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CompCare UltraCare Medical Aid Plan (🇿🇦 2025)

Overall, the CompCare UltraCare Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and flexible risk cover. to up to its members. The CompCare Ultracare Medical Aid Plan starts from R7,518 ZAR.

🌎 International Cover	Subject to benefits per individual benefit category.
👤 Main Member Contribution	R7,518
👥 Adult Dependent Contribution	R6,766
🍼 Child Dependent Contribution	R2,631
↪️ Gap Cover	No, optional extra.
📉 Annual Limit	Unlimited
💙 Hospital Cover	Unlimited
💶 Prescribed Minimum Benefits	☑️ Yes
➡️ Screening and Prevention	☑️ Yes
🟦 Medical Savings Account	☑️ Yes

👉🏿 Download the UltraCare Medical Aid Plan for 2025

CompCare UltraCare Plan – 7 Key Point Quick Overview

CompCare UltraCare Plan Overview

💙 The CompCare UltraCare medical aid plan is one of 7, starting from R7,518 and is a new-generation option that provides exceptional cover, including unlimited hospital cover and above-average day-to-day benefits such as a savings account and flexible risk cover.

👉🏿 Other CompCare Plans include:

👉🏿 All CompCare plans will have a late joiner fee if you join after the age of 35 years old.

💙 Gap Cover is not available on the CompCare UltraCare Plan. CompCare offers 24/7 medical emergency assistance. According to the Trust Index, CompCare has a trust rating of 3.4.

CompCare UltraCare Plan Contributions, Annual Savings, and Annual Flexi Benefit (AFB)

UltraCare Contributions

👤 Main Member	👥 Adult Dependent	🍼 Child Dependent
R7,518	R6,766	R2,631

UltraCare Above Threshold Benefit (ATB)

👤 Per Dependant	👥 Maximum per Family
R9,660	R17,200

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UltraCare Annual Flexi Benefit (AFB)

👤 Main Member	👥 Adult Dependent	🍼 Child Dependent
R16,000	R12,000	R4,600

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UltraCare Threshold Amount

👤 Main Member	👥 Adult Dependent	🍼 Child Dependent
R26,200	R19,600	R7,400

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UltraCare Self-Payment Gap (SPG)

👤 Main Member	👥 Adult Dependent	🍼 Child Dependent
R10,200	R7,600	R2,800

UltraCare Plan Benefits and Cover Comprehensive Breakdown

UltraCare In-Hospital Benefits

🟥 Hospitalization (Private Hospitals, Nursing Homes)	Covered up to 100% of the scheme rate. Any Netcare hospitals. Subject to pre-authorisation and protocols.
🟧 Biologicals and Specialised Medication	Pre-authorisation required. R261 000 PMF. Protocols apply. 25% co-payment on non- PMB medicines.
🟨 Overall Annual Limit	Unlimited
🟩 GPs and Specialists	Covered up to 100% of the scheme rate. Unlimited cover provided. Subject to pre-authorisation and protocols.
🟦 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-authorisation and protocols. Limited to an overall benefit amount of R47 000. Sub-limits per category apply.
🟧 Auxiliary Services	100% of the scheme rate. Limited to a combined sub-limit of R8 800 PMF, in-and-out of hospital. Subject to pre-authorisation and protocols. Separate pre-authorisation number required – claim will not be paid under the hospital pre-authorisation. 20% co-payment will apply if not pre- authorised.
🟨 Psychiatric In-hospital Treatment	100% of the scheme rate. Subject to pre-authorisation, protocols and PMBs. Up to a maximum of 21 days’ admission OR 15 consultations which will first be paid from AFB (where applicable), thereafter covered by the Scheme.
🟩 Refractive Eye Surgery	Annual limit of R8 350 per eye. Subject to pre-authorisation and protocols. Limit includes all services rendered: Hospitalisation and all related costs.
🟦 All specialized radiology (MRI scans & CT scans)	100% of the scheme rate. Pre- authorisation and medical motivation required for MRI, CT and high-resolution CT scans. R3 800 co-payment applies for each scan.
🟪 Basic Radiology	Covered up to 100% of the scheme rate. Unlimited cover. Subject to protocols.
🟥 Pathology	Covered up to 100% of the scheme rate. Unlimited cover. Subject to protocols.
🟧 Confinements	Covered up to 100% of the scheme tariff. Subject to pre-authorization and protocols.
🟨 Rehabilitation in-hospital (Alcoholism, Drug Dependence, Narcotics)	Unlimited for PMBs. Subject to pre-authorization and protocols.
🟩 Organ Transplants, Plasmapheresis, Renal Dialysis	Unlimited for PMBs. Subject to pre-authorisation and protocols. DSP may apply.
Professional Sports Injuries	Covered up to 100% of the scheme rate. Subject to pre-authorization and protocols.

UltraCare Hospitalisation Alternatives

🔴 Oncology Chemotherapy Radiotherapy	100% of the scheme rate. Unlimited at our oncology DSP. Subject to pre-authorisation and protocols.
🟠 Biological agents and Specialised Medication	Pre-authorisation required. R261 000 PMF. Protocols apply. 25% co-payment on non- PMB medicines.
🟡 Step-down facilities, hospice, rehabilitation	100% of the scheme rate. Unlimited. Subject to pre-authorisation and clinical guidelines.
🟢 Surgical Procedures performed out-of-hospital	Unlimited cover. Subject to pre-approval and protocols.
🔵 Refractive Eye Surgery	Annual limit of R8 350 per eye. Subject to pre-authorisation and protocols. Limit includes all services rendered: Hospitalisation and all related costs.
🟣 Wound care instead of hospitalization	Unlimited cover provided. Subject to pre-approval and protocols.

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UltraCare Day-to-Day Benefits

📌 Day-to-day Benefits and Limits	Day-to-day benefits are first paid from the AFB: P: R16 000 A: R12 000 C: R4 600 (To a maximum of 3 children.) SPG: Self-Payment Gap applicable once AFB is depleted and before Annual Threshold is reached. Thereafter ATB becomes available. Annual SPG amounts are: P: R10 200 A: R7 600 C: R2 800 (GP and specialist consultations, prescribed acute medication, radiology and pathology will accumulate to Annual Threshold and paid from the ATB.) ATB: Once Annual Threshold is reached, the following ATB amounts become available for specified day-to-day expenses: PB: R9 660 PF: R17 200.
📍 General Practitioner (GPs) Consultations	100% of the scheme rate. First paid from AFB, SPG and then ATB once Annual Threshold is reached.
🅰️ Specialist Consultations	100% of the scheme rate. First paid from the AFB and SPG. Thereafter limit of R5 200 PMF applies, subject to overall ATB limit. Referral by a GP is required, and pre- authorisation required to avoid 35% co-payment.
🅱️ Chronic Medicine (27 CDL conditions)	100% of reference price. First paid from AFB. Scheme will cover costs once AFB is depleted. DSP pharmacies apply to UltraCare. Subject to formularies, protocols and pre- authorisation. 25% co-payment for non-formulary medicine, and use of a non-DSP.
🟧 Medicine for non-CDL conditions	38 non-CDL conditions. 100% of reference price. First paid from available AFB and SPG. Thereafter limit of R3 600 PMF applies, subject to overall ATB limit. DSP pharmacies apply to UltraCare. Subject to formularies, protocols and pre- authorisation. 25% co-payment for non-formulary medicine, and use of a non-DSP. Cover also provided for the 27 listed CDL conditions.
🟥 Acute Medicine (Schedule 3>)	First paid from AFB and SPG. Thereafter limit of R3 490 PMF applies, subject to overall ATB. 25% co-payment on medicines where no generic is available. MMAP applies.
🔴 Over the Counter (OTC) Medicine	100% of the scheme rate. Paid from AFB. Limited to maximum of R1 050 PB and R1 500 PMF and one prescription per day up to a maximum of R240 per event. MMAP applies. ATB: No benefit.
❤️ Basic Radiology (Black and White X-Rays & Ultrasounds)	100% of the scheme rate. Paid from AFB and SPG. Thereafter limit of R4 170 PMF applies subject to overall ATB. ATB benefit amount combined with pathology. Referral by GP is required to avoid 35% co-payment.
📈 Specialized Radiation (MRI scans & CT scans)	100% of the scheme rate. Unlimited cover. Pre-authorisation and medical motivation required for MRI, CT and high-resolution CT scans. R3 800 co-payment applies for each scan. Referral by GP is required to avoid 35% co-payment.
☑️ Pathology	100% of the scheme rate. Paid from AFB and SPG. Thereafter limit of R4 170 PMF applies subject to overall ATB. ATB benefit amount combined with radiology. Referral by GP is required to avoid 35% co-payment.
🪥 Conservative Dentistry – Consultations – Preventative Care – Fillings – Extractions – Wisdom Teeth – Root Canal Treatment – Infection Control	100% of the scheme rate. Paid from the AFB. Limited to R4 700 PB, subject to available AFB. ATB: No benefits.
🦷 Specialized Dentistry – Maxillo-facial and oral surgery – In and Out-of-hospital combined limit	100% of the scheme rate. Paid from the AFB, subject to sub-limit of R15 400 PB and R20 800 PMF. Subject to protocols. ATB: No benefits. (Quotation must be submitted for approval prior to commencement of treatment. Orthodontic treatment for patients older than 18 excluded.)
😎 Optometry	Paid from the AFB. Two visits PB per annum. ATB: No benefits
🤓 Lenses and Contact Lenses	100% of the scheme rate. Paid from AFB, subject to sub-limit of R4 800 PB. Subject to protocols. ATB: No benefits.
🥸 Frames	100% of the scheme rate. Paid from AFB, subject to sub-limit of R2 080 per frame. One frame PB every 12 months (from date of service), included in benefit amount for lenses.
🟧 Allied Services – Speech Therapists – Social Workers – Podiatrists, etc.	100% of the scheme rate. Paid from AFB. Subject to combined sub-limit of R8 800 PMF, in-and-out of hospital. ATB: No benefit.
🟨 Clinical Psychologists & Psychiatry	100% of scheme rate. Clinical psychologists Paid from AFB, subject to sub-limit of R3 100 PMF. Psychiatry Paid from AFB, subject to sub-limit of R13 050 PMF. PMB benefit: Up to maximum of 21 days’ admission OR 15 consultations. The 15 consultations will first be paid from AFB, thereafter covered by the Scheme.
🩺 Surgical and Medical Appliances – Wheelchairs – Crutches – Glucometers – Artificial eyes – External fixators	100% of the scheme rate. Paid from the AFB. Sub-limits and protocols apply.
💗 Psychosocial Counselling	Paid from risk. Unlimited telephonic counselling sessions through Universal Wellness Care Centre, with option for referral to one-on-one sessions with qualified psychologists, social workers or registered counsellors to maximum of 3 referral sessions PB per year.
😮‍💨 Oxygen Home Ventilation	Covered up to 100% of the scheme rate. Paid from the PMSA and AFB. Subject to protocols and pre-authorisation.
🏡 Home Nurse Visits	Covered up to 100% of the scheme rate. Limited to 40 days PMF. Paid from the PMSA and AFB. Subject to protocols and preauthorisation.
🤰 Antenatal Classes	100% of the scheme rate. Subject to AFB. Limited to 12 antenatal classes and lactation consultation with a midwife and limited to R1 800 per pregnancy.
🍼 Antenatal Visits and Scans	100% of the scheme rate. Limited to 12 antenatal visits with GP, specialist or midwife. First paid from Care Maximiser. Foetal scans limited to 2 x 2D scans PB per year and can opt for 3D scan (paid at rate of a 2D scan). Maternity bag issued with registration on maternity programme.
⚠️ 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. Paid at South African rates. Register your journey and obtain a travel certificate on www.tic.co.za/compcare
🏥 Hospital Emergency room and casualty emergency visits (no admission and excluding facility fees)	Paid from the AFB.
✔️ Lipogram	Paid from Risk

UltraCare Wellness, Lifestyle, and Preventative Care Benefits

🥰 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 per lifetime.
🟢 Adult Pneumococcal Vaccine	Per beneficiary as required. Subject to pre-approval and protocols.
🥎 Fitness Assessment and Exercise Prescription	Access to Universal’s Network of biokineticists for annual fitness assessments, virtual consultations, exercise prescription and regular monitoring. One additional assessment per pregnant member per pregnancy. Strict protocols apply.
🍏 Nutritional Assessment and Healthy Eating Plan	Access to Universal’s Network of dietitians for annual assessment, virtual consultations, healthy eating plan prescription and regular monitoring. One additional assessment per pregnant member per pregnancy. Strict protocols apply.
🤰 Additional Assessment for pregnant members	Limited to one additional assessment. Strict protocols will apply.
🟪 Contraceptives (Oral/IUD device)	Up to the age of 55 years 13 scripts to maximum of R3 540, OR IUD to maximum of R3 540.
🟣 Home test bundle	• One Covid test • One urinary tract test • One ovulation test • One pregnancy test Overall limit of R350.
💜 Pulse Oximeter	Limited to R850 per family.
😮‍💨 Nebulizer	Limited to R550 per family.
🌡️ Thermal Thermometer	Limited to R450 per family.

UltraCare Newborn to Adult Benefit

👶 Newborn Screening and Paediatric Consultations	Newborn screenings: Hearing screening and congenital hypothyroidism test. Paediatric consultations: Three visits to track development and milestones.
🍼 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 (ages 5-7). Preschool eye and hearing screenings (ages 5-6). Dental screenings (ages 5-7).
⚽ Kids Active Benefit	Fitness assessment and exercise plan for children aged 8-12 with Universal Network biokineticist. SporTeen: Annual fitness assessment, virtual consultations, and exercise plan for children aged 13-17 with Universal Network biokineticist.
🍎 Kids Nutritional Benefit	Access to dietitian for assessments and healthy eating plan for children aged 8-15.

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UltraCare Chronic Conditions Covered

💙 The following chronic conditions are covered under the UltraCare plan:

✅ Addison’s disease
✅ Angina
✅ Asthma
✅ Attention deficit disorder
✅ Bipolar mood disorder
✅ Bronchiectasis
✅ Cardiac arrhythmias
✅ Cardiomyopathy
✅ Chronic renal failure
✅ Congestive cardiac failure

UltraCare Plan Exclusions and Waiting Periods

UltraCare Exclusions

The following are some of the exclusions on the CompCare UltraCare Plan:

☑️ The scheme will not pay for expenses that exceed the annual maximum benefit.
☑️ A general waiting period of 3 months may be applied to new members and their dependents according to the scheme rules.
☑️ According to the scheme rules, a condition-specific waiting period of up to 12 months may be applied for pre-existing sickness conditions.
☑️ The scheme will not cover any costs incurred during waiting periods.
☑️ Certain professional fees and expenses incurred by healthcare professionals will not be covered, such as after-hours consultations at the member’s choice, unattended appointments, interest charges by healthcare providers, costs incurred for insurance medical purposes, fees for medical reports, and motivations unless required by the scheme, and discretionary conditions and services with unauthorized hospital admissions.
☑️ Costs for services rendered by unregistered professionals or institutions, except state or provincial hospitals registered under South African law, will not be covered.

💙 Frail care services will not be covered, including accommodation and nursing care in convalescent or nursing homes catering to the aged or chronically ill.

UltraCare Waiting Periods

💙 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 UltraCare plan, the following applies:

☑️ A general waiting period of 3 months and a 12-month condition-specific waiting period may be imposed for pre-existing medical conditions if not covered on a medical scheme for more than 90 days.
☑️ A condition-specific waiting period of 12 months may be imposed if applying for membership within 3 months of termination from a previous scheme and having been on a medical scheme for less than 24 months.
☑️ If applying for membership within 3 months of termination from a previous scheme and having been on a medical scheme for more than 24 months, a general waiting period of 3 months will apply.
☑️ Prescribed Minimum Benefits are available during waiting periods.
☑️ The scheme may impose any unexpired balances by the previous scheme if the beneficiary suffers from any pre-existing condition.
☑️ New members and their dependents have a 3-month general waiting period.
☑️ Prescribed Minimum Benefits are available during the general waiting period.
☑️ The waiting period does not apply to emergency medical treatment.
☑️ Any costs incurred during waiting periods will not be covered.

💙 Members are responsible for submitting all claims within the required time frame.

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CompCare UltraCare Plan vs. Similar Plans from Other Medical Schemes

🔎 Medical Aid Plan	🥇 CompCare UltraCare plan	🥈 Bestmed Pace 1	🥉 Momentum Extender
👤 Main Member Contribution	R7,518	R5,706	R7,215 – R10,381
👥 Adult Dependent Contribution	R6,766	R4,008	R5,472 – R8,361
🍼 Child Dependent Contribution	R2,631	R1,440	R2,121 – R2,977
↪️ Gap Cover	No, optional extra	No, optional extra	No, optional extra
💙 Hospital Cover	Unlimited	Unlimited	Unlimited

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Our Verdict on The UltraCare Plan

💙 The UltraCare plan from CompCare is a comprehensive healthcare plan that covers both in-hospital and day-to-day medical expenses.

💙 The plan offers different options to suit individuals’ needs and budgets, with affordable premiums and various benefits. In addition, members can access specialist consultations, diagnostic tests, and preventative care services under the plan.

💙 One of the key benefits of the UltraCare plan is its flexibility, allowing individuals to customize their cover to suit their needs and budget.

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UltraCare Plan Frequently Asked Questions

What is the CompCare UltraCare plan?

The CompCare UltraCare plan is a comprehensive healthcare plan that covers both in-hospital and day-to-day medical expenses, including specialist consultations, diagnostic tests, and preventative care services.

Is the CompCare UltraCare plan customizable?

Yes, the CompCare UltraCare plan offers different options to suit individuals’ needs and budgets, allowing members to customize their cover.

What is the wellness program included in the UltraCare plan?

The UltraCare plan includes a wellness program that offers health assessments and coaching to help members maintain a healthy lifestyle.

Are co-payments required for certain medical services or treatments under the UltraCare plan?

Yes, the UltraCare plan might require co-payments for certain medical services or treatments.

Are there waiting periods for certain benefits under the UltraCare plan?

Yes, there may be waiting periods for certain benefits under the UltraCare plan.

What are the restrictions on certain medical services under the UltraCare plan?

There are restrictions on certain medical services under the UltraCare plan, such as certain prescription medications and elective cosmetic procedures.

Does the UltraCare plan include cover for emergency medical treatment and evacuation services?

Yes, the UltraCare plan includes cover for emergency medical treatment and evacuation services.

Is chronic medication covered under the UltraCare plan?

Yes, chronic medication is covered under the UltraCare plan as part of its day-to-day medical expenses.

Does the UltraCare plan include a 24-hour health advice line?

Yes, the UltraCare plan includes a 24-hour health advice line that members can access for medical assistance or advice.

Does the UltraCare plan cover funeral benefits?

The UltraCare plan does not appear to include funeral benefits.

Adriaan Schoeman

Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.