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Overall, the CompCare PINNACLE Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and generous savings account for up to 3 Family Members. The CompCare PINNACLE Medical Aid Plan starts from R9,187 ZAR.
👤 Main Member Contribution | R9,187 |
👥 Adult Dependent Contribution | R7,151 |
🍼 Child Dependent Contribution | R2,544 |
🌎 International Cover | Subject to benefits per individual benefit category. |
↪️ Gap Cover | None |
📉 Annual Limit | Unlimited |
💶 Prescribed Minimum Benefits | ☑️ Yes |
💙 Medical Savings Account | ☑️ Yes |
👶 Maternity Benefits | ☑️ Yes |
➡️ Hospital Cover | Unlimited |
The CompCare PINNACLE medical aid plan is one of 9, starting from R9,187 and features complete and unlimited hospital cover, a generous savings account, maternity benefits, pathology and radiology benefit, chronic conditions management, HIV/AIDS, and more.
Other CompCare Plans include:
All CompCare plans will have a late joiner fee.
Gap Cover is not available on the CompCare PINNACLE Plan. CompCare offers 24/7 medical emergency assistance. According to the Trust Index, CompCare has a trust rating of 3.4.
👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
R9,187 | R7,151 | R2,544 |
👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
R22,044 | R17,160 | R6,096 |
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👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
R4,788 | R3,720 | R1,296 |
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👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
R26,832 | R20,880 | R7,392 |
👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
R30,492 | R23,400 | R8,148 |
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👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
R3,660 | R2,520 | R756 |
🟥 Hospitalization Private Hospitals Nursing Homes | Covered up to 100% of the scheme rate. The cover is provided in a private ward. Subject to pre-approval, case management, and scheme protocols. |
🟧 Efficiency Discounted (ED) Members can choose Designated Service Providers (DSPs) for in-hospital services and chronic medicines to receive discounts. Voluntary admission to a non-Netcare facility requires a 30% co-payment of R7 500 – Not applicable to emergencies. Non-DSP pharmacies require a 25% co-payment. | Netcare hospitals can be used. Medicine can be obtained from Dis-Chem pharmacies. |
🟨 Overall Annual Limit | Unlimited |
🟩 GPs and Specialists | Specialists are covered up to 200% of the scheme rate (dental treatment is excluded). GPs are covered up to 100% of the scheme rate. Unlimited cover provided. |
🟦 Medication in-hospital | Covered up to 100% of the cost. |
🟪 Medication upon discharge from the hospital | Subject to Reference Pricing (RP) and Formularies. Limited to 7 days’ supply. |
🟥 Surgical Prostheses | Subject to pre-authorization. Limited to an overall limit of R60,000. Sub-limits will apply according to categories. |
🟧 Auxiliary Services | Limited to R12,500 per family. The combined limit for in and out-of-hospital treatment. Subject to pre-approval and protocols. A medical practitioner must recommend treatment. |
🟨 Psychiatric In-hospital Treatment | Covered up to 100% of the scheme rate. Subject to pre-authorization, protocols, and PMBs. |
🟩 Psychology (non-psychiatric admissions) | Limited to R5,500 per family. |
🟦 All specialized radiology MRI scans CT scans PET scans | Covered up to 100% of the scheme rate. Unlimited cover. Authorization is required. PET scans require special motivation and approval. Unauthorized scans are not covered. Screening scans are not covered. The PMSA covers the first R3,000. Claims accumulate to the threshold unless there is a PMB. |
🟪 Basic Radiology | Covered up to 100% of the scheme rate. Unlimited cover but subject to scheme protocols. |
🟥 Pathology | Covered up to 100% of the scheme rate. Subject to pre-approval and protocols. The cover is unlimited. |
🟧 Confinements for Maternity | Covered up to 100% of the scheme tariff. Subject to pre-authorization and clinical protocols. |
🟨 Rehabilitation in-hospital Alcoholism Drug Dependence Narcotics | Subject to pre-authorization, protocols, and PMBs. |
🟩 Organ Transplants, Plasmapheresis, Renal Dialysis | Subject to pre-authorization, protocols, and PMBs. |
🟦 Professional Sports Injuries | Subject to pre-approval. Scheme protocols will apply. |
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🔴 Oncology Chemotherapy Radiotherapy | Unlimited cover when using an Oncology DSP. Subject to pre-approval and protocols. The Oncology formulary will apply. |
🟠 Biological agents and Specialised Medication | Limited to R330,000 per family per year. Pre-approval is required. Protocols will apply. Non-PMB medicines attract a 25% co-payment. |
🟡 Step-down facilities, hospice, rehabilitation | The unlimited coverage is offered. Subject to pre-authorization and clinical guidelines. |
🟢 Surgical Procedures performed out-of-hospital | Unlimited cover. Subject to pre-approval and protocols. |
🔵 Radial Keratotomy and Excimer Laser | Limited to R9,000 per eye. Subject to the optical benefit. Pre-authorization is required, and protocols will apply. The limit includes all services offered, including hospitalization and related costs. |
🟣 Wound care instead of hospitalization | Unlimited cover provided. Subject to pre-approval and protocols. |
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🅰️ Aviation Medical Exams Typical examination and reporting for aviation medicals that are performed by doctors licensed for CAA | This benefit includes the following: Typical medical examination ECG Eye Test Spirometry Audiology Lipogram Chest X-Ray Report drafting |
🅱️ Executive Wellness Screening | The following are available for PINNACLE members: Medical Assessment with a GP or Registered Nurse. Health questionnaire or assessment. Tests such as glucose, lipogram, PSA, etc. Vision and hearing screening. Stress ECG. Chest X-Rays. All other Wellness and Preventative tests. Consolidated result reporting. |
🔎 Day-to-day Benefits and Limits | Paid from the PMSA and then the AFB. After depleting these, the member enters the Self-Payment Gap, where they must pay for all out-of-pocket claims. Claims will accumulate to the threshold at the scheme rate. Once the threshold is reached, Above Threshold Benefits (ATB) will be available up to R10,700 per beneficiary and R22,050 per family. Sub-limits might apply. |
👩⚕️ General Practitioner (GPs) Consultations | Covered up to 100% of the scheme rate and includes consultation fees, procedures, and material costs. The benefit is paid from the PMSA, AFB, and SPG. Unlimited after the threshold is reached. Children <6 years have unlimited GP visits. |
👨⚕️ Specialist Consultations | Covered up to 200% of the scheme rate. The benefit is paid from the PMSA, AFB, and SPG. Unlimited after the threshold is reached. Members must be referred by a GP or face a 30% co-payment. |
💊 Chronic Medicine | Subject to the formulary. Reference Pricing will apply. Unlimited coverage for 74 conditions (27 CDL and 47 non-CDL conditions). Unlimited cover for registered conditions. |
🟥 Acute Medicine (Schedule 3>) | The benefit is paid from the PMSA, AFB, and SPG. Unlimited after the threshold is reached. There is a 25% co-payment for non-generic products. Subject to the MMAP. |
🟧 Over the Counter (OTC) Medicine | The benefit is paid from the PMSA and AFB. Limited to R1,250 per beneficiary and R1,800 per family, with an R315 maximum per event. Specified Sports supplements are available if there is a valid NAPPI code. |
🧪 Basic Radiology Black and White X-Rays Ultrasounds | Covered up to 100% of the scheme rate. The benefit is paid from the PMSA, AFB, and SPG. Paid from ATB once the limit is reached. |
📌 Specialized Radiation MRI scans CT scans PET scans | Combined in and out-of-hospital specialized radiology benefits. The first R3,000 is paid from the PMSA, AFB, and SPG and will accumulate to the threshold. |
📍 Pathology | Covered up to 100% of the scheme rate. The benefit is paid from the PMSA, AFB, and SPG. After that, benefits are paid from the ATB. |
🦷 Conservative Dentistry Consultations Preventative Care Fillings Extractions Infection Control | Paid up to 100% of the scheme rate. The benefit is paid from the PMSA, AFB, and SPG Unlimited cover once the threshold is reached. Unlimited cover for children <6 years. |
➡️ Specialized Dentistry Maxillo-facial and oral surgery In and Out-of-hospital combined limit | Covered up to 100% of the scheme rate. Paid from the PMSA and AFB, followed by ATB. Subject to protocols. |
😎 Optometry | Paid from the PMSA and AFB. Limited to two visits per beneficiary every second year. |
👁️ Lenses and Contact Lenses | Paid up to 100% of the scheme rate. Paid from the PMSA and AFB. Subject to a sub-limit of R5,700 per beneficiary. Subject to protocols. |
🤓 Frames | A sub-limit of R2,880 applies per frame. There is a limit of one frame per beneficiary per second year included in the lens limit. |
↪️ Allied Services Speech Therapists Social Workers Podiatrists Occupational Therapists and more. | Covered up to 100% of the scheme rate. The benefit is paid from the PMSA, AFB, and SPG. Collectively limited to R12,500 per family in and out-of-hospital. |
🧠 Clinical Psychologists | Covered up to 100% of the scheme rate. The benefit is paid from the PMSA, AFB, and SPG. Subject to a sub-limit of R6,000 per family. |
🔁 Surgical and Medical Appliances Wheelchairs Crutches Glucometers Artificial eyes External fixators | Covered up to 100% of the scheme rate. Subject to sub-limits and protocols. Paid from the PMSA and AFB. |
💖 Psychiatry | Covered up to 100% of the scheme rate. Paid from the AFB up to a sub-limit of R22,000 per family. |
💗 Psychosocial Counselling | Paid from risk. Unlimited telephonic counseling sessions through the Universal Wellness Care Centre Member can opt for referral to one-on-one sessions with qualified psychologists, social workers, or registered counselors up to three referral sessions PB per year. |
😮💨 Oxygen Home Ventilation | Covered up to 100% of the scheme rate. Paid from the PMSA and AFB. |
🏠 Home Nurse Visits | Covered up to 100% of the scheme rate. Limited to 60 days per family. Paid from the PMSA and AFB. |
🥰 Antenatal Classes | Covered up to 100% of the scheme rate. Paid from the PMSA and AFB. Limited to 12 antenatal classes and one lactation consultation with a midwife. Limited to R1,800 per pregnancy. |
☑️ Antenatal Visits and Scans | Covered up to 100% of the scheme rate. Limited to 12 visits with a GP, midwife, or specialist. The benefit is paid from risk. Limited to 2 x 2D fetal scans per beneficiary per year. Members can opt for one 3D scan, which is paid at the rate of a 2D scan. A maternity bag is issued once a pregnant member registers for the maternity program. |
⚠️ Emergency roadside assistance and ambulance transport (Netcare 911) | Covered up to 100% of the scheme rate. Netcare 911 must authorize non-emergency transportation within 24 hours or risk a 25% co-payment. |
🌎 International Travel Benefit Healthcare services outside South Africa | Subject to benefits per individual benefit category. All claims are paid according to South African rates. Members must register their journey and get a travel certificate to qualify for cover. |
🅰️ Hospital Emergency room and casualty emergency visits (no admission and excluding facility fees) | Paid from the PMSA and AFB. |
🅱️ Lipogram | Limited to one fasting lipogram per beneficiary 20 years> once every 5 years. |
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👩⚕️ GP Wellness Consultation | Limited to one visit per beneficiary yearly. |
🩸 Blood Pressure, Blood Sugar, Cholesterol, BMI, and Waist Circumference | Limited to one measurement per beneficiary yearly for those 18 years>. |
🎗️ Rapid HIV Test | One test per beneficiary yearly. |
💉 Flu Vaccine | One vaccine per beneficiary yearly. |
☑️ Tetanus Vaccine | One injection as required. |
✅ Prostate Specific Antigen (PSA) | One per male beneficiary 40 years>. |
📌 Bowel Cancer Screening | One screening per beneficiary between 45 and 75 every two years. |
📍 Glaucoma Test | One per beneficiary per year. |
🅰️ Pap Smear | One per female beneficiary 18 years> once yearly. |
🅱️ Mammogram | One test per female beneficiary 35 years> every two years. |
🟦 HPV Vaccine | One course per female beneficiary between 12 and 18 years. |
🟪 Adult Pneumococcal Vaccine | Per beneficiary as required. Subject to pre-approval and protocols. |
🏈 Fitness Assessment and Exercise Prescription | Fitness assessment and exercise prescription: Annual fitness assessment, virtual consultations, exercise prescription, and monitoring by Universal Network biokinetics. |
🤰 Additional Assessment for pregnant members | Limited to one additional assessment. Strict protocols will apply. |
🍎 Nutritional Assessment and Healthy Eating Plan | Fitness assessment and exercise prescription: Annual fitness assessment, virtual consultations, exercise prescription, and monitoring by Universal Network biokinetics. |
↪️ Contraceptives | Limited to R3,360 per beneficiary per year for female beneficiaries up to 55 years. Reference pricing will apply. CompCare only covers UID devices. |
😷 COVID-19 | Those who test positive for COVID-19 have access to several benefits in addition to PMBs. Subject to pre-approval and managed care protocols. |
📈 Pulse Oximeter | Limited to R850 per month. |
📉 Nebulizer | Limited to R550 per month. |
📊 Thermal Thermometer | Limited to R450 per month. |
👶 Newborn Hearing Screening and Congenital Hypothyroidism Test | Limited to three Paediatric consultations. Access is given to pediatric telephonic advisory services. |
🍼 Baby Wellness Visit | Two visits yearly for children between 4 weeks and 18 months. Members must use a DSP. |
💉 Childhood Immunisations | Available for children up to 12 years old, as per the Department of Health. |
🎓 School Readiness Assessment | Psychometric testing for children 5 – 7 years and 14 to 18. Pre-school eye and hearing screening for children between 5 and 6 years old. Dental Screening for children 5 – 7 years old. |
⚽ Kids Active Benefit | Universal Network biokinetics assesses and prescribes exercise for 8–12-year-olds. SporTeen: Universal Network bio kineticist-led annual fitness assessment, virtual consultations, and exercise prescription for 13 – 17-year-old children. |
🍎 Kids Nutritional Benefit | For 8-year-olds and older, Universal Network dietitians provide nutritional assessments and healthy eating plans. |
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The following chronic conditions are covered under the PINNACLE plan:
and many more.
The following are some of the exclusions on the CompCare PINNACLE Plan:
Prospective members must disclose all details of any past medical condition or treatment. Furthermore, waiting periods are applied when joining the scheme or registering new dependents. In terms of the CompCare PINNACLE plan, the following applies:
🔎 Medical Aid Plan | 🥇 CompCare PINNACLE | 🥈 Medihelp MedPlus | 🥉 Sizwe Hosmed Titanium Executive |
🌎 International Cover | Subject to benefits per individual benefit category. | Scheme Tariff | Covered up to 100% of the scheme rates |
👤 Main Member Contribution | R9,187 | R12,792 | R8,415 |
👥 Adult Dependent Contribution | R7,151 | R12,792 | R7,446 |
🍼 Child Dependent Contribution | R2,544 | R3,192 | R1,719 |
📉 Annual Limit | Unlimited | Unlimited | Unlimited Hospital Cover |
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One of the stand-out features of the PINNACLE plan is its comprehensive coverage. Members can enjoy unlimited private hospital cover, including access to specialized units such as intensive care and high-care wards. Additionally, the plan provides generous cover for chronic medication and day-to-day medical expenses, such as doctor’s visits, pathology tests, and radiology scans. This means that members can enjoy peace of mind knowing they are covered for a wide range of medical expenses. Another unique feature of the PINNACLE plan is its wellness program. Members can benefit from preventative and wellness services, including health assessments, flu vaccinations, and lifestyle coaching.
Furthermore, this can help members to maintain their health and prevent the development of chronic conditions. In terms of advantages, the PINNACLE plan offers a range of benefits designed to provide members with peace of mind and financial security. In addition, the plan includes a medical savings account, which can be used to cover day-to-day medical expenses. Members also have access to a hospital cash benefit, which provides a daily cash payment during an extended hospital stay. The plan also includes a maternity benefit, which covers the cost of antenatal classes, childbirth, and postnatal care costs.
However, there are also some potential disadvantages to consider. For example, the PINNACLE plan is relatively expensive compared to other medical aid plans. This means it may not be accessible to everyone, particularly those on a tight budget. Additionally, the plan includes some exclusions and limitations, meaning certain medical expenses may not be covered. Overall, the PINNACLE plan from CompCare is a comprehensive medical aid plan with a range of unique features and benefits. While it may be relatively expensive, it provides members with peace of mind and financial security by covering a wide range of medical expenses. The wellness program is particularly noteworthy, as it helps members maintain their health and prevent the development of chronic conditions. However, potential members should carefully consider the exclusions and limitations of the plan before deciding if it is right for them.
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The PINNACLE plan is a comprehensive medical aid plan offered by CompCare that provides unlimited private hospital coverage, chronic medication cover, and cover for day-to-day medical expenses.
The cost of the PINNACLE plan can vary depending on the member’s age, health status, and other factors. However, PINNACLE typically costs R9,187 for the main member, R7,151 per adult, and R2,544 per child dependent.
The wellness program offered by the PINNACLE plan includes a range of preventative and wellness services, such as health assessments, flu vaccinations, and lifestyle coaching.
The hospital cash benefit provides a daily cash payment to members during an extended hospital stay.
Yes, the PINNACLE plan includes a maternity benefit covering antenatal classes, childbirth, and postnatal care costs.
The medical savings account is a portion of the member’s contribution that can be used to cover day-to-day medical expenses.
Yes, the PINNACLE plan includes several exclusions and limitations. Therefore, potential members should carefully review the plan to understand what medical expenses are covered.
Potential members can apply for the PINNACLE plan online or by contacting CompCare directly.
The PINNACLE plan may not be accessible to everyone due to its relatively high cost. Therefore, potential members should consider their budget before applying.
Yes, you could switch to the PINNACLE plan from another medical aid. However, potential members should carefully review the terms and conditions before switching.
Members can claim with the PINNACLE plan by submitting a claim form and supporting documents to CompCare.
The time it takes to process a claim with the PINNACLE plan can vary depending on the complexity of the claim. However, CompCare aims to process claims as quickly as possible.
Members can see a specialist with the PINNACLE plan but may need to obtain pre-authorization from CompCare first.
Yes, members can add dependents to their PINNACLE plans, such as a spouse or children.
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