PRODUCTS
Since its inception more than 10 years ago, Resolution Health Medical Scheme has been a forerunner in the provision of quality, affordable medical cover. With no hidden claims loopholes or benefit sacrifices, each of the Scheme's 4 cover options offers you real rand-for-rand value for money, and real benefits.
Whether you are looking for basic hospital cover, primary healthcare cover, a bit of everything or more comprehensive cover, Resolution has a healthcare plan to suit your needs, and your pocket. Our commitment to excellence, integrity and customer centricity have ensured that at Resolution Health you are not just a number, you are a member of our family.
Hospital Plan
Young, healthy and looking for a basic cover plan to take care of those in-hospital expenses? The Hospital Plan is designed for those who can take care of their own day-to-day medical expenses and want extensive appropriate in-hospital cover that is a leader in the market.
Cover includes emergency evacuation from ER24, R5 million international travel cover, access to the Preventative Care programme, including access to a cervical cancer vaccine, and access to the ResoBaby and ResoTot programmes for new and expectant moms. Find out more
Fundamental Plan (groups of 30 or more individuals)
A primary healthcare plan, the Fundamental Plan provides for exceptional appropriate in-hospital cover and limited day-to-day cover through the CareCross network. Cover is limited to PMB conditions.
Cover includes emergency evacuation from ER24, R5 million international travel cover, access to aspects of the Preventative Care programme which are available at CareCross, and access to the ResoBaby and ResoTot programmes for new and expectant moms. Find out more
Progressive Plan
Focused on cover for individuals and small families, the Pr0gressive Plan is the perfect in-betweener and offers balanced cover for day-to-day medical expenses as well as appropriate in-hospital cover.
Cover includes emergency evacuation from ER24, R5 million international travel cover, access to the Preventative Care programme, including access to a cervical cancer vaccine, and access to the ResoBaby and ResoTot programmes for new and expectant moms. Find out more
Prestige Plan
Ideal for those who want or need comprehensive cover, the Prestige Plan offers extensive appropriate in-hospital cover and generous day-to-day cover.
Cover includes emergency evacuation from ER24, R5 million international travel cover, access to the Preventative Care programme, including access to a cervical cancer vaccine, and access to the ResoBaby and ResoTot programmes for new and expectant moms. Find out more
Hospital Plan 2010
A hospital product designed for the individual who is able to manage his own healthcare needs. Generous in-hospital benefits paid at 100% NRPL with the benefit of adding day-to-day cover via the HealthCard. The Voila! Loyalty and wellness programme is designed to reward members for positive lifestyle changes.
Members have access to the following:
- R5 million International Travel Cover – limited to emergency medical cover, up to 90 days (per incident, per beneficiary).
- ResoBaby and ResoTot Programmes
- Emergency Assistance Cover via ER 24
- Preventative Care Programme – Specific preventative measures covered by benefit to assist members in managing their health proactively. This benefit now also includes access to a cervical cancer vaccine.
Emergency Assistance Cover via ER24
Preventative Care Programme - Specific preventative measures covered by benefit to assist members in managing their health proactively. This benefit now also includes access to a cervical cancer vaccine.
Hospital Benefits
| Casualty Cover | R1 050 per family per annum | Limited to emergency visits |
|---|---|---|
| Overall Annual limit | Per incident limit | Unlimited |
| Sub-limits | Confinements: |
Normal delivery - R15 000 Caesarean section - R18 800 |
| Neonatal intensive care: | Limited to Scheme Protocols | |
| Psychiatric Disorders: | Limited to PMB | |
| Cochlear implants: | R52 500 per family | |
| Organ transplants: | R78 500 per family | |
| Prostheses: |
Limited to R42 000 per family
Subject to Prosthesis specific limit |
|
| Chemo- and radiotherapy: | Limited to R157 500 per beneficiary Covered at the oncology network of doctors & subject to SAOC protocols - Tier 2 | |
| HIV/AIDS Management Programme: | Management Programme. Hospitalisation limited to Network Provider and subject to Scheme Protocols, if registered on programme | |
| Specialised radiology: | Limited to R7 250, in-and-out-of-hospital, 100% NRPL | |
| Hospice: | R15 750 per family, 100% NRPL | |
| Antenatal (Specialist/GP) visits: | 2 visits at NRPL rates |
Day-to-day benefits
Routine expenses outside the hospital environment are not covered by this option. The HealthCard could be used as an additional savings vehicle to provide for out-of-hospital medical expenses. Examples of these expenses include: Medical appliances * General practitioners * Dentists* Specialists* Acute medication * Optometrists * Over-the-counter medicine * etc.
Monthly contributions
| Member | R753 |
|---|---|
| Adult dependant | R556 |
| Child dependant | R174 |
*** This is a summary of the benefits. Please refer to the brochure and Scheme Rules for more information.
Fundamental Plan 2010
The Fundamental Plan is a primary healthcare plan. It provides access to private healthcare at designated service providers. The Fundamental Plan is a condition and treatment specific product.
Members also have access to the following:
- ResoBaby and ResoTot Programmes
- Emergency Assistance Cover via ER24
- The Voila! Loyalty and wellness programme rewards members for positive lifestyle changes.
Hospital Benefits
| Casualty Cover | R1 050 per family per annum | Limited to emergency and out of area visits |
|---|---|---|
| Overall Annual limit | Unlimited within PMB Private Hospitals |
Limited to PMB at DSP |
| Sub-limits | Psychiatric disorders: | Limited to DSP and subject to PMB |
| Confinements: |
Normal delivery - R15 000 per family Caesarean section - R18 800 per family |
|
| Neo-natal intensive care: | Subject to Scheme Protocols | |
| Organ transplants: | Limited to liver, heart & kidney only where these are provided at Provincial Hospitals in accordance with public sector protocols and subject to public sector waiting lists. | |
| Prostheses: | R28 850 per family; subject to Prosthesis specific limit per beneficiary | |
| Related hospitalisation | Chemo- and radiotherapy: | Limited to R157 500; covered at the oncology network of doctors and subject to SAOC protocols. Tier 1. |
| HIV/AIDS Management Programme: | Management Programme. Hospitalisation Limited to Network Provider and subject to Scheme Protocols, if registered on programme | |
| Specialised radiology: | Limited to PMB at Network Hospital or Network Provider | |
| Chronic Cover | PMB only | Subject to registration and approval by CareCross Network and limited to CareCross formularies. |
| Day-to-day benefits Overall annual limits |
Limited to Network Providers | Unlimited GP visits at Network Provider |
| Not limited to AOL Specialist visits Dentistry Optometry |
Limited to PMB protocols Primary care (basic) |
Referral by Network Provider limited to PMB and pre-auth required 2 check ups per beneficiary per annum 1 consultation per beneficiary per benefit cycle (24 months) as per DSP protocols |
Monthly contributions
| Principal Member | Adult Dependant | Child Dependant | |
|---|---|---|---|
| Income Category | |||
| R0 - R5 000 | R529 | R435 | R185 |
| R5 001 - R8 000 | R593 | R488 | R207 |
| R8 000 + | R730 | R600 | R255 |
This is a summary of the benefits. Please refer to the brochure and Scheme Rules for more information.
Progressive Plan 2010
The Progressive Plan provides a combination of hospital cover and day-to-day benefits and is designed for young families or the individual. Benefits are paid at 100% NRPL. The Progressive Plan is the only option with a compulsory Medical Current Account contribution. Members have access to the ResoBaby and ResoTot programme, emergency evacuation assistance via ER24 and up to R 5million international travel cover (per incident, per beneficiary, limited to 90 days) The HealthCard is also available as a savings vehicle to provide for additional medical expenses. It is a Visa Electron Debit Card, issued by Mercantile Bank Limited and can be used to purchase goods and services at any medical service provider who has a Credit Card facility.The Voila! Loyalty and wellness programme was designed to reward members for positive lifestyle changes.
Preventative Care Programme – Specific preventative measures covered by benefit to assist members in managing their health proactively. This benefit now also includes access to a cervical cancer vaccine.
Hospital Benefits
| Casualty Cover | Limited to R1 050 per family per annum | Limited to emergency visits |
|---|---|---|
| Hospital limits | Single member Families |
R210 000 R420 000 |
| Sub-limits | Psychiatric disorders: | Limited to Network Provider, subject to PMB |
| Confinements: |
Normal delivery R15 000
Caesarean section R18 800 |
|
| Internal prostheses: | R42 000 per family, subject to Prosthesis specific limit | |
| External medical appliances: | R2 600 per family, 100% NRPL | |
| Antenatal visits (specialists/GP): | 6 visits at 100% NRPL | |
| Related hospitalisation | Chemotherapy & Radiotherapy: | Covered at the oncology network of doctors, subject to SAOC protocols. Tier 1. Limited to R210 000 |
| HIV/AIDS: | Management Programme Hospitalisation limited to DSP hospitals and subject to Scheme Protocols |
|
| Specialised radiology: | R5 750 per family per annum | |
| Hospice: | R18 350 per family | |
| Chronic Cover | 25 PMB CDL’s | Subject to Progressive Formularies, reference pricing may apply, PMB Unlimited |
| Day-to-day benefits | Set benefits that are prorated on an annual basis | |
| Overall Annual Limits | M - R1 600 M+1 - R2 200 M+2 - R2 500 |
|
| Not limited to AOL | General Practitioners and specialists | 100% of NRPL |
| Dentistry benefits | 100% of NRPL | |
| Optometry benefits | 100% of NRPL |
Monthly contributions
| Member | R963 + R48 MCA = total R1011 |
|---|---|
| Adult dependant | R915 + R48 MCA = total R963 |
| Child dependant | R285 + R24 MCA = total R309 |
This is a summary of the benefits. Please refer to the brochure and Scheme Rules for more information.
Prestige Plan 2010
The Prestige Plan provides comprehensive cover for both hospitalisation and day-to-day benefits and is designed for people who want or need comprehensive cover. All members have access to the ResoBaby and ResoTot programmes, emergency evacuation assistance via ER24 and up to R5million international travel cover (per incident, per beneficiary, limited to 90 days). The HealthCard is also available as a savings vehicle to provide for additional medical expenses. The Voila! Loyalty and wellness programme was designed to reward members for positive lifestyle changes.
Preventative Care Programme - Specific preventative measures covered by benefit to assist members in managing their health proactively. This now also includes access to a cervical cancer vaccine.
Hospital Benefits
| Casualty Cover | Limited to emergency visits | R1 050 per family per annum |
|---|---|---|
| Hospital Benefits | Unlimited Professional fees (in-hospital) |
100% NRPL 200% NRPL |
| Sub-limits | Psychiatric disorders: | Limited to DSP and subject to PMB. |
| Cochlear benefit: | R78500 per annum | |
| Confinements: | Normal delivery R15 000 Caesarean section R18 800 |
|
| Internal prostheses: | R42 000 per family | |
| External medical appliances: | R9 900 per family. 100% of NRPL |
|
| Antenatal visits (specialists/GP): | 9 visits at 100% NRPL | |
| Auxiliary services | Chemotherapy & Radiotherapy: | R262 500 per beneficiary. Covered at the oncology network of doctors, subject to SAOC protocols - Tier 2 |
| HIV/AIDS: | Management Programme Hospitalisation limited to DSP hospitals and subject to Scheme Protocols |
|
| Specialised radiology: | R7 850 per family per annum in-and-out-of-hospital | |
| Chronic Cover | Single member Families |
R3 675 and subject to Formulary R7 350 and subject to Prestige Formulary PMB Unlimited |
| Prestige | Families | R3 675 and subject to Formulary
R7 350 and subject to Prestige Formulary PMB Unlimited |
| Day-to-day benefits | Set benefits that are prorated on an annual basis | |
| Overall Annual Limits: | M - R5 000 | |
| M+1 - R7 000 | ||
| M+2 - R9 000 | ||
| NOT limited to AOL: | General Practitioners and Specialists 100% NRPL, subject to limits Optometry – subject to limits Dentistry – subject to limits |
|
Monthly contributions
| Member | R1 677 |
|---|---|
| Adult dependant | R1 630 |
| Child dependant | R430 |
This is a summary of the benefits. Please refer to the brochure and Scheme Rules for more information.
