(Treatment after discharge pertaining to hospitalisation paid from Risk benefits)
Comprehensive
(High Cover)
Advanced illness benefit in lieu of
hospitalisation: Limited to R133,182 pbpa.
Subject to pre-authorisation and treatment plan
R61,480 per family for physical
rehabilitation. R20,500 per family for hospice/step-down facilities. Subject to preauthorisation
Access to Connected Care. Includes cover and treatment for COVID-19 and/or follow-up care once discharged Trauma Recovery Benefits (refer to brochure for details)
Unlimited at negotiated tariff, subject to protocols, and pre-authorisation
Unlimited sub-acute care and private nursing services as an alternative to hospitalisation.
Speech therapy, occupational therapy & physiotherapy covered up to 30 days after discharge, limited to R2,200 single member or R3,150 pfpa. Palliative Care R32,200 pfpa
R68,000 per family for medical rehabilitation, step-down facilities, Hospice and private nursing. Protocols apply
Reabilitation: Limit of R84,619 per family. In lieu of hospitalisation: Limit of R18,288 per beneficiary for out-patient care. Subject to pre-authorisation and use of DSPN
Comprehensive
(High Cover)
Advanced illness benefit in lieu of
hospitalisation: Limited to R133,182 pbpa.
Subject to pre-authorisation and treatment plan
R61,480 per family for physical
rehabilitation. R20,500 per family for hospice/step-down facilities. Subject to preauthorisation
–
–
Unlimited sub-acute care and private nursing services as an alternative to hospitalisation.
Speech therapy, occupational therapy & physiotherapy covered up to 30 days after discharge, limited to R2,200 single member or R3,150 pfpa. Palliative Care R29,900 pfpa
R68,000 per family for medical rehabilitation, step-down facilities, Hospice and private nursing. Protocols apply
–
Comprehensive
(Medium to High Cover)
Advanced illness benefit in lieu of
hospitalisation: Limited to R83,239 pbpa.
Subject to pre-authorisation and treatment plan
R57,890 per family for physical
rehabilitation. R19,310 per family for hospice/step-down facilities. Subject to preauthorisation
Access to Connected Care. Includes cover and treatment for COVID-19 and/or follow-up care once discharged Trauma Recovery Benefits (refer to brochure for details)
–
Unlimited sub-acute care and private nursing services as an alternative to hospitalisation. Speech therapy, occupational therapy & physiotherapy covered up to 30 days after discharge, limited to R2,200 single member or R3,150 pfpa. Palliative Care R27,500 pfpa
R64,000 per family for medical rehabilitation, step-down facilities, Hospice and private nursing. Protocols apply
Reabilitation: Limit of R56,252 per family. In lieu of hospitalisation: Limit of R15,437 per beneficiary for out-patient care. Subject to pre-authorisation and use of DSPN
Comprehensive
(Medium to High Cover)
–
R61,480 per family for physical
rehabilitation. R20,500 per family for hospice/step-down facilities. Subject to preauthorisation
Access to Connected Care. Includes cover and treatment for COVID-19 and/or follow-up care once discharged Trauma Recovery Benefits (refer to brochure for details)
Unlimited at negotiated tariff, subject to protocols, and pre-authorisation. Sub-acute facilities, physical rehab: Unlimited at cost up to PMB level of care
Unlimited sub-acute care and private nursing services as an alternative to hospitalisation. Speech therapy, occupational therapy & physiotherapy covered up to 30 days after discharge, limited to R2,200 single member or R3,150 pfpa. Palliative Care R27,500 pfpa
R64,000 per family for medical rehabilitation, step-down facilities, Hospice and private nursing. Protocols apply
Reabilitation: Limit of R56,252 per family. In lieu of hospitalisation: Limit of R15,437 per beneficiary for out-patient care. Subject to pre-authorisation and use of DSPN
Comprehensive
(Medium to High Cover)
–
R61,480 per family for physical
rehabilitation. R20,500 per family for hospice/step-down facilities. Subject to preauthorisation
Access to Connected Care. Includes cover and treatment for COVID-19 and/or follow-up care once discharged Trauma Recovery Benefits (refer to brochure for details)
Unlimited at negotiated tariff, subject to protocols, and pre-authorisation. Sub-acute facilities, physical rehab: Unlimited at cost up to PMB level of care
Unlimited sub-acute care and private nursing services as an alternative to hospitalisation. Speech therapy, occupational therapy & physiotherapy covered up to 30 days after discharge, limited to R2,200 single member or R3,150 pfpa. Palliative Care R27,500 pfpa
R64,000 per family for medical rehabilitation, step-down facilities, Hospice and private nursing. Protocols apply
Reabilitation: Limit of R56,252 per family. In lieu of hospitalisation: Limit of R15,437 per beneficiary for out-patient care. Subject to pre-authorisation and use of DSPN
Hospital & Savings
(Low to Medium Cover)
Advanced illness benefit in lieu of
hospitalisation: Limited to R66,591 pbpa.
Subject to pre-authorisation and treatment plan
R61,480 per family for physical
rehabilitation. R20,500 per family for hospice/step-down facilities. Subject to preauthorisation
Access to Connected Care. Includes cover and treatment for COVID-19 and/or follow-up care once discharged Trauma Recovery Benefits (refer to brochure for details)
Unlimited at negotiated tariff, subject to protocols, and pre-authorisation. Sub-acute facilities, physical rehab: Unlimited at cost up to PMB level of care
Unlimited sub-acute care and private nursing services as an alternative to hospitalisation.
Speech therapy, occupational therapy & physiotherapy covered up to 30 days after
discharge, limited to R2,200 single member or R3,150 pfpa. Palliative Care R25,200 pfpa
R64,000 per family for medical rehabilitation, step-down facilities, Hospice and private nursing. Protocols apply
–
Hospital & Savings
(Low to Medium Cover)
Advanced illness benefit in lieu of
hospitalisation: Limited to R66,591 pbpa.
Subject to pre-authorisation and treatment plan
R57,890 per family for physical
rehabilitation. R19,310 per family for hospice/step-down facilities. Subject to preauthorisation
Access to Connected Care. Includes cover and treatment for COVID-19 and/or follow-up care once discharged Trauma Recovery Benefits (refer to brochure for details)
Unlimited at negotiated tariff, subject to protocols, and pre-authorisation. Sub-acute facilities, physical rehab: Unlimited at cost up to PMB level of care
Limit of R26,600 for sub-acute care and private nursing services as an alternative to hospitalisation. Palliative Care R20,700 pfpa
R64,000 per family for medical rehabilitation, step-down facilities, Hospice and private nursing. Protocols apply
Reabilitation: Limit of R28,126 per family. In lieu of hospitalisation: Limit of R13,164 per beneficiary for out-patient care. Subject to pre-authorisation and use of DSPN
Hospital & Savings
(Low to Medium Cover)
Advanced illness benefit in lieu of
hospitalisation: Limited to R66,591 pbpa.
Subject to pre-authorisation and treatment plan
R57,890 per family for physical
rehabilitation. R19,310 per family for hospice/step-down facilities. Subject to preauthorisation
Access to Connected Care. Includes cover and treatment for COVID-19 and/or follow-up care once discharged Trauma Recovery Benefits (refer to brochure for details)
Unlimited at negotiated tariff, subject to protocols, and pre-authorisation. Sub-acute facilities, physical rehab: Unlimited at cost up to PMB level of care
Unlimited sub-acute care and private nursing services as an alternative to hospitalisation. Speech therapy, occupational therapy & physiotherapy covered up to 30 days after discharge, limited to R2,200 single member or R3,150 pfpa. Palliative Care R25,200 pfpa
R64,000 per family for medical rehabilitation, step-down facilities, Hospice and private nursing. Protocols apply
Reabilitation: Limit of R28,126 per family. In lieu of hospitalisation: Limit of R13,164 per beneficiary for out-patient care. Subject to pre-authorisation and use of DSPN
Hospital & Savings
(Low to Medium Cover)
–
R61,480 per family for physical
rehabilitation. R20,500 per family for hospice/step-down facilities. Subject to preauthorisation
Access to Connected Care. Includes cover and treatment for COVID-19 and/or follow-up care once discharged Trauma Recovery Benefits (refer to brochure for details)
Unlimited at negotiated tariff, subject to protocols, and pre-authorisation. Sub-acute facilities, physical rehab: Unlimited at cost up to PMB level of care
Unlimited sub-acute care and private nursing services as an alternative to hospitalisation. Speech therapy, occupational therapy & physiotherapy covered up to 30 days after discharge, limited to R2,200 single member or R3,150 pfpa. Palliative Care R25,200 pfpa
R64,000 per family for medical rehabilitation, step-down facilities, Hospice and private nursing. Protocols apply
Reabilitation: Limit of R28,126 per family. In lieu of hospitalisation: Limit of R13,164 per beneficiary for out-patient care. Subject to pre-authorisation and use of DSPN
Capitation
(Low Cover)
–
R57,230 per family for physical
rehabilitation, subject to pre-authorisation.
R19,100 per family for hospice/step-down facilities. Subject to pre-authorisation
Access to Connected Care. Includes cover and treatment for COVID-19 and/or follow-up care once discharged.(refer to brochure for details)
–
–
R55,000 per family for medical rehabilitation, step-down facilities, private nursing and Hospice. Protocols apply
–
Capitation
(Low Cover)
–
R57,230 per family for physical
rehabilitation, subject to pre-authorisation.
R16,480 per family for hospice/step-down facilities. Subject to pre-authorisation
Access to Connected Care. Includes cover and treatment for COVID-19 and/or follow-up care once discharged.(refer to brochure for details)
–
Subject to Prescribed Minimum Benefits.
Listed essential cases – clinical guidelines and pre-authorisation apply
R55,000 per family for medical rehabilitation, step-down facilities, private nursing and Hospice. Protocols apply
–
Hospital Plan
(Hospitalization Cover)
–
R57,890 per family for physical
rehabilitation. R19,310 per family for hospice/step-down facilities. Subject to preauthorisation
Access to Connected Care. Includes cover and treatment for COVID-19 and/or follow-up care once discharged.(refer to brochure for details)
–
–
–
–
Hospital Plan
(Hospitalization Cover)
Advanced illness benefit in lieu of
hospitalisation: Limited to R66,591 pbpa.
Subject to pre-authorisation and treatment plan
R57,890 per family for physical
rehabilitation. R19,310 per family for hospice/step-down facilities. Subject to preauthorisation
Access to Connected Care. Includes cover and treatment for COVID-19 and/or follow-up care once discharged.(refer to brochure for details)
Unlimited at negotiated tariff, subject to protocols, and pre-authorisation. Sub-acute facilities, physical rehab: Unlimited at cost up to PMB level of care
Unlimited sub-acute care and private nursing services as an alternative to hospitalisation.
Speech therapy, occupational therapy & physiotherapy covered up to 30 days after
discharge, limited to R2,200 single member or R3,150 pfpa. Palliative Care R22,800 pfpa
R61,000 per family for medical rehabilitation, step-down facilities, private nursing and Hospice. Protocols apply
–
Hospital Plan
(Hospitalization Cover)
Advanced illness benefit in lieu of
hospitalisation: Limited to R66,591 pbpa.
Subject to pre-authorisation and treatment plan
R57,890 per family for physical
rehabilitation. R19,310 per family for hospice/step-down facilities. Subject to preauthorisation
Access to Connected Care. Includes cover and treatment for COVID-19 and/or follow-up care once discharged.(refer to brochure for details)
Unlimited at negotiated tariff, subject to protocols, and pre-authorisation. Sub-acute facilities, physical rehab: Unlimited at cost up to PMB level of care
Unlimited sub-acute care and private nursing services as an alternative to hospitalisation.
Speech therapy, occupational therapy & physiotherapy covered up to 30 days after
discharge, limited to R2,200 single member or R3,150 pfpa. Palliative Care R22,800 pfpa
R61,000 per family for medical rehabilitation, step-down facilities, private nursing and Hospice. Protocols apply
Reabilitation: Limit of R28,126 per family. In lieu of hospitalisation: Limit of R13,164 per beneficiary for out-patient care. Subject to pre-authorisation and use of DSPN
Primary Care
(Network & Income Based)
Advanced illness benefit in lieu of
hospitalisation: Approved PMBs at DSPs
R57,890 per family for physical
rehabilitation. R16,860 per family for hospice/step-down facilities. Subject to preauthorisation
Access to Connected Care. Includes cover and treatment for COVID-19 and/or follow-up care once discharged.(refer to brochure for details)
Unlimited at cost at PMB level of care
Limit of R26,600 for sub-acute care and private nursing services as an alternative to hospitalisation. Palliative Care R20,700 pfpa
R15,900 per beneficiary for medical rehabilitation and step-down facilities. No benefit for private nursing and Hospice
–