(Limits apply only on Prostheses)

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

Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R134,715 per family. Sub-limits apply
Refer to member guide for full list and limits

R64,300 per family. Sub-limits and Managed Care protocols apply. Subject to preauthorisation and use of a preferred provider

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 R32,700 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 managment. Sub-limits apply
(Benefits for wear/tear)
Refer to member guide for full list and limits

Cochlear implants: R222,000 pb per event (max 1 event pa); Intraocular lenses: R8,670 pb per event (max 2 events pa); Other internal prostheses: R83,800 pb per event (max 2 events pa)

Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits

Comprehensive

(High Cover)

BESTMED

Pace 2

BONITAS

BonClassic

DISCOVERY

-

FEDHEALTH

-

MEDIHELP

MedElite

MOMENTUM

Extender
(Associated Hospital,
Any Chronic)

PROFMED

-

Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R134,028 per family. Sub-limits apply
Refer to member guide for full list and limits

R67,670 per family. Sub-limits and Managed Care protocols apply. Subject to preauthorisation and use of a preferred provider

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: R222,000 pb per event (max 1 event pa); Intraocular lenses: R8,670 pb per event (max 2 events pa); Other internal prostheses: R83,800 pb per event (max 2 events pa)

Comprehensive

(Medium to High Cover)

BESTMED

Pace 1

BONITAS

BonComplete

DISCOVERY

Classic Priority

FEDHEALTH

-

MEDIHELP

MedPrime

MOMENTUM

Incentive
(Any Hospital,
Any Chronic + Health Saver)

PROFMED

ProSecure Plus

Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R104,366 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits

R54,780 per family. Sub-limits and Managed Care protocols apply. Subject to preauthorisation and use of a preferred provider

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: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)

Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits

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

R54,780 per family. Sub-limits and Managed Care protocols apply. Subject to preauthorisation and use of a preferred provider

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 R27,900 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 managment. Sub-limits apply
(Benefits for wear/tear)
Refer to member guide for full list and limits

Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)

Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits

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)

R54,780 per family. Sub-limits and Managed Care protocols apply. Subject to preauthorisation and use of a preferred provider

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 R27,900 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 managment. Sub-limits apply
(Benefits for wear/tear)
Refer to member guide for full list and limits

Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)

Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits

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

-

Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R92,145 per family. Sub-limits apply 
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits

R39,040 per family. Managed Care
protocols apply. Subject to pre-authorisation and use of a preferred provider Joint replacement subject to PMB

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 R27,900 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 managment. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits

Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)

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

Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R91,183 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits

Subject to PMB. Managed Care protocols apply

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

Subject to Prescribed Minimum Benefits.
Listed essential cases – clinical guidelines and pre-authorisation apply
Refer to member guide for full list and limits

Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)

Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits

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)

Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R91,183 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits

Subject to PMB. Managed Care protocols apply

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 managment. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits

Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)

Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits

Hospital & Savings

(Low to Medium Cover)

BESTMED

-

BONITAS

BonFit Select

DISCOVERY

Essential Delta Saver

FEDHEALTH

FlexiFed 2
(GRID)

MEDIHELP

MedAdd Elect
(Network)

MOMENTUM

Incentive
(Associated Hospital,
Associated Chronic)

PROFMED

ProActive Plus Savvy
(Network)

Subject to PMB. Managed Care protocols apply

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 managment. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits

Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)

Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits

Capitation

(Low Cover)

BESTMED

-

BONITAS

BonStart Plus
(Network)

DISCOVERY

Classic Smart
(Network)

FEDHEALTH

-

MEDIHELP

-

MOMENTUM

Evolve
(Network)

PROFMED

-

R18,180 per family. Managed Care
protocols apply. Subject to pre-authorisation and use of a preferred provider Joint replacements are excluded

Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Smart Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits

Intraocular lenses: R6,000 pb per event;
Other internal prostheses: R40,000 pb per event
All limited to maximum of 2 events per year.
Joint replacements limited to PMBs and state facilities

Capitation

(Low Cover)

BESTMED

-

BONITAS

BonStart
(Network)

DISCOVERY

Essential Smart
(Network)

FEDHEALTH

-

MEDIHELP

MedMove
(Network)

MOMENTUM

Evolve
(Network)

PROFMED

-

Subject to PMB. Managed Care protocols apply

Unlimited at a Dynamic Smart Network Provider. Subject to Prescribed Minimum Benefits, else *EXCLUSIONS apply.
Refer to last page, and Member Guide for full list, limits and exclustions

Subject to Prescribed Minimum Benefits.
Listed essential cases – clinical guidelines and pre-authorisation apply
Refer to member guide for full list and limits

Intraocular lenses: R6,000 pb per event;
Other internal prostheses: R40,000 pb per event
All limited to maximum of 2 events per year.
Joint replacements limited to PMBs and state facilities

Hospital Plan

(Hospitalization Cover)

BESTMED

-

BONITAS

Hospital Standard

DISCOVERY

Classic Core

FEDHEALTH

-

MEDIHELP

-

MOMENTUM

-

PROFMED

-

R51,590 per family. Managed Care protocols apply. Subject to pre-authorisation and use of a preferred provider Joint replacements and back and neck surgery subject to PMB

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

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

-

Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R91,183 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits

Subject to PMB. Managed Care protocols apply

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

Intraocular lenses: R6,600 pb per event;
Other internal prostheses: R56,000 pb per event
All limited to maximum of 2 events per year.
All limited to maximum of 2 events per year

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)

Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R91,183 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits

Subject to PMB. Managed Care protocols apply

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

Intraocular lenses: R6,600 pb per event;
Other internal prostheses: R56,000 pb per event
All limited to maximum of 2 events per year.
All limited to maximum of 2 events per year

Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits

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

-

Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R61,384 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 Provider.
Managed Care protocols apply

Subject to PMB and Network Hospitals

Unlimited at cost at PMB level of care (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details

Subject to Prescribed Minimum Benefits.
Listed essential cases – clinical guidelines and pre-authorisation apply
Refer to member guide for full list and limits

Limited to Prescribed Minimum Benefits at State facilities