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    January 9, 2017

    Getting to know Topmed Hospital Plan

    Topmed, initially established in 1972 and currently a household name in South Africa, is well-known for its comprehensive medical aid plans. However, they offer the affordable Topmed hospital plan too.

    Also, this scheme utilises expertise and industry strengths and provides tailor-made products to meet the growing needs of prospective clients.

    Recently they have innovatively partnered with other service providers to ensure that members receive value for money as well as service excellence.


    TopMed Hospital Plan

    NB! Effective 1 January 2017, TopMed Hospital is changing to TopMed Essential.

    TopMed Hospital Plan is an introductory Hospital Only Plan (no Day-to-Day benefits apply).

    Topmed Hospital Plan

    That is an ideal plan, specially geared towards younger people who seek In-Hospital cover plus cover in the event of catastrophic occurrences that might require a stay in a hospital.

    The plan is also for those who are content to cover their Out-of-Hospital expenses in conjunction with cover from an In-Hospital Plan.


    Topmed Hospital / Topmed Essential Benefits

    Significantly, benefits only apply provided that the mandatory pre-authorisation is obtained, especially before the commencement of any In-Hospital treatment or any related clinical procedure.

    However, in the case of emergency admittance benefits are forfeited if authorisation is not obtained within two business days after that.

    NB! Scheme Policies and Protocols then apply throughout.

    Importantly, the Topmed hospital plan covers the following In-Hospital treatments:


    ·      Treatment of Immunocompromise & Opportunistic Infections irrespective of cause

    ·      Psychiatric Hospitalisation

    ·      7 Days Take Home Medication

    Accommodation, Theatre, Material, Hospital Equipment & Medicine


    Medical Practitioners


    ·      General Practitioners

    ·      Specialists

    ·      Associated Clinical Procedures

    Radiology & Pathology Radioisotope Studies, CT & MRI Scans
    Secondary Facilities Hospice, Rehabilitation & Step Down Nursing
    Out-Patient Treatment at Hospital Facilities Only for Trauma
    Maternity Programme / Confinements


    Qualification for this benefit:

    Register between weeks 12 and 20 of pregnancy

    ·      6 Antenatal Consultations, Antenatal Classes and Prenatal Vitamins

    ·      2 Scans per Beneficiary per Pregnancy

    ·      Pediatric / Newborn Visits

    ·      Confinement

    ·      Home Births

    Ambulance Services ·      Preferred Provider ER 24

    ·      Non-Preferred Provider

    Disease Management / Case Management

    Disease Management – Focuses on the patient’s disease or condition, utilising all the cost elements involved.

    Case Management – Intervention involves patient counselling & education, behaviour modification, therapeutic guidelines & incentives

    ·      AIDS and HIV-Infections

    ·      Organ Transplants & Kidney Dialysis

    ·      Oncology

    Auxiliary Services ·      Clinical and Medical Technologists

    ·      Blood Transfusions

    ·      Internal Medical & Surgical Accessories

    ·      Physio, Speech & Occupational Therapy, Dieticians & Social Workers

    Chronic Medication
    Maxillo-Facial Surgery
    Scopes Colonoscopies & Gastroscopies
    Wellness Benefit
    International Business & Leisure Travel Insurance
    Post Operative Medical Cover


    ·      Heart Attack

    ·      Stroke

    ·      Post-Crime Trauma

    ·      Hip and Knee Replacements (only in the event of trauma)

    Monthly Contributions


    Reflected below, is the Topmed Hospital / Topmed Essential monthly contribution table:


    Main Member R1 458
    Adult Dependant R1 174
    Student/Minor Dependent R592

    For More Information

    Importantly, to acquire the Topmed Hospital / Topmed Essential Hospital Plan or for any other Topmed Healthcare plan, we recommend that first you request a quote or more information

    Contact Details


    Information / Queries
    Client Services, Pre-authorisation

    Case Management and

    Disease Management Programmes

    Tel: 0860 00 21 58
    International 087 740 2899 (for calls outside SA)
    Fax 086 762 4050
    Postal Address PO Box 1462, Durban, 4000



    NB!  Although we took every care to source and reflect accurate information, we do not accept any accountability for possible inaccuracies.  Therefore it is imperative then that you consult a Consultant or a Broker before making any healthcare decision.

    To get a hospital plan quote, please complete and then submit the short form on this page

    All info was correct at time of publishing