Internally Implanted Prostheses
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
R58,110 per family. Managed Care protocols apply. Subject to pre-authorisation and use of a preferred supplier
Prosthesis subject to preferred provider, otherwise limits and co-payments apply Limit of R116,489 per family. Sub-limits apply
Refer to member guide for full list and limits
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Combined benefit limit of R31,500 per family for unlisted prosthesis (elbow – hip – shoulder replacements, spinal plates and screws etc.)
Sub-limits apply for listed prosthesis (e.g aorta stent grafts, intraocular lenses etc.) Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case management. Sub-limits apply
(Benefits for wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R190,000 pb per event (max 1 event pa); Intraocular lenses: R7,460 pb per event (max 2 events pa); Other internal prostheses: R72,000 pb per event (max 2 events pa)
HIGH COVER LEVEL 2
BONITAS
2021
BonClassic
BESTMED
2021
Page
DISCOVERY
2021
Essential Comprehensive
FEDHEALTH
MEDIHELP
2021
Elite
MOMENTUM
2021
Extender: Any (Chronic: Any)
R57,580 per family. Managed Care protocols apply. Subject to pre-authorisation and use of a preferred supplier
Prosthesis subject to preferred provider, otherwise limits and co-payments apply Limit of R115,895 per family. Sub-limits apply
Refer to member guide for full list and limits
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits for wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R190,000 pb per event (max 1 event pa); Intraocular lenses: R7,460 pb per event (max 2 events pa); Other internal prostheses: R72,000 pb per event (max 2 events pa)
MEDIUM-HIGH LEVEL 1 COVER
BONITAS
2021
BonComplete
BESTMED
2021
Pace 1
DISCOVERY
2021
Classic Priority
FEDHEALTH
MEDIHELP
MOMENTUM
R46,620 per family. Managed Care protocols apply. Sub-limits apply. Subject to pre-authorisation and use of a preferred supplier
Prosthesis subject to preferred provider, otherwise limits and co-payments apply Limit of R90,246 per family. Sub-limits apply Refer to member guide for full list and limits
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
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
R46,620 per family. Managed Care protocols apply. Subject to pre-authorisation and use of a preferred supplier
Prosthesis subject to preferred provider, otherwise limits and co-payments apply Limit of R90,246 per family. Sub-limits apply Refer to member guide for full list and limits
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Combined benefit limit of R26,900 per family for unlisted prosthesis (elbow – hip – shoulder replacements, spinal plates and screws etc.)
Sub-limits apply for listed prosthesis (e.g aorta stent-grafts, intraocular lenses etc.) Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case management. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R174,700 pb per event (max 1 event pa); Intraocular lenses: R6,970 pb per event (max 2 events pa); Other internal prostheses: R53,000 pb per event (max 2 events pa)
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
R46,620 per family. Managed Care protocols apply. Subject to pre-authorisation and use of a preferred supplier
Prosthesis subject to preferred provider, otherwise limits and co-payments apply Limit of R90,246 per family. Sub-limits apply Refer to member guide for full list and limits
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Delta Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Combined benefit limit of R26,900 per family for unlisted prosthesis (elbow – hip – shoulder replacements, spinal plates and screws etc.)
Sub-limits apply for listed prosthesis (e.g aorta stent-grafts, intraocular lenses etc.) Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case management. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R174,700 pb per event (max 1 event pa); Intraocular lenses: R6,970 pb per event (max 2 events pa); Other internal prostheses: R53,000 pb per event (max 2 events pa)
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
R33,220 per family. Managed Care protocols apply. Subject to pre-authorisation and use of a preferred supplier
Joint replacement subject to PMB
Prosthesis subject to preferred provider, otherwise limits and co-payments apply Limit of R79,678 per family. Sub-limits apply Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Combined benefit limit of R26,900 per family for unlisted prosthesis (elbow – hip – shoulder replacements, spinal plates and screws etc.)
Sub-limits apply for listed prosthesis (e.g aorta stent grafts, intraocular lenses etc.) Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case management. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R174,700 pb per event (max 1 event pa); Intraocular lenses: R6,970 pb per event (max 2 events pa); Other internal prostheses: R53,000 pb per event (max 2 events pa)
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
R33,220 per family. Managed Care protocols apply. Subject to pre-authorisation and use of a preferred supplier
Joint replacement subject to PMB
Prosthesis subject to preferred provider, otherwise limits and co-payments apply Limit of R78,846 per family. Sub-limits apply Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Delta Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Unlimited at cost at PMB level of care (e.g aorta stent grafts, intraocular lenses etc.) Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case management. Sub-limits apply
(Benefits not applicable to wear/tear)Refer to member guide for full list and limits
Cochlear implants: R174,700 pb per event (max 1 event pa); Intraocular lenses: R6,970 pb per event (max 2 events pa); Other internal prostheses: R53,000 pb per event (max 2 events pa)
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
R33,220 per family. Managed Care protocols apply. Subject to pre-authorisation and use of a preferred supplier
Joint replacement subject to PMB
Prosthesis subject to preferred provider, otherwise limits and co-payments apply Limit of R78,846 per family. Sub-limits apply Joint Replacements, subject to Prescribed Minimum BenefitsRefer to member guide for full list and limits
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Unlimited at cost at PMB level of care (e.g aorta stent-grafts, intraocular lenses etc.) Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R174,700 pb per event (max 1 event pa); Intraocular lenses: R6,970 pb per event (max 2 events pa); Other internal prostheses: R53,000 pb per event (max 2 events pa)
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 PMB and Network Provider. Managed Care protocols apply
Prosthesis subject to preferred provider, otherwise limits and co-payments apply Limit of R79,678 per family. Sub-limits apply Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Delta Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Combined benefit limit of R26,900 per family for unlisted prosthesis (elbow – hip – shoulder replacements, spinal plates and screws etc.)
Sub-limits apply for listed prosthesis (e.g aorta stent grafts, intraocular lenses etc.) Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case management. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R174,700 pb per event (max 1 event pa); Intraocular lenses: R6,970 pb per event (max 2 events pa); Other internal prostheses: R53,000 pb per event (max 2 events pa)
HOSPITAL COVER 1
BONITAS
2021
Hospital Standard
BESTMED
2021
Beat 1
DISCOVERY
2021
Essential Core
FEDHEALTH
MEDIHELP
MOMENTUM
2021
Custom – Any Hospital, Associated Chronic
R46,620 per family. Managed Care protocols apply. Subject to pre-authorisation and use of a preferred supplier
Joint replacement subject to PMB
Prosthesis subject to preferred provider, otherwise limits and co-payments apply Limit of R78,846 per family. Sub-limits apply Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Intraocular lenses: R5,700 pb per event; Other internal prostheses: R48,500 pb per event
All limited to maximum of 2 events per year
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
R33,220 per family. Managed Care protocols apply. Subject to pre-authorisation and use of a preferred supplier
Joint replacement subject to PMB
Prosthesis subject to preferred provider, otherwise limits and co-payments apply Limit of R78,846 per family. Sub-limits apply Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits applyfer to Member Guide for full list and limits
Prosthesis subject to pre-authorisation, protocols and case management. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Intraocular lenses: R5,700 pb per event; Other internal prostheses: R48,500 pb per event
All limited to maximum of 2 events per year
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
R33,220 per family. Managed Care protocols apply. Subject to pre-authorisation and use of a preferred supplier
Joint replacement subject to PMB
Prosthesis subject to preferred provider, otherwise limits and co-payments apply Limit of R78,846 per family. Sub-limits apply Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Unlimited at cost at PMB level of care (e.g aorta stent grafts, intraocular lenses etc.) Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case management. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Intraocular lenses: R5,700 pb per event; Other internal prostheses: R48,500 pb per event
All limited to maximum of 2 events per year
Primary Care Network
BONITAS
2021
BonCap
BESTMED
2021
Pulse 1
DISCOVERY
2021
KeyCare Plus
FEDHEALTH
MyFed
MEDIHELP
Ingwe Network
MOMENTUM
2021
Necesse Network
Subject to PMB and Network Provider. Managed Care protocols apply
Prosthesis subject to preferred provider, otherwise limits and co-payments apply Limit of R53,079 per family. Sub-limits apply Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Subject to PMB and Network Hospitals
Unlimited at cost at PMB level of care
Limit of R23,900 pbpa. Subject to Prescribed Minimum Benefits
Limited to Prescribed Minimum Benefits at State facilities