Comprehensive
(High Cover)
Subject to Savings first, then GP limit
Subject to Savings and ATB
Subject to available Savings. Unlimited after Threshold is reached (100% of Scheme Tariff for non-contracted specialists)
Subject to Savings and Threshold. Unlimited once Threshold is reached (10% co-payment for non GP referral)
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 GP limit
Subject to Savings
–
–
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)
–
Comprehensive
(Medium to High Cover)
Subject to Savings first, then GP limit
Subject to Savings and ATB
Subject to available Savings and Threshold (ATB limit)
–
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, GP Sublimits and referral from GP. 1 Additional Network Specialist covered from overall annual limit.
Subject to available Savings and Threshold (ATB limit)
Subject to Savings/ Wallet or self-funded and Threshold. Unlimited once Threshold is reached (20% co-payment for non GP referral)
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, GP Sublimits and referral from GP. 1 Additional Network Specialist covered from overall annual limit.
Subject to available Savings and Threshold (ATB limit)
Subject to Savings/ Wallet or self-funded and Threshold. Unlimited once Threshold is reached (20% co-payment for non GP referral)
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 available Savings
Subject to Savings/ Wallet or self-funded
Subject to Savings
Subject to Savings, if available
–
Hospital & Savings
(Low to Medium Cover)
Subject to Savings
Subject to Day-to-Day Benefits, GP Sublimits and referral from GP. 1 Additional Network Specialist covered from overall annual limit
Subject to available Savings
Subject to Savings/ Wallet or self-funded
Subject to Day-to-Day Benefits, and referral by Network GP
Subject to Savings, if available
Subject to day-to-day benefits
Hospital & Savings
(Low to Medium Cover)
Subject to Savings
Subject to Day-to-Day Benefits, GP Sublimits and referral from GP. 1 Additional Network Specialist covered from overall annual limit
Subject to available Savings
Subject to Savings/ Wallet or self-funded
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 available Savings
Subject to Savings/ Wallet or self-funded
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)
–
2 Visits per family limited to R2,260. R120 co-payment per visit. Subject to referral from a network GP
Sport Injuries: 2 specialist visits per beneficiary. Subject to referral of Smart Network GP
–
–
Subject to Health Saver, if available
–
Capitation
(Low Cover)
–
1 Visits per family limited to R1,250. R250 co-payment per visit. Subject to referral from a network GP
No Benefit
–
Unlimited. For certain listed chronic conditions only – on referral by network GP
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
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/ Wallet or self-funded
Subject to Day-to-Day Benefits
Subject to Health Saver, if available
Subject to PPS Wallet, if available
Primary Care
(Network & Income Based)
Limited to 2 consultations at a max of R2,325 per family per year. Subject to referral by a Rhythm Network Provider and Rhythm Specialist Network
Network Specialist – 3 visits or R3,710 pbpa | 5 visits or R5,510 pfpa. Subject to referral from a network GP (incl prescribed meds,
radiology, pathology etc)
R5,300 per beneficiary. Subject to referral by your chosen KeyCare GP and preauthorisation
Subject to Savings or self-funded
Subject to Day-to-Day Benefits, and referral by Network GP
Limit of 2 visits pfpa, limited to R1,290 per visit and up to max R2,580 pfpa. Subject to referral by Primary Care Netowrk GP and
pre-authorisation
–