Unlimited. Subject to approval of treatment plan and use of network provider, otherwise co-payment will apply
Comprehensive
(High Cover)
Unlimited. Subject to pre-authorisation. Protocols apply
Unlimited at a DSP or 20% co-payment applies at a non-DSP
Unlimited. Subject to approval of treatment plan and use of network provider, otherwise co-payment will apply
Limited to R624,000 at 100% of Fedhealth Rate at DSP. A 40% co-payment is applicable, for voluntary non-DSP utilisation
Unlimited. Acute (subject to hospital authorisation) and Chronic (subject to preauthorisation and clinical protocols)
Unlimited, subject to Management Programme
Unlimited, subject to Disease Management Programme and pre-authorisation
Comprehensive
(High Cover)
Unlimited. Subject to pre-authorisation. Protocols apply
Unlimited at a DSP or 20% co-payment applies at a non-DSP
–
–
Unlimited. Acute (subject to hospital authorisation) and Chronic (subject to preauthorisation and clinical protocols)
Unlimited, subject to Management Programme
–
Comprehensive
(Medium to High Cover)
PMBs only. Subject to DSPs
Unlimited at a DSP or 20% co-payment applies at a non-DSP
Unlimited. Subject to approval of treatment plan and use of network provider, otherwise co-payment will apply
–
Unlimited. Acute (subject to hospital authorisation) and Chronic (subject to preauthorisation and clinical protocols)
Unlimited, subject to Management
Programme
Unlimited, subject to Disease Management Programme and pre-authorisation
Comprehensive
(Medium to High Cover)
–
Unlimited at a DSP or 20% co-payment applies at a non-DSP
Unlimited. Subject to approval of treatment plan and use of network provider, otherwise co-payment will apply
Limited to R499,100 at 100% of Fedhealth Rate at DSP. A 40% co-payment is applicable, for voluntary non-DSP utilisation
Unlimited. Acute (subject to hospital authorisation) and Chronic (subject to preauthorisation and clinical protocols)
Unlimited, subject to Management Programme
Unlimited, subject to Disease Management Programme and pre-authorisation
Comprehensive
(Medium to High Cover)
–
Unlimited at a DSP or 20% co-payment applies at a non-DSP
Unlimited. Subject to approval of treatment plan and use of network provider, otherwise co-payment will apply
Limited to R499,100 at 100% of Fedhealth Rate at DSP. A 40% co-payment is applicable, for voluntary non-DSP utilisation
Unlimited. Acute (subject to hospital authorisation) and Chronic (subject to preauthorisation and clinical protocols)
Unlimited, subject to Management Programme
Unlimited, subject to Disease Management Programme and pre-authorisation
Hospital & Savings
(Low to Medium Cover)
PMBs only. Subject to DSPs
Unlimited at a DSP or 20% co-payment applies at a non-DSP
Unlimited. Subject to approval of treatment plan and use of network provider, otherwise co-payment will apply
Limited to R311,900 at 100% of Fedhealth Rate at DSP. A 40% co-payment is applicable, for voluntary non-DSP utilisation
Unlimited. Acute (subject to hospital authorisation) and Chronic (subject to preauthorisation and clinical protocols)
Unlimited, subject to Management Programme
–
Hospital & Savings
(Low to Medium Cover)
PMBs only. Subject to DSPs
Unlimited at a DSP or 20% co-payment applies at a non-DSP
Unlimited. Subject to approval of treatment plan and use of network provider, otherwise co-payment will apply
Limited to R311,900 at 100% of Fedhealth Rate at DSP. A 40% co-payment is applicable, for voluntary non-DSP utilisation
Unlimited. Acute (subject to hospital authorisation) and Chronic (subject to preauthorisation and clinical protocols)
Unlimited, subject to Management Programme
Unlimited, subject to Disease Management Programme and pre-authorisation
Hospital & Savings
(Low to Medium Cover)
PMBs only. Subject to DSPs
Unlimited at a DSP or 20% co-payment applies at a non-DSP
Unlimited. Subject to approval of treatment plan and use of network provider, otherwise co-payment will apply
Limited to R311,900 at 100% of Fedhealth Rate at DSP. A 40% co-payment is applicable, for voluntary non-DSP utilisation
Unlimited. Acute (subject to hospital authorisation) and Chronic (subject to preauthorisation and clinical protocols)
Unlimited, subject to Management Programme
Unlimited, subject to Disease Management Programme and pre-authorisation
Hospital & Savings
(Low to Medium Cover)
–
Unlimited at a DSP or 20% co-payment applies at a non-DSP
Unlimited. Subject to approval of treatment plan and use of network provider, otherwise co-payment will apply
Limited to R311,900 at 100% of Fedhealth Rate at DSP. A 40% co-payment is applicable, for voluntary non-DSP utilisation
Unlimited. Acute (subject to hospital authorisation) and Chronic (subject to preauthorisation and clinical protocols)
Unlimited, subject to Management
Programme
Unlimited, subject to Disease Management Programme and pre-authorisation
Capitation
(Low Cover)
–
Unlimited at a DSP or 30% co-payment applies at a non-DSP
Subject to registration, approval of treatment plan and use of network provider or state facility.
–
–
Limited to Prescribed Minimum Benefits at State facilities
–
Capitation
(Low Cover)
–
Unlimited at a DSP or 30% co-payment applies at a non-DSP
Subject to registration, approval of treatment plan and use of network provider or state facility.
–
Subject to Prescribed Minimum Benefits.
Listed essential cases – clinical guidelines and pre-authorisation apply
Limited to Prescribed Minimum Benefits at State facilities
–
Hospital Plan
(Hospitalization Cover)
–
Unlimited at a DSP or 20% co-payment applies at a non-DSP
Subject to registration, approval of treatment plan and use of network provider, otherwise co-payments will apply
–
–
–
–
Hospital Plan
(Hospitalization Cover)
PMBs only. Subject to DSPs
Unlimited at a DSP or 20% co-payment applies at a non-DSP
Subject to registration, approval of treatment plan and use of network provider, otherwise co-payments will apply
Unlimited at cost at PMB level of care at DSP. A 40% co-payment is applicable, for voluntary non-DSP utilisation
Unlimited. Acute (subject to hospital authorisation) and Chronic (subject to preauthorisation and clinical protocols)
Unlimited, subject to Management
Programme
–
Hospital Plan
(Hospitalization Cover)
PMBs only. Subject to DSPs
Unlimited at a DSP or 20% co-payment applies at a non-DSP
Subject to registration, approval of treatment plan and use of network provider, otherwise co-payments will apply
Unlimited at cost at PMB level of care at DSP. A 40% co-payment is applicable, for voluntary non-DSP utilisation
Unlimited. Acute (subject to hospital authorisation) and Chronic (subject to preauthorisation and clinical protocols)
Unlimited, subject to Management
Programme
Unlimited, subject to Disease Management Programme and pre-authorisation
Primary Care
(Network & Income Based)
Approved PMBs and DSPs
Unlimited at a DSP or 20% co-payment applies at a non-DSP
Subject to registration, approval of treatment plan and use of network provider or state facility.
Unlimited at cost at PMB level of care at DSP
Unlimited. Acute (subject to hospital authorisation) and Chronic (subject to preauthorisation and clinical protocols)
Limited to Prescribed Minimum Benefits at State facilities
–