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)