Comprehensive
(High Cover)
Subject to Savings first, then limited to
M=R4,840, M1+R9,8909.
Subject to overall
day-to-day limit
Subject to Savings and Above Threshold Benefit
Subject to Savings. Extender Benefit (DEB):
Covers unlimited pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP
consultations per year up to the DHR.
Network GP needs to meet digital criteria (in Self Payment Gap). Unlimited after Threshold is reached
Subject to Savings then unlimited from Risk at Fedhealth Network GPs
R4,300 per person (pooled per family)
Subject to Savings, if available.
(Unlimited once Threshold is reached)
Subject to day-to-day benefits
Comprehensive
(High Cover)
Subject to Savings first, then limited to
M=R4,579, M1+R9,280.
Subject to overall
day-to-day limit
Subject to Savings
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Limited to M: R3,550 | M+1: R4,600 | M+2: R5,750 | M+3+: R6,900 . Subject to Day-to-Day Benefits after Savings is depleted
Subject to Savings, if available.
(Unlimited once Threshold is reached)
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Comprehensive
(Medium to High Cover)
Subject to Savings first, then limited to
M=R2,472, M1+R4,970.
Subject to overall
day-to-day limit
Subject to Savings and Above Threshold Benefit
Subject to Savings. Extender Benefit (DEB):
Covers unlimited pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP
consultations per year up to the DHR.
Network GP needs to meet digital criteria
–
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
Subject to day-to-day benefits
Comprehensive
(Medium to High Cover)
–
Subject to Day-to-Day Benefits. Sub-limits:
M=R3,200 | M+1=R4,790 | M+2=R5,330 | M+3+=R6,390
Subject to Savings. Extender Benefit (DEB):
Covers unlimited pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP
consultations per year up to the DHR.
Network GP needs to meet digital criteria
Unlimited consultations at nominated Network GP. Non-network GP paid from Savings/ Wallet or self-funded and Threshold
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
Subject to day-to-day benefits
Comprehensive
(Medium to High Cover)
–
Nominate 2 Network GPs. Subject to Day-to-
Day Benefits.
Sub-limits: M=R3,200 | M+1=R4,790 | M+2=R5,330 | M+3+=R6,390 2 non-nominated GP visits pfpa. Nonnetwork GPs subject to PMBs only
Subject to Savings. Extender Benefit (DEB):
Covers unlimited pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP
consultations per year up to the DHR.
Network GP needs to meet digital criteria
Unlimited consultations at nominated Network GP. Non-network GP paid from Savings/ Wallet or self-funded and Threshold
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
Subject to day-to-day benefits
Hospital & Savings
(Low to Medium Cover)
Subject to Savings
Subject to Savings
Subject to Savings. Extender Benefit (DEB):
Covers up to 6 pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP consultations
per year up to the DHR. Network GP needs to meet digital criteria
Subject to Savings/ Wallet or self-funded. Unlimited consultations at nominated Network GP, once Benefit Maximizer Threshold Level is reached
Subject to Savings
CHILD CARE BENEFITS:
Limited to R1,200
for GP consults for children 2 to 12yrs, once savings is depleted
Subject to Savings, if available
–
Hospital & Savings
(Low to Medium Cover)
Subject to Savings
Subject to Day-to-Day Benefits. Sub-limits:
M=R2,130 | M+1=R3,730 | M+2+=R4,790
Subject to Savings. Extender Benefit (DEB):
Covers up to 4 pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP consultations
per year up to the DHR. Network GP needs to meet digital criteria
Subject to Savings/ Wallet or self-funded. Unlimited consultations at nominated Network GP, once Benefit Maximizer Threshold Level is reached
Limit of M:R2,200 | M+1:R4,050 |
M+2:R4,750 | M+1:R5,100 | M+1:R5,700
Subject to Savings, if available
Subject to day-to-day benefits
Hospital & Savings
(Low to Medium Cover)
Subject to Savings
Nominate 2 Network GPs. Subject to Day-to-Day Benefits. Sub-limits: M=R2,130 | M+1=R3,730 | M+2+=R4,790 2 non-nominated GP visits pfpa. Nonnetwork GPs subject to PMBs only
Subject to Savings. Extender Benefit (DEB):
Covers up to 4 pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP consultations
per year up to the DHR. Network GP needs to meet digital criteria
Subject to Savings/ Wallet or self-funded. Unlimited consultations at nominated Network GP, once Benefit Maximizer Threshold Level is reached
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
Subject to day-to-day benefits
Hospital & Savings
(Low to Medium Cover)
–
Subject to Savings
Subject to Savings. Extender Benefit (DEB):
Covers up to 4 pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP consultations
per year up to the DHR. Network GP needs to meet digital criteria
Subject to Savings/ Wallet or self-funded. Unlimited consultations at nominated Network GP, once Benefit Maximizer Threshold Level is reached
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
Subject to day-to-day benefits
Capitation
(Low Cover)
–
Unlimited network GP consultations. 2 Nonnetwork
GP consults. R65 co-payment per visit. Authorisation required after the 10th visit.. Unlimited virtual care consult. with no co-payment
Unlimited visits at a Smart Network GP. R65 co-payment is applicable. Video consults with your Smart Network GP covered in full
–
–
Subject to Health Saver, if available
–
Capitation
(Low Cover)
–
Unlimited network GP consultations. 2 Nonnetwork
GP consults. R120 co-payment per visit. Authorisation required after the 6th visit. Unlimited virtual care consult. with no co-payment
Unlimited visits at a Smart Network GP. R120 co-payment is applicable. Video consults with your Smart Network GP covered in full
–
Virtual Network GP: Unlimited. R126 copayment per visit (no co-pay for nurse visits).
Network GP: Unlimited. R126 co-payment per visit (1-10). 11th visit onwards, only listed conditions (no co-payment).
Authorisation after 6th visit and clinical guidelines apply
Subject to Health Saver, if available
–
Hospital Plan
(Hospitalization Cover)
–
No Benefit
No Benefit
–
–
–
–
Hospital Plan
(Hospitalization Cover)
No Benefit
Subject to BENEFIT BOOSTER
No Benefit
Subject to Savings or self-funded. Unlimited consultations at nominated Network GP, once Threshold Level is reached
Subject to Day-to-Day Benefits
Subject to Health Saver, if available
–
Hospital Plan
(Hospitalization Cover)
No Benefit
Subject to BENEFIT BOOSTER
No Benefit
Subject to Savings or self-funded. Unlimited consultations at nominated Network GP, once Threshold Level is reached
Subject to Day-to-Day Benefits
Subject to Health Saver, if available
Subject to PPS Wallet, if available
Primary Care
(Network & Income Based)
Unlimited GP visits, subject to Bestmed Rhythm Network. Subject to preauthorisation
after the 10th visit. Nurse consultations: Unlimited medically necessary consults for basic primary care.
Unlimited consultations (max 2 Network GPs). Pre-auth required from 8th visit. 1 Out-of-Network visit pb (max 2 pf) limited to R400 per visit (30% co-pay applies)
Unlimited at chosen KeyCare Network GP.
Second GP can be nominated.
Authorisation required after the 15th visit. 4 Out-of-Network GP visit per beneficiary
Unlimited virtual GP consults and 3 face-toface
consults at Network GP. Non-Network GPs limited to 2 Consults per family, subject to 3 in-person consults. Further consults subject to Savings or self-funded
Limit of M:R2,200 | M+1:R4,050 |
M+2:R4,750 | M+1:R5,100 | M+1:R5,700
Unlimited at Primary Care Network GP. Pre- auth required from 11th visit. Subject to out- of-network GP, casualty OR after-hours visits: 1 visit pbpa, max of 2 visits pfpa.
R100 co-payment applies per visit. Subject to authorisation within 72 hours else 30% co-payment applies
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