
AXIS
NETWORX

R25 165 p/f unless
otherwise pre-authorised

R19 550 p/f unless
otherwise pre-authorised.
Subject to OAL
80% of AT.
Limited to OAL

R25 170 p/f unless
otherwise pre-authorised
Subject to OAL, case

management and
protocols in DSP
Oncology including
Chemotherapy
and Radiotherapy
Unlimited. Subject to pre- Unlimited. Subject to pre- Unlimited. Subject to preauthorisation

authorisation
authorisation
and protocols
and protocols
and protocols
Unlimited. Subject to
pre-authorisation and
protocols. Limited to OAL
80% of AT
Subject to OAL except
for PMBs
Unlimited. Subject to preauthorisation

and protocols
Unlimited. Subject to
pre-authorisation and
protocols. Limited to OAL
Radial Keratotomy &

Excimer Laser
Annual limit of R5 670

per eye, subject to preper eye, subject to preper eye, subject to preauthorisation and specific authorisation and specific authorisation and specific
degree of myopia,
degree of myopia,
degree of myopia,
dioptres and astigmatism, dioptres and astigmatism, dioptres and astigmatism,
or subject to optical limit or subject to optical limit or subject to optical limit
Subject to optical benefit
80% of AT
Subject to optical benefit,
pre-authorisation required
No benefit
No benefit
Claims are paid initially

from the annual Medical
Savings Account - MSA
(15%). Once MSA
become exhausted claims
are paid from an Annual
Flexi Benefit AFB, equal
to 5% of contributions
where after the member
is then liable for the
Self Payment Gap (SPG).
During this period, claims
will accumulate to the
Threshold Level at AT.
Once the Threshold Level
is reached, specific above
threshold benefits will be
available up to a limit of
R5 055 p/b and
R10 110 p/f
with sub-limits
Benefits are paid from

an Annual Flexi-benefit
(AFB). If AFB is exhausted
additional benefits are
available.
AFB limits:
P: R4 944
A: R3 096
C: R1 236
Total AFB= Family limit.
No p/b limit
Max 3 child dependants
Reimbursed on an 80%
basis for doctors and
healthcare providers.
Sub limits apply
Post operative rehab

physio, occupational
therapy,
Biokinesis, limited to
R5 750 p/f for
14 Days
Pre-authorisation
required.
PMBs only
If services are rendered

by Universal Network
Providers, benefits will be
paid at AT up to specified
limits. Some benefits
subject to an Annual Flexi
Benefit (AFB):
R2 532 p/b
R3780 p/f
Hospitalisation
Pathology
100% of AT. Unlimited
Claims are paid initially

from the Annual Medical
Savings Account - MSA.
(20%). Once MSA
become exhausted claims
are paid from an Annual
Flexi Benefit AFB, equal
to 5% of contributions
where after the member
is then liable for the Self
Day-to-Day Cover
Payment (SPG). During
(non hospital expenses)
this period, claims will
accumulate to the
Threshold Level at AT.
Once the Threshold Level
is reached, specific above
threshold benefits will be
available up to a limit of
R7 525 p/b and R15 135
p/f with sub-limits
100% of AT. Unlimited
Benefits are paid from

an annual Flexi-benefit
(AFB). If AFB is exhausted
additional benefits are
available.
AFB limits:
P: R6 552
A: R4 164
C: R1548
Total AFB = Family limit.
No p/b limit
Max 3 child dependants
BENEFIT SCHEDULE
PINNACLE
DYNAMIX
SYMMETRY
MUMED
EXCESS DIRECT
AXIS
NETWORX
No benefit
Unlimited at Universal
Network GP. However
Universal Care requires
clinical motivation to give
an authorisation for GP
visits, where more than
3 visits p/b are required.
2 out-of-area visits p/b.
Co-payment of 20%. Pay
at point of service. limited
to R900 per event.
No benefit
100% AT.
2 visits p/b max 3 p/f per
annum. Two additional
anti-natal visits per
pregnancy. Subject to
referral by a Universal
Network GP and preauthorisation of each
specialist visit. Referrals
limited to specialists
located at DSP Network
Hospitals only. Subject
to AFB.
Subject to formulary.
RP applies.
Unlimited for the
27 CDL Conditions.
Not subject to AFB
RP applies.
27 CDL conditions
- unlimited only if
prescribed by Universal
Network Provider and
dispensed within Universal
Network pharmacy or
dispensing Universal
Network doctor. Any
voluntary use of chronic
medicine prescribed by
out-of-network provider
and any non-formulary
medicines are for
members own account,
unless pre-authorised by
the medical advisor. PMB
rules apply
Day-to-day benefits
General Practitioners
100% AT. Paid from AFB

first.
Consultations (excluding
100% AT. Paid from
procedures and materials)
limited to M:6visits,
100% AT. Paid from
100% AT. Paid from
AFB first, thereafter
MSA, AFB, SPG, after
MSA, SPG, after
consultations (excluding
M+1: 8 visits,
M+2: 10 visits,
threshold unlimited.
threshold unlimited.
procedures and materials)
Utilisation of a Universal
are unlimited. Utilisation
M+3+: 11 visits
Network GP will earn you Network GP will earn you
of a Universal Network
Once the AFB is depleted,
10% of payment amount 10% of payment amount
GP will earn you 10%
the balance of the
into your AFB++ Account into your AFB++ Account of payment amount into
visits will be available.
your AFB++ Account
Network GP will earn you
10% of payment amount
into your AFB++ Account
Specialists
200% AT.
Initially paid from MSA,
AFB, SPG, thereafter an
above threshold benefit
of R3 785 is available,
subject to overall above
threshold limit. Utilisation
of payment amount into
your AFB++ Account
100% AT.
of R3 275 is available
threshold limit. Utilisation
your AFB++ Account
Chronic Medicine
RP applies.
72 Conditions (27 CDL
conditions
+ 45 Chronic)
Unlimited for registered
CDL conditions.
Paid from risk.
Non-CDL Chronic
medication is paid from
MSA, AFB and SPG first,
limited to R10 090 p/b,
Max R15 150 p/f
Above threshold benefits
limited to R3 785 and
threshold limit
RP applies.
63 Conditions (27 CDL
conditions
+ 36 Chronic)
Unlimited for registered
CDL conditions.
Paid from risk.
Non-CDL Chronic
medication is paid from
MSA, and SPG first
limited to R7 570 p/b,
Max R12 625 p/f
Above threshold benefits
limited to R2 520 and
threshold limit
100% AT
Paid from AFB. Utilisation
your AFB++ Account
RP applies.
46 Conditions (27
+ 19 non-CDL Chronic)
Limited to R3 785 p/b,
R5 670 p/f. Once benefit,
depleted CDL medicines
are unlimited
100% AT
Paid from AFB. Utilisation
your AFB++ Account
RP applies.
Unlimited for the
27 Conditions.
Not subject to AFB
Limit of R5 935 p/f.

Combined limit with
specialists. Payable at
80% of AT
Limit of R5 935 p/f.

Combined limit with GPs.
Payable at 80% of AT
Non CDL, Max R9 645

per family per year
CDL/PMB Unlimited
through DSP, Formulary
and reference pricing
apply
BENEFIT SCHEDULE
PINNACLE

Acute medicines
(Schedule 3 and higher) of R3 150 p/f is available,
threshold limit
All Specialised
Radiology including
MRI, CT and PET Scans
Pathology
Subject to in-hospital
Specialised radiology
benefit
100% AT. Paid from MSA,

AFB, SPG, after threshold
unlimited. Utilisation of a
Universal Network GP will
earn you 10% of payment
amount into your AFB++
Account
Specialised Dentistry,
including MaxilloFacial and Oral surgery
(In-and-out of hospital
combined limit)
100% AT. Paid from

MSA and AFB, subject to
a sub-limit of R14 575
p/b, including hospital &
related costs.
Subject to protocols
Optometry visits
100% SAOA Rates

2 visits p/b per annum.
SYMMETRY
MUMED
Day-to-day benefits
EXCESS DIRECT
AXIS
NETWORX
Unlimited if prescribed by
a Universal Network GP,
or by a specialist, provided
member was referred by
a Universal Network GP.
Subject to formulary. No
cover for non-formulary
medicines unless otherwise
pre-authorised. No cover
in cases of voluntary use
of non-DSPs, or voluntary
use of specialist without
Network GP
100% AT. PMBs
only. Subject to preauthorisation and case
management
100% AT. Unlimited when
clinically appropriate
within a Universal
Network and subject to
Network GP. Limited to
list of codes. Subject to
case management. No
benefit if not referred by a
Network provider, or by a
specialist following referral
by a Universal Network GP
(except when involuntary)

of R2520 p/f is available,
threshold limit
Paid from AFB
Paid from AFB
80% of AT. Max R6 600

per family per year
No benefits
benefit
benefit
benefit
1 incident per family per

year. Co-payment of
R1 000
No benefit
80% AT. Maximum of

100% of AT.
100% of AT.
R4 280 per family per
Paid from AFB subject to
Limited to hospital basic
year. Combined limit with
scheme protocols
pathology limit of R19 550
radiology
No benefit
100% AT. Unlimited.

Paid from AFB. thereafter
80% AT. Max R4 220 per
family per family per year
Account
No benefit
100% of AT. Subject to

AFB, protocols apply
Paid from AFB. Subject to Paid from AFB. Subject to

scheme protocols. Limited scheme protocols. Limited
80% AT. Max R6 730 per
toR1 700 p/b
to R6 360 p/b
family per family per year
Implants: for members
Implants: for members
account
account
No benefit
No benefit unless PMB.

Subject to protocols. Paid
from AFB
100% SAOA Rates
DSP Network only
No benefit
1 visit p/b every second

year. Paid from AFB
100% of AT.
above threshold benefit of
R2 520 p/f is available,
of R3 785 p/f is available,
threshold limit. Combined
threshold limit. Combined
limit with radiology
limit with radiology
Conservative dentistry
including consultations,
preventative care,
fillings, extractions and
infection control
Optical
DYNAMIX
100% AT. Paid from MSA,

AFB, SPG, after threshold
Account
100% AT - Paid from MSA
and AFB, subject to a
sub-limit of
R9 530 p/b or R13 260
p/f, including hospital &
related costs.
100% SAOA Rates
2 visits p/b per annum.
100% AT. Unlimited.

Paid from AFB, thereafter
Account
100% SAOA Rates

100% SAOA Rates
80% of SAOA rates
1 visit p/b per annum.
1 visit p/b per annum.
1 test payable at 80% to a
Network GP will earn you Network GP will earn you
limit of R390
10% of payment amount 10% of payment amount
into your AFB++ Account into your AFB++ Account
BENEFIT SCHEDULE
Lenses, Frames and

Contact Lenses
Frames
Speech Therapists,
Social Workers,
Podiatrists,
Occupational Therapists,
Homeopaths &
Naturopaths, Dieticians,
Chiropractors (x-rays
excluded), Audiologist,
Physiotherapy and
Biokinetics
(Subject to protocols)
Wellness, Lifestyle and

Preventative Care (All
benefits are paid from
risk, except where
indicated differently)
Newborn to Adult
Benefit
Emotional Wellness
PINNACLE
AXIS
NETWORX
Single vision (incl. test)

100% AT. Paid from MSA 100% AT. Paid from MSA
100% of AT. Paid from
R770
and AFB,
and AFB, subject to a
100% of AT. Paid from
AFB, subject to a sub-limBifocal (incl. test) R1 170
subject to a sub-limit of
sub-limit of
AFB, subject to a sub-limit
it of
Multifocal (incl. test)
R3 785 p/b.
R3 030 p/b.
of R1700 p/b per annum
R1 315 p/b and R3 795
R1 550. Frames included
p/f per annum
in the lens benefit
No benefit
Clear plastic single vision

(limited to R695) or
bi-focal lenses (limited to
R1 113) every second year.
No benefit for contact
lenses. Paid from AFB
Max of R1 910 per frame Max of R1 270 per frame Max of R900 per frame - 1 frame p/b per annum - - 1 frame p/b per annum - 1 frame p/b per annum included in lenses limit
included in lenses limit
included in lenses limit
100% of AT. Initially paid
from MSA, AFB and SPG
up to a collective limit of
R6 295 p/f , thereafter an
for physiotherapy and
bio kinetics of R2 530
is available. Subject to
overall above threshold
limit
DYNAMIX
100% of AT. Initially paid

from MSA, AFB and SPG
up to a collective limit of
R4380 p/f, thereafter an
for physiotherapy and
bio kinetics of R1 640
is available. Subject to
overall above threshold
limit
SYMMETRY
100% of AT.
Collective limit of
R 2530 p/b. Paid from
AFB
MUMED
EXCESS DIRECT
Max of R660 per frame 1 frame p/b per annum included in lenses limit
Included in lenses limit
No benefit
Limited range of frames

within DSP Network. Paid
from AFB
100% AT - Collective
limit of
R1 645 p/b and R2 615
p/f. Paid from AFB
Physiotherapy,
Chiropractor and
Biokineticist: Max R2 390
per family per year for
all services Audiologist,
Dietician, Occupational
therapist, Speech
therapist: Max
R1 900 per family per year
for all services
No benefit
No benefit unless PMB.

PMB rules apply
No benefit
Blood Pressure, Blood

sugar, Cholesterol, BMI
R155 p/b over the
age of 18 only at DSP
pharmacy. Flu Vaccine,
once per year p/b, limited
to R80
Wellness Benefits
Blood Pressure, Blood sugar, Cholesterol, BMI R155 p/b over the age of 18 only at DSP pharmacy
Rapid HIV tests 1 test p/b per annum
Prophylaxis Malaria as required
Flu Vaccine, once per year p/b, limited to R80
Tetanus vaccine, one injection when required
PSA (Prostate specific antigen) one test per male beneficiary over age 40.
Quite smoking programme limited to R2 650 once a lifetime. Cost of programme will be refunded after the cotanine test to prove nonsmoking
Glaucoma test one p/b per annum
Pap Smear one test per female over age of 18 per annum
Mammogram one test per female beneficiary over the age of 35 every second year
HPC (Cervical Cancer) vaccine One course (3 doses per registered schedule) per female beneficiary between
12 and 18 years of age per life
Adult Pneumococcal Vaccine, PB over 60 and high risk members subject to pre-authorisation.
Fitness Assessment and exercise prescription: Access to Universal Network Biokineticists for: annual fitness assessment, exercise
prescription, regular monitoring. Strict Protocols apply
Nutritional assessment and healthy eating plan: Access to the Universal Network of dieticians for: annual assessment, healthy eating plan
prescription, regular monitoring. Strict protocols apply
Oral contraceptives, limited to R110 p/b per month

Baby wellness visit, two visits per annum for children between 4 weeks and 18 months at a DSP
Baby bag or voucher to value of R1 000. Childhood immunisations, applicable to children up to the age of 12 years, as per recommendation of the Department of
Health
School readiness, 5 - 7 years old
Psychometric testing, 14 - 18 years
Unlimited telephone counseling with referral for one on one counseling, to a limit of 3 sessions per annum
No benefit
NEW
2015 contributions
Income
Pinnacle
Principal
Adult
Child
All
Risk
Income
Pinnacle ED
Principal
Adult
Child
All
3 536
2 751
985
Risk
876
684
240
Savings
Total
4 412
3 435
1 225
Annual Savings
10 512
8 208
2 880
Annual Flexi
Benefit
2 388
1 860
660
Total Day to Day
12 900
10 068
3 540
Total Day to Day
12 900
10 068
3 540
Threshold (incl
AFB)
14 208
11 043
3 857
Threshold (incl
AFB)
14 208
11 043
3 857
Self Payment
GAP
1 308
975
317
Self Payment
GAP
1 308
975
317
Savings
2 904
2 258
816
876
684
240
Total
3 780
2 942
1 056
Annual Savings
10 512
8 208
2 880
Annual Flexi
Benefit
2 388
1 860
660
Mumed
Mumed Network
ED
Axis
Dynamix
All
Risk
Dynamix ED
Principal
Adult
Child
501 6 000
1 563
1 211
443
6 001 7 900
1 731
1 351
493
Mumed ED
Income
Principal
Adult
Child
06 000
1 296
1 000
366
6 001 7 900
1 429
1 105
408
1 548
1 211
436
7 901 15 000
1 886
1 471
535
7 901 15 000
15 001+
2 097
1 634
591
15 001+
1 717
1 337
479
501 7 900
1 212
946
346
7 901 15 000
1 321
1 030
376
15 001+
1 469
1 143
415
All
1 436
1 436
444
All
1 077
1 077
339
Axis ED
All
2 323
1 813
6 44
0 - 500
325
325
158
0 - 500
310
306
168
492
384
144
Total
2 815
2 197
788
501 4 000
523
497
183
501 4 000
353
346
174
Annual Savings
5 904
4 608
1 728
4 001 5 000
540
513
189
4 001 6 000
452
429
215
Annual Flexi
Benefit
1 800
1 416
504
5 001 6 000
646
613
227
6 0019 000
539
512
256
2 831
2 213
785
Risk
492
384
144
Savings
Total
3 323
2 597
929
Annual savings
5 904
4 608
1 728
Savings
Income
Annual Flex
benefit
1 800
1 416
504
Total Day to Day
7 704
6 024
2 232
Total Day to Day
7 704
6 024
2 232
Annual threshold
10 620
8 286
3 050
Threshold (incl
AFB)
10 620
8 286
3 050
6 001 8000
676
643
237
9 001 10 000
571
543
272
Annual Selfpayment GAP
2 916
2 262
818
Self Payment
GAP
2 916
2 262
818
8 001 9 000
769
732
270
10001+
1 126
1 013
500
9 001 10 000
816
776
286
10001+
1 501
1 351
526
Symmetry
All
Symmetry ED
Risk
2 640
2 055
746
Annual Flexi
benefit
6 552
4 164
1 548
NetworX
All
Risk
2 217
1 725
627
Annual Flexi
benefit
6 652
4 164
1 548
Excess Direct
NetworX ED
R2 161 per family
All information relating to the 2015 CompCare Wellness Medical Scheme benefits and contributions are subject
to formal approval by the Council for Medical Schemes. On joining the Scheme, all members will receive a
detailed member brochure, as approved. The final registered Rules of the Scheme will apply.
*This brochure is a summary of the CompCare Wellness Medical Scheme.
Glossary
PMB Prescribed Minimum Benefit
MSA Medical Savings Account
CDL Chronic Disease List
P/F Per family
RP Reference Pricing
TTO To Take Out i.e. medicines taken out of
hospital when discharged
AFB Annual Flexi Benefit
AFB++ Annual Flexi Benefit Plus Plus Account

SPG Self Payment Gap
P/B Per beneficiary
AT Agreed Tariff
DSP Designated Service Provider
TL Threshold Limit
OTC Over The Counter Medicine

CompCare 2015 Product PDF

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CompCare 2015 Product PDF

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Product summary

CompCare Medical Scheme offers a

The Mumed option is an affordable

The Excess Direct option, a traditional

The Dynamix option is an attractive

The Axis option is a premium

The Symmetry Option provides

The NetworX option is an affordable

CompCare has introduced a few exciting new benefits:

100% of AT Treatment subject to

Members will receive a

All day-to-day benefits

Overall Annual Limit

R1.5 million p/f

R500 000 per incident

100% of AT. Unlimited.

20% co-payment and

Members will receive a

100% AT. Subject to

100% of AT. Limited to

100% of AT. Limited to

100% of AT. Limited to

Subject to OAL, case

Unlimited. Subject to pre- Unlimited. Subject to pre- Unlimited. Subject to preauthorisation

Unlimited. Subject to preauthorisation

Radial Keratotomy &

Annual limit of R5 670

Subject to optical benefit

Claims are paid initially

Benefits are paid from

Post operative rehab

If services are rendered

100% of AT. Unlimited

Claims are paid initially

100% of AT. Unlimited

Benefits are paid from

100% AT. Paid from AFB

Limit of R5 935 p/f.

Limit of R5 935 p/f.

Non CDL, Max R9 645

Initially paid from MSA,

100% AT. Paid from MSA,

100% AT. Paid from

100% SAOA Rates

Initially paid from MSA,

Paid from AFB

Paid from AFB

80% of AT. Max R6 600

1 incident per family per

80% AT. Maximum of

100% AT. Unlimited.

100% of AT. Subject to

Paid from AFB. Subject to Paid from AFB. Subject to

No benefit unless PMB.

100% SAOA Rates

DSP Network only

1 visit p/b every second

100% AT. Paid from MSA,

100% AT. Unlimited.

100% SAOA Rates

Lenses, Frames and

Wellness, Lifestyle and