All Schemes provide unlimited Prescribed Minimum Benefits (PMB) for the treatment of Conditions (Chronic Disease List)

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

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)

BESTMED

Pace 2

BONITAS

BonClassic

DISCOVERY

-

FEDHEALTH

-

MEDIHELP

MedElite

MOMENTUM

Extender
(Associated Hospital,
Any Chronic)

PROFMED

-

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

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)

BESTMED

Pace 1

BONITAS

BonComplete

DISCOVERY

Classic Priority

FEDHEALTH

-

MEDIHELP

MedPrime

MOMENTUM

Incentive
(Any Hospital,
Any Chronic + Health Saver)

PROFMED

ProSecure Plus

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)

BESTMED

-

BONITAS

Standard

DISCOVERY

Classic Priority

FEDHEALTH

FlexiFed 4
(Any Hospital)

MEDIHELP

MedPrime

MOMENTUM

Incentive
(Associated Hospital,
Associated Chronic)

PROFMED

ProSecure

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)

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)

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)

BESTMED

Beat 3
(Network)

BONITAS

BonSave

DISCOVERY

Classic Delta Saver
(Network)

FEDHEALTH

FlexiFed 3
(GRID)

MEDIHELP

MedSaver

MOMENTUM

Incentive
(Any Hospital,
Associated Chronic)

PROFMED

-

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)

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

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)

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)

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)

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)

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)

BESTMED

-

BONITAS

BonStart Plus
(Network)

DISCOVERY

Classic Smart
(Network)

FEDHEALTH

-

MEDIHELP

-

MOMENTUM

Evolve
(Network)

PROFMED

-

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)

BESTMED

-

BONITAS

BonStart
(Network)

DISCOVERY

Essential Smart
(Network)

FEDHEALTH

-

MEDIHELP

MedMove
(Network)

MOMENTUM

Evolve
(Network)

PROFMED

-

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)

BESTMED

-

BONITAS

Hospital Standard

DISCOVERY

Classic Core

FEDHEALTH

-

MEDIHELP

-

MOMENTUM

-

PROFMED

-

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)

BESTMED

Beat 1

BONITAS

BonEssential

DISCOVERY

Essential Core

FEDHEALTH

FlexiFed 1
(Network)
No Medivault

MEDIHELP

MediVital

MOMENTUM

Custom
(Any Hospital,
Associated Chronic)

PROFMED

-

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)

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)

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)

BESTMED

Rhythm 1
(Network)

BONITAS

BonCap
(Network)

DISCOVERY

KeyCare Plus
(Network)

FEDHEALTH

FlexiFed Savvy
(Network)

MEDIHELP

MedElect Student
(Network)

MOMENTUM

Ingwe
(Network)

PROFMED

-

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