In-Hospital Benefits

In-Hospital Benefits

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

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

(R14,364 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

(R14,364 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

(R14,364 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

(R14,364 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)

–