Rate of Cover for Specialist fees during hospitalisation Hospitals that may be utilized (Pre-authorisation is required before treatment starts, or in case of an emergency within the next two business days) Overall limits & Deductibles
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
100% of Scheme Rate
Any Hospital
Unlimited
150% of Scheme Rate
(Contracted specialists paid in full)
Any Hospital
Unlimited
(R2,590 co-payment for use of non-network day hospitals)
200% of Scheme Rate
(Contracted specialists covered in full)
Any Hospital
Unlimited
(Private ward up to R2,600 per day)
200% of Scheme Rate
(Contracted specialists covered at cost)
Any Hospital
Unlimited
100% of Scheme Rate
Any Hospital
Unlimited
200% of Scheme Rate
(Associated specialists covered in full)
Any Hospital
Unlimited
300% of Scheme Rate
Any Hospital
Unlimited
Comprehensive
(High Cover)
BESTMED
Pace 2
BONITAS
BonClassic
DISCOVERY
-
FEDHEALTH
-
MEDIHELP
MedElite
MOMENTUM
Extender
(Associated Hospital,
Any Chronic)
PROFMED
-
100% of Scheme Rate
Any Hospital
Unlimited
100% of Scheme Rate
(Contracted
specialists paid in full)
Select Network Hospitals
(30% co-payment for use of non-network
hospitals and R2,590 co-payment for use of non-network day hospitals)
Unlimited
–
–
100% of Scheme Rate
Any Hospital
Unlimited
200% of Scheme Rate
(Associated specialists covered in full)
Associated Hospitals
Unlimited
(30% co-payment for use of non-network hospital)
Comprehensive
(Medium to High Cover)
BESTMED
Pace 1
BONITAS
BonComplete
DISCOVERY
Classic Priority
FEDHEALTH
-
MEDIHELP
MedPrime
MOMENTUM
Incentive
(Any Hospital,
Any Chronic)
PROFMED
ProSecure Plus
100% of Scheme Rate
Any Hospital
Unlimited
100% of Scheme Rate
(Contracted specialists paid in full)
Select Network Hospitals
Unlimite
(30% co-payment for use of non-network hospitals and R2,590 co-payment for use of non-network day hospitals)
200% of Scheme Rate
(Contracted specialists covered in full)
Any Hospital
Unlimited
–
100% of Scheme Rate
Any Hospital
Unlimited
200% of Scheme Rate
(Associated specialists covered in full)
Any Hospital
Unlimited
200% of Scheme Rate
Any Hospital
Unlimited
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
–
100% of Scheme Rate
(Contracted specialists paid in full)
Any Hospital
Unlimited
(R2,590 co-payment for use of non-network day hospitals)
200% of Scheme Rate
(Contracted specialists covered in full)
Any Hospital
Unlimited
100% of Scheme Rate
(Contracted specialists covered at cost)
Any Hospital
Unlimited
100% of Scheme Rate
Any Hospital
Unlimited
200% of Scheme Rate
(Associated specialists covered in full)
Associated Hospitals
Unlimited
(30% co-payment for use of non-network hospital)
100% of Specific Tariff
Any Hospital
Unlimited
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)
–
100% of Scheme Rate
(Contracted specialists paid in full)
Select Network Hospitals
Unlimited
(30% co-payment for use of non-network hospitals and R5,170 co-payment for use of non-network day hospitals)
100% of Scheme Rate
(Contracted specialists covered in full)
Any Hospital
Unlimited
100% of Scheme Rate
(Contracted specialists covered at cost)
Network Private Hospitals
Unlimited
(R14,700 co-payment for use of non-network hospitals and R2,500 co-payment for use of non-network day facilities)
100% of Scheme Rate
Network Hospitals
Unlimited
(35% co-payment for use of non-network hospitals)
200% of Scheme Rate
(Associated specialists covered in full)
Associated Hospitals
Unlimited
(30% co-payment for use of non-network hospital)
100% of Specific Tariff
Network Hospitals
Unlimited
(R12,500 co-payment for use of non-DSP hospitals. R5,000 co-payment for day procedures)
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
-
100% of Scheme Rate
Network Hospitals
Unlimited
(R13,732 co-payment for use of non-DSPs)
100% of Scheme Rate
(Contracted specialists paid in full)
Select Network Hospitals
Unlimited
(30% co-payment for use of non-network hospitals and R2,590 co-payment for use of non-network day hospitals)
200% of Scheme Rate
(Contracted specialists covered in full)
Delta Hospital Network
Unlimited
(R10,200 co-payment for use of non-network hospital)
100% of Scheme Rate
(Contracted specialists covered at cost)
Network Private Hospitals
Unlimited
(R14,700 co-payment for use of non-network hospitals and R2,500 co-payment for use of non-network day facilities)
100% of Scheme Rate
Any Hospital
Unlimited
200% of Scheme Rate
(Associated specialists covered in full)
Any Hospital
Unlimited
–
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
100% of Scheme Rate
Any Hospital
Unlimited
100% of Scheme Rate
(Contracted specialists paid in full)
Any Hospital
Unlimited
(R2,590 co-payment for use of non-network day hospitals)
100% of Scheme Rate
(Contracted specialists covered in full)
Any Hospital
Unlimited
100% of Scheme Rate
(Contracted specialists covered at cost)
Any Hospital
Unlimited
100% of Scheme Rate
(Specialist Network applies for PMB’s)
MedElect Network Hospitals
Unlimited
200% of Scheme Rate
(Associated specialists covered in full)
Associated Hospitals
Unlimited
(30% co-payment for use of non-network hospital)
200% of Scheme Rate
Any Hospital
Unlimited
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)
100% of Scheme Rate
Network Hospitals
Unlimited
(R13,732 co-payment for use of non-DSPs)
100% of Scheme Rate
(Contracted
specialists paid in full)
Select Network Hospitals
Unlimited
(30% co-payment for use of non-network hospitals and R5,170 co-payment for use of non-network day hospitals)
100% of Scheme Rate
(Contracted specialists covered in full)
Delta Hospital Network
Unlimited
(R10,200 co-payment for use of non-network hospital)
100% of Scheme Rate
(Contracted specialists covered at cost)
Network Private Hospitals
Unlimited
(R13,800 co-payment for use of non-network hospitals and R2,200 co-payment for use of non-network day facilities)
100% of Scheme Rate
Network Hospitals
Unlimited
(35% co-pay for use of non-network hospitals)
200% of Scheme Rate
(Associated specialists covered in full)
Associated Hospitals
Unlimited
(30% co-payment for use of non-network hospital)
200% of Scheme Rate
Network Hospital
Unlimited
(R12,500 co-payment for use of non-DSP hospitals. R5,000 co-payment for day procedures)
Hospital & Savings
(Low to Medium Cover)
BESTMED
-
BONITAS
BonFit 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)
–
100% of Scheme Rate
(Contracted
specialists paid in full)
Select Hospital Networks
Unlimited
(30% co-payment for use of non-network hospitals and R5,170 co-payment for use of non-network day hospitals)
100% of Scheme Rate
(Contracted specialists covered in full)
Delta Hospital Network
Unlimited
(R10,200 co-payment for use of non-network hospital)
100% of Scheme Rate
(Contracted specialists covered at cost)
Network Private Hospitals
Unlimited
(R13,800 co-payment for use of non-network hospitals and R2,200 co-payment for use of non-network day facilities)
100% of Scheme Rate
Network Hospitals
Unlimited
(35% co-pay for use of non-network hospitals)
200% of Scheme Rate
(Associated specialists covered in full)
Associated Hospitals
Unlimited
(30% co-payment for use of non-network hospital)
200% of Scheme Rate
Network Hospital
Unlimited
(R12,500 co-payment for use of non-DSP hospitals. R5,000 co-payment for day procedures)
Capitation
(Low Cover)
BESTMED
-
BONITAS
BonStart Plus
(Network)
DISCOVERY
Classic Smart
(Network)
FEDHEALTH
-
MEDIHELP
-
MOMENTUM
Evolve
(Network)
PROFMED
-
–
100% of Scheme Rate
Start Hospital Network
Unlimited
(R12,050 co-payment for use of non-network hospitals)
200% of Scheme Rate
(Contracted specialists covered in full)
Smart Hospital Network
Unlimited
(R11,650 co-payment for use of non-network hospital)
–
–
100% of Scheme Rate
(Associated specialists covered in full)
Evolve Network Hospitals
Unlimited
(R1,830 co-payment applies)
(30% co-payment for use of non-network hospital)
–
Capitation
(Low Cover)
BESTMED
-
BONITAS
BonStart
(Network)
DISCOVERY
Essential Smart
(Network)
FEDHEALTH
-
MEDIHELP
MedMove
(Network)
MOMENTUM
Evolve
(Network)
PROFMED
-
–
100% of Scheme Rate
Start Hospital Network
Unlimited
(R12,050 co-payment for use of non-network hospitals)
100% of Scheme Rate
(Contracted specialists covered in full)
Smart Hospital Network
Unlimited
(R11,650 co-payment for use of non-network hospital)
–
100% of Scheme Rate
MedMove Network Hospitals
Unlimited
(R1,650 co-payment for all hospital admissions. R11,800 co-payment for use of non-network DSP)
100% of Scheme Rate
(Associated specialists covered in full)
Evolve Network Hospitals
Unlimited
(R1,830 co-payment applies)
(30% co-payment for use of non-network hospital)
–
Hospital Plan
(Hospitalization Cover)
BESTMED
-
BONITAS
Hospital Standard
DISCOVERY
Classic Core
FEDHEALTH
-
MEDIHELP
-
MOMENTUM
-
PROFMED
-
–
100% of Scheme Rate
(Contracted specialists paid in full)
Select Network Hospitals
Unlimited
(30% co-payment for use of non-network hospitals and R2,590 co-payment for use of non-network day hospitals)
200% of Scheme Rate
(Contracted specialists covered in full)
Any Hospital
Unlimited
–
–
–
–
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
-
100% of Scheme Rate
Any Hospital
Unlimited
100% of Scheme Rate
(Contracted specialists paid in full)
Any Hospitals
Unlimited
(R2,590 co-payment for use of non-network day hospitals)
100% of Scheme Rate
(Contracted specialists paid in full)
Any Hospital
Unlimited
100% of Scheme Rate
(Contracted specialists paid at cost)
Network Private Hospitals
Unlimited
(R8,400 co-payment for use of non-network hospitals and R2,500 co-payment for use of non-network day facilities)
100% of Scheme Rate
Any Hospital
Unlimited
100% of Scheme Rate
(Associated specialists covered in full)
Any Hospital
Unlimited
(R1,830 co-payment applies)
–
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)
100% of Scheme Rate
Network Hospital
Unlimited
(R13,732 co-payment for use of non-DSPs)
100% of Scheme Rate
(Contracted
specialists paid in full)
Select Network Hospitals
Unlimited
(30% co-payment for use of non-network hospitals and R5,170 co-payment for use of non-network day hospitals)
100% of Scheme Rate
(Contracted
specialists paid in full)
Delta Hospital Network
Unlimited
(R10,200 co-payment for use of non-network hospital)
100% of Scheme Rate
(Contracted specialists paid in full)
Elect – Network Private Hospitals
Unlimited
(R14,700 co-payment for use of non-network hospitals)
100% of Scheme Rate
Network Hospitals
Unlimited
(35% co-pay for use of non-network hospitals)
100% of Scheme Rate
Associated Hospitals
Unlimited
(R1,830 co-payment applies)
(30% co-payment for use of non-network hospital)
100% of Scheme Rate
Network Hospitals
Unlimited
(R12,500 co-payment for use of non-DSP hospitals. R5,000 co-payment for day procedures)
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
-
100% of Scheme Rate
Rhythm Network Hospitals
Unlimited
(R13,732 co-payment for use of non-DSPs)
100% of Scheme Rate
BonCap Network Hospitals
Unlimited
(30% co-payment for use of non-network hospitals)
100% of Scheme Rate
KeyCare Network Hospitals
Unlimited (*exclusions apply)
100% of Scheme Rate
(Contracted specialists paid at cost)
Network Private Hospitals
Unlimited
(R8,600 co-payment for use of non-network hospitals. Non-network GP’s and Specialists limited to R2500 pfpa)
100% of Scheme Rate
(Specialist Network applies for PMB’s)
MedElect Network Hospitals
Unlimited
100% of Scheme Rate
Ingwe Network Hospitals
Unlimited
(30% co-payment for use of non-network hospital)
(ICU ltd to 10 days per admission)
–