Comprehensive
(High Cover)
BESTMED
Pace 3
BONITAS
Bon
Comprehensive
DISCOVERY
Classic Comprehensive
FEDHEALTH
Maxima Exec
MEDIHELP
MedPlus
MOMENTUM
Extender
(Any Hospital,
Any Chronic)
PROFMED
ProPinnacle
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R134,715 per family. Sub-limits apply
Refer to member guide for full list and limits
R64,300 per family. Sub-limits and Managed Care protocols apply. Subject to preauthorisation and use of a preferred provider
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Combined benefit limit of R32,700 per family for unlisted prosthesis (elbow – hip – shoulder replacements, spinal plates and screws etc.)
Sub-limits apply for listed prosthesis (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits for wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R222,000 pb per event (max 1 event pa); Intraocular lenses: R8,670 pb per event (max 2 events pa); Other internal prostheses: R83,800 pb per event (max 2 events pa)
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Comprehensive
(High Cover)
BESTMED
Pace 2
BONITAS
BonClassic
DISCOVERY
-
FEDHEALTH
-
MEDIHELP
MedElite
MOMENTUM
Extender
(Associated Hospital,
Any Chronic)
PROFMED
-
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R134,028 per family. Sub-limits apply
Refer to member guide for full list and limits
R67,670 per family. Sub-limits and Managed Care protocols apply. Subject to preauthorisation and use of a preferred provider
–
–
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits for wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R222,000 pb per event (max 1 event pa); Intraocular lenses: R8,670 pb per event (max 2 events pa); Other internal prostheses: R83,800 pb per event (max 2 events pa)
–
Comprehensive
(Medium to High Cover)
BESTMED
Pace 1
BONITAS
BonComplete
DISCOVERY
Classic Priority
FEDHEALTH
-
MEDIHELP
MedPrime
MOMENTUM
Incentive
(Any Hospital,
Any Chronic + Health Saver)
PROFMED
ProSecure Plus
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R104,366 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
R54,780 per family. Sub-limits and Managed Care protocols apply. Subject to preauthorisation and use of a preferred provider
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
–
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits for wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Comprehensive
(Medium to High Cover)
BESTMED
-
BONITAS
Standard
DISCOVERY
Classic Priority
FEDHEALTH
FlexiFed 4
(Any Hospital)
MEDIHELP
MedPrime
MOMENTUM
Incentive
(Associated Hospital,
Associated Chronic)
PROFMED
ProSecure
–
R54,780 per family. Sub-limits and Managed Care protocols apply. Subject to preauthorisation and use of a preferred provider
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Combined benefit limit of R27,900 per family for unlisted prosthesis (elbow – hip – shoulder replacements, spinal plates and screws etc.)
Sub-limits apply for listed prosthesis (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits for wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Comprehensive
(Medium to High Cover)
BESTMED
-
BONITAS
Standard Select
(Network)
DISCOVERY
Essential Priority
FEDHEALTH
FlexiFed 4
(GRID)
MEDIHELP
MedPrime Elect
(Network)
MOMENTUM
Incentive
(Associated Hospital,
Associated Chronic)
PROFMED
ProSecure Savvy
(Network)
–
R54,780 per family. Sub-limits and Managed Care protocols apply. Subject to preauthorisation and use of a preferred provider
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Combined benefit limit of R27,900 per family for unlisted prosthesis (elbow – hip –
shoulder replacements, spinal plates and screws etc.)
Sub-limits apply for listed prosthesis (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits for wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Hospital & Savings
(Low to Medium Cover)
BESTMED
Beat 3
(Network)
BONITAS
BonSave
DISCOVERY
Classic Delta Saver
(Network)
FEDHEALTH
FlexiFed 3
(GRID)
MEDIHELP
MedSaver
MOMENTUM
Incentive
(Any Hospital,
Associated Chronic)
PROFMED
-
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R92,145 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
R39,040 per family. Managed Care
protocols apply. Subject to pre-authorisation and use of a preferred provider Joint replacement subject to PMB
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Delta Network
Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Combined benefit limit of R27,900 per family for unlisted prosthesis (elbow – hip –
shoulder replacements, spinal plates and screws etc.)
Sub-limits apply for listed prosthesis (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)
–
Hospital & Savings
(Low to Medium Cover)
BESTMED
Beat 2
BONITAS
Primary
DISCOVERY
Essential Saver
FEDHEALTH
FlexiFed 2
(Any Hospital)
MEDIHELP
MedElect
(Network)
MOMENTUM
Incentive
(Associated Hospital,
Associated Chronic)
PROFMED
ProActive Plus
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R91,183 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Subject to PMB. Managed Care protocols apply
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Unlimited at cost at PMB level of care (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Subject to Prescribed Minimum Benefits.
Listed essential cases – clinical guidelines and pre-authorisation apply
Refer to member guide for full list and limits
Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Hospital & Savings
(Low to Medium Cover)
BESTMED
Beat 2
(Network)
BONITAS
Primary Select
(Network)
DISCOVERY
Essential Delta Saver
(Network)
FEDHEALTH
FlexiFed 2
(GRID)
MEDIHELP
MedAdd Elect
(Network)
MOMENTUM
Incentive
(Associated Hospital,
Associated Chronic)
PROFMED
ProActive Plus Savvy
(Network)
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R91,183 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Subject to PMB. Managed Care protocols apply
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Delta Network
Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Unlimited at cost at PMB level of care (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Hospital & Savings
(Low to Medium Cover)
BESTMED
-
BONITAS
BonFit Select
DISCOVERY
Essential Delta Saver
FEDHEALTH
FlexiFed 2
(GRID)
MEDIHELP
MedAdd Elect
(Network)
MOMENTUM
Incentive
(Associated Hospital,
Associated Chronic)
PROFMED
ProActive Plus Savvy
(Network)
–
Subject to PMB. Managed Care protocols apply
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Delta Network
Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Unlimited at cost at PMB level of care (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Capitation
(Low Cover)
BESTMED
-
BONITAS
BonStart Plus
(Network)
DISCOVERY
Classic Smart
(Network)
FEDHEALTH
-
MEDIHELP
-
MOMENTUM
Evolve
(Network)
PROFMED
-
–
R18,180 per family. Managed Care
protocols apply. Subject to pre-authorisation and use of a preferred provider Joint replacements are excluded
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Smart Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
–
–
Intraocular lenses: R6,000 pb per event;
Other internal prostheses: R40,000 pb per event
All limited to maximum of 2 events per year.
Joint replacements limited to PMBs and state facilities
–
Capitation
(Low Cover)
BESTMED
-
BONITAS
BonStart
(Network)
DISCOVERY
Essential Smart
(Network)
FEDHEALTH
-
MEDIHELP
MedMove
(Network)
MOMENTUM
Evolve
(Network)
PROFMED
-
–
Subject to PMB. Managed Care protocols apply
Unlimited at a Dynamic Smart Network Provider. Subject to Prescribed Minimum Benefits, else *EXCLUSIONS apply.
Refer to last page, and Member Guide for full list, limits and exclustions
–
Subject to Prescribed Minimum Benefits.
Listed essential cases – clinical guidelines and pre-authorisation apply
Refer to member guide for full list and limits
Intraocular lenses: R6,000 pb per event;
Other internal prostheses: R40,000 pb per event
All limited to maximum of 2 events per year.
Joint replacements limited to PMBs and state facilities
–
Hospital Plan
(Hospitalization Cover)
BESTMED
-
BONITAS
Hospital Standard
DISCOVERY
Classic Core
FEDHEALTH
-
MEDIHELP
-
MOMENTUM
-
PROFMED
-
–
R51,590 per family. Managed Care protocols apply. Subject to pre-authorisation and use of a preferred provider Joint replacements and back and neck surgery subject to PMB
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
–
–
–
–
Hospital Plan
(Hospitalization Cover)
BESTMED
Beat 1
BONITAS
BonEssential
DISCOVERY
Essential Core
FEDHEALTH
FlexiFed 1
(Network)
No Medivault
MEDIHELP
MediVital
MOMENTUM
Custom
(Any Hospital,
Associated Chronic)
PROFMED
-
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R91,183 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Subject to PMB. Managed Care protocols apply
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Unlimited at cost at PMB level of care (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits
apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Intraocular lenses: R6,600 pb per event;
Other internal prostheses: R56,000 pb per event
All limited to maximum of 2 events per year.
All limited to maximum of 2 events per year
–
Hospital Plan
(Hospitalization Cover)
BESTMED
Beat 1
(Network)
BONITAS
BonEssential Select
(Network)
DISCOVERY
Essential Delta Core
(Network)
FEDHEALTH
FlexiFed 1 Elect
(Network)
No Medivault
MEDIHELP
MediVital Elect
(Network)
MOMENTUM
Custom
(Associated Hospital,
Associated Chronic)
PROFMED
ProSelect Savvy
(Network)
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R91,183 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Subject to PMB. Managed Care protocols apply
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Delta Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Unlimited at cost at PMB level of care (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case management. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Intraocular lenses: R6,600 pb per event;
Other internal prostheses: R56,000 pb per event
All limited to maximum of 2 events per year.
All limited to maximum of 2 events per year
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Primary Care
(Network & Income Based)
BESTMED
Rhythm 1
(Network)
BONITAS
BonCap
(Network)
DISCOVERY
KeyCare Plus
(Network)
FEDHEALTH
FlexiFed Savvy
(Network)
MEDIHELP
MedElect Student
(Network)
MOMENTUM
Ingwe
(Network)
PROFMED
-
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R61,384 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Subject to PMB and Network Provider.
Managed Care protocols apply
Subject to PMB and Network Hospitals
Unlimited at cost at PMB level of care (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Subject to Prescribed Minimum Benefits.
Listed essential cases – clinical guidelines and pre-authorisation apply
Refer to member guide for full list and limits
Limited to Prescribed Minimum Benefits at State facilities
–