General Practitioner Visits
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
Subject to Savings and Above Threshold Benefit
Subject to Savings first, then limited to
M=R4,394, M1+R8,906.
Subject to overall day-to-day limit
Subject to Savings. Extender Benefit (DEB):
Covers unlimited pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP consultations per year up to the DHR. Network GP needs to meet digital criteria (in Self Payment Gap).
Unlimited after Threshold is reached
Subject to Savings then unlimited from Risk at Fedhealth Network GPs
Subject to Pooled Benefit Limit
Subject to Savings, if available.
(Unlimited once Threshold is reached)
HIGH COVER LEVEL 2
BONITAS
2021
BonClassic
BESTMED
2021
Page
DISCOVERY
2021
Essential Comprehensive
FEDHEALTH
MEDIHELP
2021
Elite
MOMENTUM
2021
Extender: Any (Chronic: Any)
Subject to Savings
Subject to Savings first, then limited to
M=R4,394, M1+R8,906.
Subject to overall day-to-day limit
Subject to Savings. Extender Benefit (DEB):
Covers unlimited pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP consultations per year up to the DHR. Network GP needs to meet digital criteria (in Self Payment Gap).
Unlimited after Threshold is reached
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available.
(Unlimited once Threshold is reached)
MEDIUM-HIGH LEVEL 1 COVER
BONITAS
2021
BonComplete
BESTMED
2021
Pace 1
DISCOVERY
2021
Classic Priority
FEDHEALTH
MEDIHELP
MOMENTUM
Subject to Savings. Extender Benefit (DEB):
Covers unlimited pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP consultations per year up to the DHR. Network GP needs to meet digital criteria
Subject to Savings and Above Threshold Benefit
Subject to Savings first, then limited to M=R2,245, M1+R4,512. Subject to overall day-to-day limit
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
Nominate 2 Network GPs. Limits (sub-limits for non-network GP):
M=R4,390 (R1,430) | M+1=R6,440 (R2,200) | M+2=R7,140 (R2,410) | M+3=R7,500 (R2,510) | M+4=R8,140 (R2,710)
Subject to Savings first, then limited to M=R2,245, M1+R4,512.
Subject to overall day-to-day limit
Subject to Savings. Extender Benefit (DEB):
Covers unlimited pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP consultations per year up to the DHR. Network GP needs to meet digital criteria
Unlimited consultations at nominated Network GP. Non-network GP paid from Savings/ Wallet or self-funded and Threshold
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
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
Subject to Savings first, then limited to M=R2,245, M1+R4,512.
Subject to overall day-to-day limit
Subject to Savings. Extender Benefit (DEB):
Covers unlimited pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP consultations per year up to the DHR. Network GP needs to meet digital criteria (in Self Payment Gap). Unlimited after Threshold is reached
Unlimited consultations at nominated Network GP. Non-network GP paid from Savings/ Wallet or self-funded and Threshold
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
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
Subject to Savings
Subject to Savings
Subject to Savings. Extender Benefit (DEB):
Covers up to 6 pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP consultations per year up to the DHR. Network GP needs to meet digital criteria
Subject to Savings/ Wallet or self-funded. Unlimited consultations at nominated Network GP, once Benefit Maximizer Threshold Level is reached
Subject to Savings
CHILD CARE BENEFITS:
Limited to R1,100
for GP consults for children 2 to 12yrs, once savings is depleted
Subject to Savings, if available
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
Nominate 2 Network GPs. Limits (sub-limits for non-network/nominated GP):
M=R1,960 (R635) | M+1=R3,610 (R1,200) | M+2=R4,270 (R1,360) | M+3=R4,590 (R1,530) | M+4=R5,200 (R1,810)
Subject to Savings
Subject to Savings. Extender Benefit (DEB):
Covers up to 4 pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP consultations per year up to the DHR. Network GP needs to meet digital criteria
Subject to Savings/ Wallet or self-funded. Unlimited consultations at nominated Network GP, once Benefit Maximizer Threshold Level is reached
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
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
Nominate 2 Network GPs. Limits:
M=R1,960
| M+1=R3,610 | M+2=R4,270 | M+3=R4,590
| M+4=R5,200
Subject to Savings
Subject to Savings. Extender Benefit (DEB):
Covers up to 4 pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP consultations per year up to the DHR. Network GP needs to meet digital criteria
Subject to Savings/ Wallet or self-funded. Unlimited consultations at nominated Network GP, once Benefit Maximizer Threshold Level is reached
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
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
Subject to Savings
Subject to Savings
Subject to Savings. Extender Benefit (DEB):
Covers up to 4 pharmacy clinic consultations (DSP Dischem and MediCare) and pharmacy clinic referred GP consultations per year up to the DHR. Network GP needs to meet digital criteria
Subject to Savings/ Wallet or self-funded. Unlimited consultations at nominated Network GP, once Benefit Maximizer Threshold Level is reached
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
HOSPITAL COVER 1
BONITAS
2021
Hospital Standard
BESTMED
2021
Beat 1
DISCOVERY
2021
Essential Core
FEDHEALTH
MEDIHELP
MOMENTUM
2021
Custom – Any Hospital, Associated Chronic
No Benefit
No Benefit
No Benefit
No Benefit
Subject to Health Saver, if available
No Benefit
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
No Benefit
No Benefit
No Benefit
Subject to Day-to-Day Benefits
Subject to Day-to-Day Benefits
Subject to Health Saver, if available
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
No Benefit
No Benefit
No Benefit
Subject to Savings/ Wallet or self-funded. Unlimited consultations at nominated Network GP, once Benefit Maximizer Threshold Level is reached
Subject to Day-to-Day Benefits
Subject to Health Saver, if available
Primary Care Network
BONITAS
2021
BonCap
BESTMED
2021
Pulse 1
DISCOVERY
2021
KeyCare Plus
FEDHEALTH
MyFed
MEDIHELP
Ingwe Network
MOMENTUM
2021
Necesse Network
Unlimited consultations (max 2 Network GPs). Pre-auth required from 8th visit. 1 Out- of-Network visit pb (max 2 pf) limited to R1,100 (20% co-pay applies)
Unlimited GP visits, subject to Bestmed Pulse1 Network. Out-of-network GP visits limited to R1,425 pfpa
Unlimited at chosen KeyCare Network GP. Second GP can be nominated. Authorisation required after the 15th visit. 4 Out-of- Network GP visit per beneficiary
Unlimited at contracted nominated GP (can nominate 2 GPs per beneficiary). Monitoring after 10 visits. Non-nominated GP limited to 2 visits per beneficiary at a contracted GP
9 Consultations per beneficiary per year, thereafter only for PMB conditions (subject to pre-auth)
Unlimited at Primary Care Network GP. Pre- auth required from 11th visit. Subject to out- of-network GP, casualty OR after-hours visits: 1 visit pbpa, max of 2 visits pfpa.
R100 co-payment applies per visit. Subject to authorisation within 72 hours else 30% co-payment applies