All Schemes provide unlimited Prescribed Minimum Benefits (PMB) for the treatment of Conditions (Chronic Disease List)
Comprehensive
(High Cover)
Cover for Prescribed Minimum Benefits plus additional chronic conditions Limit: M-R16,136 | M+R32,272
Subject to formulary medicine
15% co-payment for use of non-formulary medicine
Cover for Prescribed Minimum Benefits plus 33 additional chronic conditions. Applicable
formulary applies Limit: R17,150 pbpa and R34,140 pfpa
DSP: Bonitas Pharmacy Network
40% Co-pay for use of non-formulary or non-DSP
Cover for Prescribed Minimum Benefits plus22 additional conditions on Additional
Disease List Refer to Member Guide for full list
DSP: Any pharmacy in the Discovery pharmacy network
20% co-payment applies for use of non-DSP Pharmacy
56 Chronic conditions covered (incl Prescribed Minimum Benefits)
Limit: R7,890 pbpa and R14,500 pfpa, thereafter unlimited cover cover for CDL
conditions 100% MPL. Comprehensive formulary
DSP: Clicks, Dis-Chem, Medirite & Pharmacy Direct
40% co-payment for non compliance of the formulary
Cover for Prescribed Minimum Benefits (unlimited after depletion of limit) plus additional chronic conditions
plus additional chronic conditions plus additional chronic conditions
Limit for non-PMB: R22,000 per beneficiary
DSP: Any
Co-payments may apply
Cover for Prescribed Minimum Benefits plus 36 additional conditions. Limit of R12,400
pfpa for non-CDL
DSP: Any Provider
Subject to registration on Chronic Managment Programme and approval by the
Scheme
Cover for Prescribed Minimum Benefits plus additional CDL conditions and relevant
DTPs
Unlimited, subject to Single Exit Price and dispensing fee. Subject to Scheme formulary
and reference price
Co-payment applies for use of non-DSP
Comprehensive
(High Cover)
Cover for Prescribed Minimum Benefits plus additional chronic conditions Limit: M-R10,500 | M+R21,000
Subject to formulary medicine
20% co-payment for use of non-formulary medicine
Cover for Prescribed Minimum Benefits plus 20 additional chronic conditions. Applicable
formulary applies Limit: R14,050 pbpa and R29,040 pfpa
DSP: Bonitas Pharmacy Network whilst in
benefit limit
40% Co-pay for use of non-formulary or non-DSP
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–
Cover for Prescribed Minimum Benefits (unlimited after depletion of limit) plus additional chronic conditions
plus additional chronic conditions plus additional chronic conditions
Limit: M-R5,450 | M+1-R8,150 | M+2-R10,900 | M+3-R11,700
DSP: Any
Co-payments may apply
Cover for Prescribed Minimum Benefits plus 36 additional conditions. Limit of R12,400
pfpa for non-CDL
DSP: Any Provider Subject to registration on Chronic
Managment Programme and approval by the Scheme
–
Comprehensive
(Medium to High Cover)
Cover for Prescribed Minimum Benefits plus additional chronic conditions Limit: M-R7,690 | M+R15,380
Subject to formulary medicine
25% co-payment for use of non-formulary medicine
Cover for Prescribed Minimum Benefits plus 4 additional chronic conditions for children.
Applicable formulary applies
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non-DSP
Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy
–
Cover for Prescribed Minimum Benefits
DSP: Any
Co-payments may apply
Cover for Prescribed Minimum Benefits plus 6 additional conditions. Limit of R12,400
pfpa for non-CDL
DSP: Any Provider Subject to registration on Chronic Managment Programme and approval by the Scheme
Cover for Prescribed Minimum Benefits plus additional CDL conditions
100% Single Exit Price and dispensing fee.
Subject to Scheme formulary and reference price
Limits: M-R17,832 | M+1-R29,201 | Max-R40,450
Co-payment applies for use of non-DSP
Comprehensive
(Medium to High Cover)
–
Cover for Prescribed Minimum Benefits plus 18 additional chronic conditions. Applicable
formulary applies Limit: R11,910 pbpa and R23,900 pfpa
DSP: Bonitas Pharmacy Network
40% Co-pay for use of non-formulary or non-DSP
Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy
44 Chronic conditions covered (incl Prescribed Minimum Benefits)
Limit: R6,300 pbpa and R12,600 pfpa, thereafter unlimited cover cover for CDL
conditions 100% MPL. Intermediate formulary
DSP: Clicks, Dis-Chem, Medirite, Clicks Direct Medicines, Dis-Chem Direct, Medirite Courier Pharmacy and Pharmacy Direct
40% co-payment for non compliance of the formulary
Cover for Prescribed Minimum Benefits DSP: Any
Co-payments may apply
Cover for Prescribed Minimum Benefits plus 6 additional conditions. Limit of R12,400
pfpa for non-CDL
DSP: Associated Provider
Subject to registration on Chronic Managment Programme and approval by
the Scheme
Cover for Prescribed Minimum Benefits plus additional CDL conditions
100% Single Exit Price and dispensing fee.
Subject to Scheme formulary and reference price
Limits: M-R17,832 | M+1-R29,201 | Max-R40,450
Co-payment applies for use of non-DSP
Comprehensive
(Medium to High Cover)
–
Cover for Prescribed Minimum Benefits plus 18 additional chronic conditions. Applicable
formulary applies Limit: R11,910 pbpa and R23,900 pfpa
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non-DSP
Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy
44 Chronic conditions covered (incl Prescribed Minimum Benefits)
Limit: R6,300 pbpa and R12,600 pfpa, thereafter unlimited cover cover for CDL
conditions 100% MPL. Intermediate formulary
DSP: Clicks, Dis-Chem, Medirite, Clicks Direct Medicines, Dis-Chem Direct, Medirite Courier Pharmacy and Pharmacy Direct
40% co-payment for non compliance of the formulary
Cover for Prescribed Minimum Benefits DSP: Any
Co-payments may apply
Cover for Prescribed Minimum Benefits plus 6 additional conditions. Limit of R12,400
pfpa for non-CDL
DSP: Associated Provider
Subject to registration on Chronic Managment Programme and approval by
the Scheme
Cover for Prescribed Minimum Benefits plus additional CDL conditions
100% Single Exit Price and dispensing fee.
Subject to Scheme formulary and reference price
Limits: M-R17,832 | M+1-R29,201 | Max-R40,450
Co-payment applies for use of non-DSP
Hospital & Savings
(Low to Medium Cover)
Cover for Prescribed Minimum Benefits plus additional chronic conditions Limit: M-R3,983 | M+R8,102
Subject to formulary medicine
30% co-payment for use of non-formulary medicine
Cover for Prescribed Minimum Benefits plus additionally added condtion: Depression. Applicable formulary applies
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non-DSP
Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy
34 Chronic conditions covered (incl Prescribed Minimum Benefits)
Unlimited cover for CDL conditions. Limit of R3,100 for ADHD, Depression, Anxiety
disorder etc. (refer to member guide) 100% MPL. Intermediate formulary
DSP: Clicks, Dis-Chem, Medirite, Clicks Direct Medicines, Dis-Chem Direct, Medirite Courier Pharmacy and Pharmacy Direct
40% co-payment for non compliance of the formulary
Cover for Prescribed Minimum Benefits DSP: Any
Co-payments may apply
Cover for Prescribed Minimum Benefits plus 6 additional conditions. Limit of R12,400
pfpa for non-CDL
DSP: Associated Provider
Subject to registration on Chronic Managment Programme and approval by the
Scheme
–
Hospital & Savings
(Low to Medium Cover)
Cover for Prescribed Minimum Benefits
Subject to formulary medicine
30% co-payment for use of non-formulary medicine
Cover for Prescribed Minimum Benefits plus additionally added condtion: Depression.
Applicable formulary applies
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non-DSP
Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy
27 Chronic conditions covered (Prescribed Minimum Benefits)
100% MPL. Intermediate formulary
DSP: Clicks, Dis-Chem, Medirite, Clicks Direct Medicines, Dis-Chem Direct, Medirite Courier Pharmacy and Pharmacy Direct
40% co-payment for non compliance of the formulary
Cover for Prescribed Minimum Benefits
DSP: Pharmacy Network
Cover for Prescribed Minimum Benefits plus 6 additional conditions. Limit of R12,400
pfpa for non-CDL
DSP: Associated Provider
Subject to registration on Chronic Managment Programme and approval by the
Scheme
Cover for Prescribed Minimum Benefits
100% Single Exit Price and dispensing fee.
Subject to Scheme formulary and strict reference price
Co-payment applies for use of non-DSP
Hospital & Savings
(Low to Medium Cover)
Cover for Prescribed Minimum Benefits
Subject to formulary medicine
30% co-payment for use of non-formulary medicine
Cover for Prescribed Minimum Benefits plus additionally added condtion: Depression.
Applicable formulary applies
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non-DSP
Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy
27 Chronic conditions covered (Prescribed Minimum Benefits)
100% MPL. Intermediate formulary
DSP: Clicks, Dis-Chem, Medirite, Clicks Direct Medicines, Dis-Chem Direct, Medirite Courier Pharmacy and Pharmacy Direct
40% co-payment for non compliance of the formulary
Cover for Prescribed Minimum Benefits
DSP and formulary applies
Co-payments may apply
Cover for Prescribed Minimum Benefits plus 6 additional conditions. Limit of R12,400
pfpa for non-CDL
DSP: Associated Provider
Subject to registration on Chronic Managment Programme and approval by the
Scheme
Cover for Prescribed Minimum Benefits
100% Single Exit Price and dispensing fee.
Subject to Scheme formulary and strict reference price
Co-payment applies for use of non-DSP
Hospital & Savings
(Low to Medium Cover)
–
Cover for Prescribed Minimum Benefits plus additionally added condtion: Depression.
Applicable formulary applies
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non-DSP
Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy
27 Chronic conditions covered (Prescribed Minimum Benefits)
100% MPL. Intermediate formulary
DSP: Clicks, Dis-Chem, Medirite, Clicks Direct Medicines, Dis-Chem Direct, Medirite Courier Pharmacy and Pharmacy Direct
40% co-payment for non compliance of the formulary
Cover for Prescribed Minimum Benefits
DSP and formulary applies
Co-payments may apply
Cover for Prescribed Minimum Benefits plus 6 additional conditions. Limit of R12,400
pfpa for non-CDL
DSP: Associated Provider
Subject to registration on Chronic Managment Programme and approval by the
Scheme
Cover for Prescribed Minimum Benefits
100% Single Exit Price and dispensing fee.
Subject to Scheme formulary and strict reference price
Co-payment applies for use of non-DSP
Capitation
(Low Cover)
–
Cover for Prescribed Minimum Benefits plus additionally added condtion: Depression.
Applicable formulary applies and subject to authorisation
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non-DSP
Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy
–
–
Cover for Prescribed Minimum Benefits
DSP: State facilities
Subject to registration on Chronic Managment Programme and approval by the
Scheme
–
Capitation
(Low Cover)
–
Cover for Prescribed Minimum Benefits plus additionally added condtion: Depression.
Applicable formulary applies and subject to authorisation
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non-DSP
Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy
–
Cover for Prescribed Minimum Benefits
DSP: Pharmacy Network
Cover for Prescribed Minimum Benefits
DSP: Associated Provider Subject to registration on Chronic
Management Programme and approval by the Scheme
–
Hospital Plan
(Hospitalization Cover)
–
Cover for Prescribed Minimum Benefits plus additionally added condtion: Depression.
Applicable formulary applies
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non-DSP
Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy
–
–
–
–
Hospital Plan
(Hospitalization Cover)
Cover for Prescribed Minimum Benefits
Subject to formulary medicine
30% co-payment for use of non-formulary medicine
Cover for Prescribed Minimum Benefits plus additionally added condtion: Depression.
Applicable formulary applies
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non-DSP
Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy
27 Chronic conditions covered (Prescribed Minimum Benefits)
100% MPL. Basic formulary
DSP: Clicks,Dis-Chem, Medirite, Clicks Direct Medicines, Dis-Chem Direct, Medirite Courier Pharmacy and Pharmacy Direct
40% co-payment for non compliance of the formulary
Cover for Prescribed Minimum Benefits
DSP: Any
Co-payments may apply
Cover for Prescribed Minimum Benefits
DSP: Associated Provider
Subject to registration on Chronic Managment Programme and approval by the
Scheme
–
Hospital Plan
(Hospitalization Cover)
Cover for Prescribed Minimum Benefits
Subject to formulary medicine
30% co-payment for use of non-formulary medicine
Cover for Prescribed Minimum Benefits plus additionally added condtion: Depression.
Applicable formulary applies
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non-DSP
Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy
27 Chronic conditions covered (Prescribed Minimum Benefits)
100% MPL. Basic formulary
DSP: Clicks Direct Medicines, Dis-Chem Direct, Medirite Courier Pharmacy and Pharmacy Direct
40% co-payment for non compliance of the formulary
Cover for Prescribed Minimum Benefits DSP and formulary applies
Co-payments may apply
Cover for Prescribed Minimum Benefits
DSP: Associated Provider
Subject to registration on Chronic Managment Programme and approval by the
Scheme
Cover for Prescribed Minimum Benefits
100% Single Exit Price and dispensing fee.
Subject to Scheme formulary and strict reference price
Co-payment applies for use of non-DSP
Primary Care
(Network & Income Based)
Cover for Prescribed Minimum Benefits
Subject to formulary medicine
30% co-payment for use of non-formulary medicine
Cover for Prescribed Minimum Benefits plus additionally added condtion: Depression.
Applicable formulary applies and subject to authorisation
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non-DSP
Cover for Prescribed Minimum Benefits, subject to approval
DSP: Chosen primary dispensing GP or Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy
27 Chronic conditions covered (Prescribed Minimum Benefits)
100% MPL. Basic formulary
DSP: Clicks,Dis-Chem, Medirite, Clicks Direct Medicines, Dis-Chem Direct, Medirite Courier Pharmacy and Pharmacy Direct
40% co-payment for non compliance of the formulary
Cover for Prescribed Minimum Benefits DSP: Pharmacy Network
Cover for Prescribed Minimum Benefits
DSP: Ingwe Primary Care Network Subject to Network entry-level formulary
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