(Procedures normally performed in hospital, performed in Doctor’s room/Day Ward e.g. Gastroscopy, etc.)

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

In & Out of Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth

In & Out of Hospital:  Unlimited, subject to pre-authorisation

In Hospital: Endoscopic Procedures

Out of Hospital: Scopes covered up to 200% of Scheme Rate, subject to pre-auth

Unlimited, subject to pre-authorisation

In-Hospital, Day Clinic and Doctors rooms: Endoscopic procedures Unlimited. No co-payments apply

Defined list of procedures covered, subject to pre-authorisation

In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP

Comprehensive

(High Cover)

BESTMED

Pace 2

BONITAS

BonClassic

DISCOVERY

-

FEDHEALTH

-

MEDIHELP

MedElite

MOMENTUM

Extender
(Associated Hospital,
Any Chronic)

PROFMED

-

In & Out of Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth

In & Out of Hospital:  Unlimited, subject to pre-authorisation

In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)

In the doctors room: All scopes: Unlimited 

Defined list of procedures covered, subject to pre-authorisation

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

In & Out of Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth

In & Out of Hospital:  Unlimited, subject to pre-authorisation

In Hospital: Deductibles Apply

Out of Hospital: Scopes covered up to 200% of Scheme Rate, subject to pre-auth

In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)

In the doctors room: All scopes: Unlimited 

Defined list of procedures covered, subject to pre-authorisation

In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP

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

In & Out of Hospital:  Unlimited, subject to pre-authorisation

In Hospital: Deductibles Apply

Out of Hospital: Scopes covered up to 200% of Scheme Rate, subject to pre-auth

Unlimited, subject to pre-authorisation

In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)

In the doctors room: All scopes: Unlimited 

Defined list of procedures covered, subject to pre-authorisation

In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP

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)

In & Out of Hospital:  Unlimited, subject to pre-authorisation

In Hospital: Deductibles Apply

Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth

Unlimited, subject to pre-authorisation

In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)

In the doctors room: All scopes: Unlimited 

Defined list of procedures covered, subject to pre-authorisation

In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP

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

-

In & Out of Hospital: Endoscopic
Procedures covered 100% of scheme rate, subject to pre-auth

In & Out of Hospital:  Unlimited, subject to pre-authorisation

In Hospital: Endoscopic Procedures

Out of Hospital: Scopes covered up to 200% of Scheme Rate, subject to pre-auth

Unlimited, subject to pre-authorisation

In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)

In the doctors room: All scopes: Unlimited

Defined list of procedures covered, subject to pre-authorisation

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

In & Out of Hospital: Endoscopic
Procedures covered 100% of scheme rate, subject to pre-auth

In & Out of Hospital:  Unlimited, subject to pre-authorisation

In Hospital: Endoscopic Procedures

Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth

Unlimited, subject to pre-authorisation

In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)

In the doctors room: All scopes: Unlimited

Defined list of procedures covered, subject to pre-authorisation

In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP

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)

In & Out of Hospital: Endoscopic
Procedures covered 100% of scheme rate, subject to pre-auth

In & Out of Hospital:  Unlimited, subject to pre-authorisation

In Hospital: Endoscopic Procedures

Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth

Unlimited, subject to pre-authorisation

In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)

In the doctors room: All scopes: Unlimited

Defined list of procedures covered, subject to pre-authorisation

In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP

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)

In & Out of Hospital:  Unlimited, subject to pre-authorisation

In Hospital: Endoscopic Procedures

Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth

Unlimited, subject to pre-authorisation

In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)

In the doctors room: All scopes: Unlimited

Defined list of procedures covered, subject to pre-authorisation

In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP

Capitation

(Low Cover)

BESTMED

-

BONITAS

BonStart Plus
(Network)

DISCOVERY

Classic Smart
(Network)

FEDHEALTH

-

MEDIHELP

-

MOMENTUM

Evolve
(Network)

PROFMED

-

In Hospital: Unlimited, subject to preauthorisation and use of Start Network Provider

In Hospital: Endoscopic Procedures

Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth and use of Smart Network only

Defined list of procedures covered, subject to pre-authorisation

Capitation

(Low Cover)

BESTMED

-

BONITAS

BonStart
(Network)

DISCOVERY

Essential Smart
(Network)

FEDHEALTH

-

MEDIHELP

MedMove
(Network)

MOMENTUM

Evolve
(Network)

PROFMED

-

In Hospital: Unlimited, subject to preauthorisation and use of Start Network Provider

In Hospital: Endoscopic Procedures

Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth and use of Smart Network only

In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)

In the doctors room: All scopes: Unlimited

Defined list of procedures covered, subject to pre-authorisation

Hospital Plan

(Hospitalization Cover)

BESTMED

-

BONITAS

Hospital Standard

DISCOVERY

Classic Core

FEDHEALTH

-

MEDIHELP

-

MOMENTUM

-

PROFMED

-

In Hospital: Unlimited, subject to preauthorisation

In Hospital: Endoscopic Procedures

Out of Hospital: Scopes covered up to 200% of Scheme Rate, subject to pre-auth

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

-

In Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth

In Hospital: Unlimited, subject to preauthorisation

In Hospital: Endoscopic Procedures

Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth

Unlimited, subject to pre-authorisation

In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)

In the doctors room: All scopes: Unlimited

Defined list of procedures covered, subject to pre-authorisation

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)

In Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth

In Hospital: Unlimited, subject to preauthorisation

In Hospital: Endoscopic Procedures

Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth

Unlimited, subject to pre-authorisation

In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)

In the doctors room: All scopes: Unlimited

Defined list of procedures covered, subject to pre-authorisation

In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP

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

-

In Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth

Day procedures: Limited to R52,500 per family for 9 non-PMB conditions. R2,625 co-payment for use of non-network hospital

In Hospital: Unlimited, subject to pre- authorisation and use of Network Provider

Cover for a defined list of procedures in the KeyCare day surgery network

Unlimited at cost at PMB level of care

In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)

In the doctors room: All scopes: Unlimited

Defined list of procedures covered (excludes Scopes), subject to pre-authorisation