Chronic Benefits

HIGH COVER LEVEL 1

BONITAS

2021
BonComprehensive

BESTMED

2021
Pace 3

DISCOVERY

2021
Classic Comprehensive

FEDHEALTH

2021
MaximaExec

MEDIHELP

2021
Plus

MOMENTUM

2021
Extender –
Any Hospital, Any Chronic

Cover for Prescribed Minimum Benefits plus 33 additional chronic conditions. Applicable formulary applies
Limit: R14,590 pbpa and R29,060 pfpa DSP: Bonitas Pharmacy Network
40% Co-pay for use of non-formulary or non- DSP

Cover for Prescribed Minimum Benefits plus additional chronic conditions
Limit: M-R14,749 | M+R29,496
Subject to formulary medicine
25% co-payment for use of non-formulary medicine

Cover for Prescribed Minimum Benefits plus additional conditions on Additional Disease List Refer to Member Guide for full list
DSP: Any

54 Chronic conditions covered (incl Prescribed Minimum Benefits)
Limit: R7,600 pbpa and R14,000 pfpa, thereafter unlimited cover for CDL conditions
100% MPL. Comprehensive formulary
DSP: MediRite, Dis-chem, Clicks and Pharmacy Direct

Cover for Prescribed Minimum Benefits (unlimited after depletion of limit) plus additional chronic conditions
Limit for non-PMB: R18,800 per beneficiary DSP: Any
Co-payments may apply

Cover for Prescribed Minimum Benefits plus 36 additional conditions. Limit of R10,700 pfpa for non-CDL
DSP: Any Provider
Subject to registration on Chronic Management Programme and approval by the Scheme

HIGH COVER LEVEL 2

BONITAS

2021
BonClassic

BESTMED

2021
Page

DISCOVERY

2021
Essential Comprehensive

FEDHEALTH

MEDIHELP

2021
Elite

MOMENTUM

2021
Extender: Any (Chronic: Any)

Cover for Prescribed Minimum Benefits plus 20 additional chronic conditions. Applicable formulary applies
Limit: R11,950 pbpa and R24,720 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 plus additional chronic conditions
Limit: M-R9,144 | M+R18,287
Subject to formulary medicine
30% co-payment for use of non-formulary medicine

Cover for Prescribed Minimum Benefits plus additional conditions on Additional Disease List Refer to Member Guide for full list
DSP: Any

Cover for Prescribed Minimum Benefits (unlimited after depletion of limit) plus additional chronic conditions
Limit: M-R4,700 | M+1-R7,100 | M+2-R9,500
| M+3-R10,105 DSP: Any
Co-payments may apply

Cover for Prescribed Minimum Benefits plus 36 additional conditions. Limit of R10,700 pfpa for non-CDL
DSP: Any Provider
Subject to registration on Chronic Management Programme and approval by the Scheme

MEDIUM-HIGH LEVEL 1 COVER

BONITAS

2021
BonComplete

BESTMED

2021
Pace 1

DISCOVERY

2021
Classic Priority

FEDHEALTH

MEDIHELP

MOMENTUM

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 plus additional chronic conditions
Limit: M-R6,650 | M+R13,299
Subject to formulary medicine
35% co-payment for use of non-formulary medicine

Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy or MedXpress or MedXpress Network Pharmacy Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy

MEDIUM-HIGH LEVEL 2 COVER

BONITAS

2021
Standard

BESTMED

2021
Pace 1

DISCOVERY

2021
Classic Priority

FEDHEALTH

2021
FlexiFed 4 Any Hospital

MEDIHELP

2021
Prime 3

MOMENTUM

2021
Incentive:
Any Hospital, Any Chronic

Cover for Prescribed Minimum Benefits plus 18 additional chronic conditions. Applicable formulary applies
Limit: R10,130 pbpa and R20,340 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 plus additional chronic conditions
Limit: M-R6,650 | M+R13,299
Subject to formulary medicine
35% co-payment for use of non-formulary medicine

Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy or MedXpress or MedXpress Network Pharmacy Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy

42 Chronic conditions covered (incl Prescribed Minimum Benefits)
Limit: R6,100 pbpa and R12,200 pfpa, thereafter unlimited cover for CDL conditions
100% MPL. Intermediate formulary
DSP: MediRite, Dis-chem, Clicks and Pharmacy Direct

Cover for Prescribed Minimum Benefits DSP: Any
Co-payments may apply

Cover for Prescribed Minimum Benefits plus 6 additional conditions. Limit of R10,700 pfpa for non-CDL
DSP: Any Provider
Subject to registration on Chronic Management Programme and approval by the Scheme

MEDIUM-HIGH LEVEL 3 COVER

BONITAS

2021
Standard Select

BESTMED

2021
Pace 1

DISCOVERY

2021
Essential Delta Comprehensive

FEDHEALTH

2021
FlexiFed 4 GRID

MEDIHELP

2021
Prime 3 Network

MOMENTUM

2021
Incentive – Associated Hospital, Associated Chronic

Cover for Prescribed Minimum Benefits plus 18 additional chronic conditions. Applicable formulary applies
Limit: R10,130 pbpa and R20,340 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 plus additional chronic conditions
Limit: M-R6,650 | M+R13,299
Subject to formulary medicine
35% co-payment for use of non-formulary medicine

Cover for Prescribed Minimum Benefits plus additional conditions on Additional Disease List Refer to Member Guide for full list
DSP: MedXpress or MedXpress Network Pharmacy

42 Chronic conditions covered (incl Prescribed Minimum Benefits)
Limit: R6,100 pbpa and R12,200 pfpa, thereafter unlimited cover for CDL conditions
100% MPL. Intermediate formulary
DSP: MediRite, Dis-chem, Clicks and Pharmacy Direct

Cover for Prescribed Minimum Benefits DSP and formulary applies
Co-payments may apply

Cover for Prescribed Minimum Benefits plus 6 additional conditions. Limit of R10,700 pfpa for non-CDL
DSP: Associated Provider Subject to registration on Chronic
Management Programme and approval by the Scheme

MEDIUM-LOW COVER 1

BONITAS

2021
BonSave

BESTMED

2021
Beat 3

DISCOVERY

2021
Classic Saver, Coastal Saver & Classic Delta Saver

FEDHEALTH

2021
Unify

MEDIHELP

2021
Prime 3 (Network)

MOMENTUM

2021
Incentive – Any Hospital, Associated Chronic

Cover for Prescribed Minimum Benefits. Applicable formulary applies
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non- DSP

Cover for Prescribed Minimum Benefits plus additional chronic conditions
Limit: M-R3,444 | M+R7,006
Subject to formulary medicine
40% co-payment for use of non-formulary medicine

Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy or MedXpress or MedXpress Network Pharmacy Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy

29 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: MediRite, Dis-chem, Clicks and Pharmacy Direct

Cover for Prescribed Minimum Benefits DSP: Any
Co-payments may apply

Cover for Prescribed Minimum Benefits plus 6 additional conditions. Limit of R10,700 pfpa for non-CDL
DSP: Associated Provider Subject to registration on Chronic
Management Programme and approval by the Scheme

MEDIUM-LOW COVER 2

BONITAS

2021
Primary

BESTMED

2021
Beat 2

DISCOVERY

2021
Essential Saver

FEDHEALTH

2021
FlexiFed 2 Any Hospital

MEDIHELP

2021
Prime 2

MOMENTUM

2021
Incentive – Any Hospital, Associated Chronic

Cover for Prescribed Minimum Benefits. Applicable formulary applies
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non- DSP

Cover for Prescribed Minimum Benefits Subject to formulary medicine
40% co-payment for use of non-formulary medicine

Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy or MedXpress or MedXpress Network Pharmacy 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 and the following courier pharmacies: Pharmacy Direct, Clicks Direct Medicines and Dis- Chem Direct

Cover for Prescribed Minimum Benefits DSP: Any
Co-payments may apply

Cover for Prescribed Minimum Benefits plus 6 additional conditions. Limit of R10,700 pfpa for non-CDL
DSP: Associated Provider Subject to registration on Chronic
Management Programme and approval by the Scheme

MEDIUM-LOW COVER 3

BONITAS

2021
Primary Select

BESTMED

2021
Beat 2 Network

DISCOVERY

2021
Essential Delta Saver

FEDHEALTH

2021
FlexiFed 2 GRID

MEDIHELP

2021
Prime 2 Network

MOMENTUM

2021
Incentive – Associated Hospital, Associated Chronic

Cover for Prescribed Minimum Benefits. Applicable formulary applies
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non- DSP

Cover for Prescribed Minimum Benefits Subject to formulary medicine
40% co-payment for use of non-formulary medicine

Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy or MedXpress or MedXpress Network Pharmacy 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 and the following courier pharmacies: Pharmacy Direct, Clicks Direct Medicines and Dis- Chem Direct
40% co-payment for non compliance of the formulary

Unlimited. Acute (subject to hospital authorisation) and Chronic (subject to pre- authorisation and clinical protocols)

Cover for Prescribed Minimum Benefits plus 6 additional conditions. Limit of R10,700 pfpa for non-CDL
DSP: Associated Provider Subject to registration on Chronic
Management Programme and approval by the Scheme

MEDIUM-LOW COVER 4

BONITAS

2021
BonFit Select

BESTMED

2021
Beat 3 Network

DISCOVERY

2021
Essential Delta Saver

FEDHEALTH

2021
FlexiFed 3 GRID

MEDIHELP

2021
Prime 2 Network

MOMENTUM

2021
Incentive – Associated Hospital, Associated Chronic

Cover for Prescribed Minimum Benefits. Applicable formulary applies
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non- DSP

Cover for Prescribed Minimum Benefits plus additional chronic conditions
Limit: M-R3,444 | M+R7,006
Subject to formulary medicine
40% co-payment for use of non-formulary medicine

Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy or MedXpress or MedXpress Network Pharmacy 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 and the following courier pharmacies: Pharmacy Direct, Clicks Direct Medicines and Dis- Chem Direct

Cover for Prescribed Minimum Benefits DSP and formulary applies
Co-payments may apply

Cover for Prescribed Minimum Benefits plus 6 additional conditions. Limit of R10,700 pfpa for non-CDL
DSP: Associated Provider Subject to registration on Chronic
Management Programme and approval by the Scheme

HOSPITAL COVER 1

BONITAS

2021
Hospital Standard

BESTMED

2021
Beat 1

DISCOVERY

2021
Essential Core

FEDHEALTH

MEDIHELP

MOMENTUM

2021
Custom – Any Hospital, Associated Chronic

Cover for Prescribed Minimum Benefits. Applicable formulary applies
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non- DSP

Cover for Prescribed Minimum Benefits Subject to formulary medicine
40% co-payment for use of non-formulary medicine

Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy or MedXpress or MedXpress Network Pharmacy Network Pharmacy
20% co-payment applies for use of non-DSP Pharmacy

Cover for Prescribed Minimum Benefits
DSP: Associated Provider Subject to registration on Chronic
Management Programme and approval by the Scheme

HOSPITAL COVER 2 

BONITAS

2021
Bon-Essential

BESTMED

2021
Beat 1

DISCOVERY

2021
Essential Core

FEDHEALTH

MEDIHELP

Custom – Any Hospital, Associated Chronic

MOMENTUM

2021
Prime

Cover for Prescribed Minimum Benefits. Applicable formulary applies
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non- DSP

Cover for Prescribed Minimum Benefits Subject to formulary medicine
40% co-payment for use of non-formulary medicine

Cover for Prescribed Minimum Benefits, subject to approval

DSP: MedXpress or MedXpress Network Pharmacy or MedXpress or MedXpress Network Pharmacy 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
DSP: Associated Provider Subject to registration on Chronic
Management Programme and approval by the Scheme

HOSPITAL COVER 3

BONITAS

2021
Bon-Essential Select

BESTMED

2021
Beat 1 Network

DISCOVERY

2021
Essential Delta Core & Coastal Core

FEDHEALTH

FlexiFed 1 Network Hospitals

MEDIHELP

Custom – Associated Hospital, Associated Chronic

MOMENTUM

2021
Prime 1 Network

Cover for Prescribed Minimum Benefits. Applicable formulary applies
DSP: Pharmacy Direct
40% Co-pay for use of non-formulary or non- DSP

Cover for Prescribed Minimum Benefits Subject to formulary medicine
40% co-payment for use of non-formulary medicine

Cover for Prescribed Minimum Benefits, subject to approval
DSP: MedXpress or MedXpress Network Pharmacy or MedXpress or MedXpress Network Pharmacy 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 and the following courier pharmacies: Pharmacy Direct, Clicks Direct Medicines and Dis-Chem 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
Management Programme and approval by the Scheme

Primary Care Network

BONITAS

2021
BonCap

BESTMED

2021
Pulse 1

DISCOVERY

2021
KeyCare Plus

FEDHEALTH

MyFed

MEDIHELP

Ingwe Network

MOMENTUM

2021
Necesse Network

Cover for Prescribed Minimum Benefits. 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 formulary medicine
40% co-payment for use of non-formulary medicine

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: MediRite, Dis-Chem, Clicks, Pharmacy Direct, Clicks Direct Medicines and Dis-Chem Direct

Cover for Prescribed Minimum Benefits DSP: Pharmacy Network

Cover for Prescribed Minimum Benefits
DSP: Ingwe Primary Care Network Subject to Network entry-level formulary