In-Hospital Benefits

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

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

150% of Scheme Rate (Contracted Specialists paid in full)

Any Hospital

Unlimited

100% of Scheme Rate

Any Hospital

Unlimited

200% of Scheme Rate Contracted Specialists covered in full

Any Hospital (Private ward up to R2,220 per day)

Unlimited

 

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

HIGH COVER LEVEL 2

BONITAS

2021
BonClassic

BESTMED

2021
Page

DISCOVERY

2021
Essential Comprehensive

FEDHEALTH

MEDIHELP

2021
Elite

MOMENTUM

2021
Extender: Any (Chronic: Any)

100% of Scheme Rate Contracted Specialists covered in full

Any Hospital

Unlimited

100% of Scheme Rate (Contracted Specialists paid in full)

Any Hospital

Unlimited

100% of Scheme Rate

Any Hospital

Unlimited

100% of Scheme Rate

Any Hospital

Unlimited

200% of Scheme Rate (Associated specialists covered in full)

Any Hospital

Unlimited

MEDIUM-HIGH LEVEL 1 COVER

BONITAS

2021
BonComplete

BESTMED

2021
Pace 1

DISCOVERY

2021
Classic Priority

FEDHEALTH

MEDIHELP

MOMENTUM

200% of Scheme Rate Contracted Specialists covered in full

Any Hospital

Unlimited

100% of Scheme Rate (Contracted Specialists paid in full)

Any Hospital

Unlimited

100% of Scheme Rate

Any Hospital

Unlimited

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

100% of Scheme Rate (Contracted Specialists paid in full)

Any Hospital

Unlimited

100% of Scheme Rate

Any Hospital

Unlimited

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)

Any Hospital

Unlimited

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

100% of Scheme Rate (Contracted Specialists paid in full)

Network Hospitals
(30% co-payment for use of non-network hospitals)

Unlimited

100% of Scheme Rate

Any Hospital

Unlimited

100% of Scheme Rate Contracted Specialists covered in full

Delta Hospital Network

Unlimited
(R8,700 co-pay for use of non-network hospital)

100% of Scheme Rate Contracted Specialists covered at cost

Network Private Hospitals

Unlimited
(Co-payments: R12,500 for use of non-network hospitals and R2,000 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)

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

100% of Scheme Rate (Contracted Specialists paid in full)

Any Hospital

Unlimited

100% of Scheme Rate

Any Hospital

Unlimited

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)

Any Hospital

Unlimited

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

100% of Scheme Rate (Contracted Specialists paid in full)

Any Hospital

Unlimited

100% of Scheme Rate

Any Hospital

Unlimited

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

Any Hospital

Unlimited

200% of Scheme Rate (Associated specialists covered in full)

Any Hospital

Unlimited

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

100% of Scheme Rate (Contracted Specialists paid in full)

Network Hospitals
(30% co-payment for use of non-network hospitals)

Unlimited

100% of Scheme Rate

Network Hospitals

Unlimited
(R11,847 co-payment for use of non-DSPs)

100% of Scheme Rate Contracted Specialists covered in full

Delta Hospital Network

Unlimited
(R8,700 co-pay for use of non-network hospital)

100% of Scheme Rate Contracted Specialists covered at cost

Network Private Hospitals

Unlimited
(Co-payments: R12,500 for use of non- network hospitals and R2,000 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)

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

100% of Scheme Rate Contracted Specialists covered in full

Delta Hospital Network

Unlimited
(R8,700 co-pay for use of non-network hospital)

100% of Scheme Rate (Contracted Specialists paid in full)

Network Hospitals
(30% co-payment for use of non-network hospitals)

Unlimited

100% of Scheme Rate

Network Hospitals

Unlimited
(R11,847 co-payment for use of non-DSPs)

100% of Scheme Rate Contracted Specialists covered at cost

Network Private Hospitals

Unlimited
(Co-payments: R12,500 for use of non-network hospitals and R2,000 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)

HOSPITAL COVER 1

BONITAS

2021
Hospital Standard

BESTMED

2021
Beat 1

DISCOVERY

2021
Essential Core

FEDHEALTH

MEDIHELP

MOMENTUM

2021
Custom – Any Hospital, Associated Chronic

100% of Scheme Rate (Contracted Specialists paid in full)

Any Hospital

Unlimited

100% of Scheme Rate

Any Hospital

Unlimited

100% of Scheme Rate Contracted Specialists covered in full

Any Hospital

Unlimited

100% of Scheme Rate (Associated specialists covered in full)

Any Hospital

Unlimited
(R1,640 co-payment applies)

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

100% of Scheme Rate (Contracted specialists paid in full)

Any Hospital

Unlimited

100% of Scheme Rate

Any Hospital

Unlimited

100% of Scheme Rate Contracted Specialists covered in full

Any Hospital

Unlimited

100% of Scheme Rate

Any Hospital

Unlimited

100% of Scheme Rate (Associated specialists covered in full)

Any Hospital

Unlimited
(R1,640 co-payment applies)

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

100% of Scheme Rate (Contracted specialists paid in full)

Network Hospitals
(30% co-payment for use of non-network hospitals)

Unlimited

100% of Scheme Rate (Contracted specialists paid in full)

Delta Hospital Network

Unlimited
(R8,700 co-payment for use of non-network hospital)

 

100% of Scheme Rate Contracted Specialists covered in full

Delta Hospital Network

Unlimited
(R8,700 co-payment for use of non-network hospital)

100% of Scheme Rate Contracted Specialists covered at cost

Network Private Hospitals

Unlimited
(Co-payments: R7,000 for use of non-network hospitals and R2,000 for use of non-network day facilities)

100% of Scheme Rate

Network Hospitals

Unlimited
(35% co-pay for use of non-network hospitals)

100% of Scheme Rate (Associated specialists covered in full)

Associated Hospitals

Unlimited
(R1,640 co-payment applies)
30% co-payment for use of non-network hospital

Primary Care Network

BONITAS

2021
BonCap

BESTMED

2021
Pulse 1

DISCOVERY

2021
KeyCare Plus

FEDHEALTH

MyFed

MEDIHELP

Ingwe Network

MOMENTUM

2021
Necesse Network

100% of Scheme Rate

Network Hospitals

Unlimited
(*R10,000 co-payment for use of non-network hospitals *Sub-limits apply – refer to last page)

100% of Scheme Rate

Network Hospitals

Unlimited
(R11,847 co-payment for use of non-DSPs)

100% of Scheme Rate

KeyCare Network Hospitals

Unlimited (*exclusions apply)

100% of Scheme Rate Contracted Specialists covered at cost

Network Private Hospitals

Unlimited
(Co-payments: R12,500 for use of non- network hospitals and R2,000 for use of non-network Day Clinics)
Limit of R2,400 per beneficiary for non- network GPs and Specialists

100% of Scheme Rate (Specialist Network applies for PMBs)

Necesse Network Hospitals

Unlimited

100% of Scheme Rate

Ingwe Network Hospitals
(30% co-payment for use of non-network hospital)

Unlimited
(ICU ltd to 10 days per admission)