Listed Procedures
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
In & Out of Hospital:Unlimited, subject to pre-authorisation
In & Out of Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth
In Hospital: Endoscopic Procedures *refer to last page for co-payments
Out of Hospital: Scopes covered up to 200% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
Refer to last page for co-payments
In Hospital & Day Clinics: Endoscopic Procedures: Unlimited. Co-payments apply
*refer to last page
Out of Hospital: Endoscopic Procedures: Unlimited. No co-payments
Defined list of procedures covered, subject to pre-authorisation *refer to co-payments
(Refer to member guide for full list)
HIGH COVER LEVEL 2
BONITAS
2021
BonClassic
BESTMED
2021
Page
DISCOVERY
2021
Essential Comprehensive
FEDHEALTH
MEDIHELP
2021
Elite
MOMENTUM
2021
Extender: Any (Chronic: Any)
In & Out of Hospital:Unlimited, subject to pre-authorisation
In & Out of Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth
In Hospital: Endoscopic Procedures *refer co-payments
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth
In Hospital & Day Clinics: Endoscopic Procedures: Unlimited. Co-payments apply
*refer to last page
Out of Hospital: Endoscopic Procedures: Unlimited. No co-payments appy
Defined list of procedures covered, subject to pre-authorisation *refer to last page for co-payments
(Refer to member guide for full list)
MEDIUM-HIGH LEVEL 1 COVER
BONITAS
2021
BonComplete
BESTMED
2021
Pace 1
DISCOVERY
2021
Classic Priority
FEDHEALTH
MEDIHELP
MOMENTUM
In & Out of Hospital: Unlimited, subject to pre-authorisation
In & Out of Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth
In Hospital: Deductibles Apply *refer to last page for co-payments
Out of Hospital: Scopes covered up to 200% of Scheme Rate, subject to pre-auth
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
In & Out of Hospital:Unlimited, subject to pre-authorisation. *refer to last page for co- payments
Subject to Savings first, then Basic Dentistry limit
In Hospital: Deductibles Apply *refer to last page for co-payments
Out of Hospital: Scopes covered up to 200% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
Refer to last page for co-payments<
In Hospital & Day Clinics: Endoscopic Procedures: Unlimited. Co-payments apply
*refer to last page
Out of Hospital: Endoscopic Procedures: Unlimited. No co-payments appy
Defined list of procedures covered, subject to pre-authorisation *refer to last page for co-payments
(Refer to member guide for full list)
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
In & Out of Hospital: Unlimited, subject to pre-authorisation. *refer to last page for co-payments
In & Out of Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth
In Hospital: Endoscopic Procedures *refer to last page for co-payments
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
Refer to last page for co-payments
In Hospital & Day Clinics: Endoscopic Procedures: Unlimited. Co-payments apply
*refer to last page
Out of Hospital: Endoscopic Procedures: Unlimited. No co-payments appy
Defined list of procedures covered, subject to pre-authorisation *refer to last page for co-payments
(Refer to member guide for full list)
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
In & Out of Hospital: Unlimited, subject to pre-authorisation. *refer to last page for co- payments
In Hospital: Endoscopic Procedures covered 100% of scheme rate. Co-payment of R3,800 applies
Out of Hospital: Endoscopic Procedures covered 100% of Scheme Rate, subject to pre-auth
In Hospital: Endoscopic Procedures *refer to last page for co-payments
Out of Hospital: Scopes covered up to 200% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
Refer to last page for co-payments
In Hospital & Day Clinics: Endoscopic Procedures: Unlimited. Co-payments apply
*refer to last page
Out of Hospital: Endoscopic Procedures: Unlimited. No co-payments appy
Defined list of procedures covered, subject to pre-authorisation *refer to last page for co-payments
(Refer to member guide for full list)
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
In & Out of Hospital: Unlimited, subject to pre-authorisation. *refer to last page for co-payments
In Hospital: Endoscopic Procedures covered 100% of scheme rate. Co-payment of R3,800 applies
Out of Hospital: Endoscopic Procedures covered 100% of Scheme Rate, subject to pre-auth
In Hospital: Endoscopic Procedures *refer to last page for co-payments
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
Refer to last page for co-payments
In the day surgery network: All Scopes: Unlimited. Co-payments (use of day surgery or further 35% co-payment) apply. *refer to last page
In th doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation *refer to last page for co-payments
(Refer to member guide for full list)
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
In & Out of Hospital: Unlimited, subject to pre-authorisation. *refer to last page for co-payments
In Hospital: Endoscopic Procedures covered 100% of scheme rate. Co-payment of R3,800 applies
Out of Hospital: Endoscopic Procedures covered 100% of Scheme Rate, subject to pre-auth
In Hospital: Endoscopic Procedures *refer to last page for co-payments
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
Refer to last page for co-payments
In the day surgery network: All Scopes: Unlimited. Co-payments (use of day surgery or further 35% co-payment) apply. *refer to last page
In th doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation *refer to last page for co-payments
(Refer to member guide for full list)
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
In & Out of Hospital: Unlimited, subject to pre-authorisation. *refer to last page for co-payments
In Hospital: Endoscopic Procedures covered 100% of scheme rate. Co-payment of R3,800 applies
Out of Hospital: Endoscopic Procedures covered 100% of Scheme Rate, subject to pre-auth
In Hospital: Endoscopic Procedures *refer to last page for co-payments
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
Refer to last page for co-payments
In the day surgery network: All Scopes: Unlimited. Co-payments (use of day surgery or further 35% co-payment) apply. *refer to last page
In th doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation *refer to last page for co-payments
(Refer to member guide for full list)
HOSPITAL COVER 1
BONITAS
2021
Hospital Standard
BESTMED
2021
Beat 1
DISCOVERY
2021
Essential Core
FEDHEALTH
MEDIHELP
MOMENTUM
2021
Custom – Any Hospital, Associated Chronic
In Hospital: Unlimited, subject to pre- authorisation *refer to last page for co- payments
In Hospital: Endoscopic Procedures covered 100% of scheme rate. Co-payment of R3,800 applies
Out of Hospital: Endoscopic Procedures covered 100% of Scheme Rate, subject to pre-auth
In Hospital: Endoscopic Procedures *refer to last page for co-payments
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth
Defined list of procedures covered, subject to pre-authorisation *refer to last page for co-payments
(Refer to member guide for full list)
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
In Hospital: Unlimited, subject to pre- authorisation *refer to co-payments
In Hospital: Endoscopic Procedures covered 100% of scheme rate. Co-payment of R3,800 applies
Out of Hospital: Endoscopic Procedures covered 100% of Scheme Rate, subject to pre-auth
In Hospital: Endoscopic Procedures *refer to last page for co-payments
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth
In the day surgery network: All Scopes: Unlimited. Co-payments (use of day surgery or further 35% co-payment) apply. *refer to In the doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation *refer to co-payments
(Refer to member guide for full list)
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
In Hospital: Unlimited, subject to pre- authorisation *refer to last page for co- payments
In Hospital: Endoscopic Procedures covered 100% of scheme rate. Co-payment of R3,800 applies
Out of Hospital: Endoscopic Procedures covered 100% of Scheme Rate, subject to pre-auth
In Hospital: Endoscopic Procedures *refer to last page for co-payments
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
Refer to last page for co-payments
In the day surgery network: All Scopes: Unlimited. Co-payments (use of day surgery or further 35% co-payment) apply. *refer to last page
In th doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation *refer to last page for co-payments
(Refer to member guide for full list)
Primary Care Network
BONITAS
2021
BonCap
BESTMED
2021
Pulse 1
DISCOVERY
2021
KeyCare Plus
FEDHEALTH
MyFed
MEDIHELP
Ingwe Network
MOMENTUM
2021
Necesse Network
In Hospital:Unlimited, subject to pre- authorisation and use of Network Provider
In Hospital: Endoscopic Procedures covered 100% of scheme rate. Co-payment of R3,800 applies
Out of Hospital: Endoscopic Procedures covered 100% of Scheme Rate, subject to pre-auth
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 (use of day surgery or further 35% co-payment) apply. *refer to last page
In th doctors room: All scopes: Unlimited
Defined list of procedures covered (excludes Scopes), subject to pre-authorisation. (Refer to member guide for full list)