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