Chronic Benefits

Chronic Benefits

Chronic Benefits

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

–