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 Hospital: Covered 100% of scheme rate Out of Hospital: 2 MRI/CT scans, 1 PET scans (both pbpa). Subject to pre-auth
In & Out of Hospital: R36,570 per family. Subject to pre-authorisation. Co-payment of R2,600 applies, if not PMB
In-Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme
Rate. If not related to admission or for conservative neck and back scans R3,670 co-pay paid from day-to-day benefits, balance paid from Risk
Out-of-Hospital: R3,670 co-pay paid from day-to-day benefits, balance paid from Risk
(Conservative neck and back scans, specific rules and limits apply)
In & out of Hospital: Unlimited, subject to pre-authorisation. Co-payment of R2,810 applies for non-PMB scans
In & Out of Hospital: Unlimited. Subject to request of a specialist, clinical protocols and pre-auth. PET scans limited to R26,200 per case
In & Out of Hospital: Unlimited. subject to pre-authorisation. R2,770 co-payment applies
In & Out of Hospital: 2 Investigations per family, subject to pre-auth and specialist referral. Not subject to day-to-day limit
Comprehensive
(High Cover)
BESTMED
Pace 2
BONITAS
BonClassic
DISCOVERY
-
FEDHEALTH
-
MEDIHELP
MedElite
MOMENTUM
Extender
(Associated Hospital,
Any Chronic)
PROFMED
-
In Hospital: Covered 100% of scheme rate Out of Hospital: 2 MRI/CT scans, 1 PET scans (both pbpa). Subject to pre-auth
In & Out of Hospital: R35,930 per family. Subject to pre-authorisation. Co-payment of R2,660 applies, if not PMB
–
–
In & Out of Hospital: Unlimited. *Co- payment applies. Subject to request of a specialist, clinical protocols and pre-auth
In & Out of Hospital: Unlimited. subject to pre-authorisation. R2,770 co-payment applies
–
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 Hospital: Covered 100% of scheme rate Out of Hospital: R16,891 per family, subject to pre-auth
In & Out of Hospital: R28,930 per family.
Subject to pre-authorisation. Co-payment of R2,660 applies, if not PMB.
In-Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme
Rate. R3,670 co-pay paid from day-to-day benefits, balance paid from Risk. For conservative neck and back scans, deductible of R4,550 applies
Out-of-Hospital: R3,670 co-pay paid from day-to-day benefits (if done outside a Day
Surgery Network), balance paid from Risk (Conservative neck and back scans, specific rules and limits apply)
–
In & Out of Hospital: Unlimited. *Copayment applies. Subject to request of a specialist, clinical protocols and pre-auth
In & Out of Hospital: Unlimited. subject to pre-authorisation. R2,770 co-payment applies
In & Out of Hospital: 2 Investigations per family, subject to pre-auth and specialist referral. Subject to day-to-day limit out-of-hospital plus 20% co-payment
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: R32,340 per family. Subject to pre-authorisation. Co-payment of R1,770 applies. if not PMB
In-Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme
Rate. R3,670 co-pay paid from day-to-day benefits, balance paid from Risk. For conservative neck and back scans, deductible of R4,550 applies
Out-of-Hospital: R3,670 co-pay paid from day-to-day benefits (if done outside a Day
Surgery Network), balance paid from Risk (Conservative neck and back scans, specific rules and limits apply)
In & out of Hospital: Unlimited, subject to pre-authorisation. Co-payment of R2,810 applies for non-PMB scans
In & Out of Hospital: Unlimited. *Co- payment applies. Subject to request of a specialist, clinical protocols and pre-auth
In & Out of Hospital: Unlimited. subject to pre-authorisation. R2,770 co-payment applies
In & Out of Hospital: 2 Investigations per family, subject to pre-auth and specialist referral. Subject to day-to-day limit out-of-hospital plus 20% co-payment
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: R32,340 per family. Subject to pre-authorisation. Co-payment of R1,770 applies if not PMB
In-Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme
Rate. R3,670 co-pay paid from day-to-day benefits, balance paid from Risk. For conservative neck and back scans, deductible of R4,550 applies
Out-of-Hospital: R3,670 co-pay paid from day-to-day benefits (if done outside a Day
Surgery Network), balance paid from Risk (Conservative neck and back scans, specific rules and limits apply)
In & out of Hospital: Unlimited, subject to pre-authorisation. Co-payment of R2,810 applies for non-PMB scans
In & Out of Hospital: Unlimited. *Co- payment applies. Subject to request of a specialist, clinical protocols and pre-auth
In & Out of Hospital: Unlimited. subject to pre-authorisation. R2,770 co-payment applies
In & Out of Hospital: 2 Investigations per family, subject to pre-auth and specialist referral. Subject to day-to-day limit out-of-hospital plus 20% co-payment
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 Hospital: Covered 100% of scheme rate.
Out of Hospital: R12,979 per family, subject to pre-auth
In & Out of Hospital: R28,930 per family.
Subject to pre-authorisation. Co-payment of R1,770 applies, if not PMB.
In-Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme
Rate. If not related to admission or for conservative neck and back scans R3,670 co-pay paid from MSA, balance paid from
Risk
Out-of-Hospital: R3,670 co-pay paid from MSA, balance paid from Risk (Conservative neck and back scans, specific
rules and limits apply)
In & out of Hospital: Unlimited, subject to pre-authorisation. Co-payment of R2,810 applies for non-PMB scans
In & Out of Hospital: Unlimited. *Co- payment applies. Subject to request of a specialist, clinical protocols and pre-auth
In & Out of Hospital: Unlimited. subject to pre-authorisation. R2,770 co-payment applies
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 Hospital: Covered 100% of scheme rate.
Out of Hospital: R6,179 per family, subject to pre-auth
In & Out of Hospital: R15,170 per family. Subject to pre-authorisation. Co-payment of R2,130 applies, if not PMB
In-Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme Rate. If not related to admission or for conservative neck and back scans R3,670 co-pay paid from MSA, balance paid from
Risk
Out-of-Hospital: R3,670 co-pay paid from MSA, balance paid from Risk (Conservative neck and back scans, specific
rules and limits apply)
In & out of Hospital: Unlimited, subject to pre-authorisation. Co-payment of R2,810 applies for non-PMB scans
In & Out of Hospital: Unlimited. *Co- payment applies. Subject to request of a specialist, clinical protocols and pre-auth
In & Out of Hospital: Unlimited. subject to pre-authorisation. R2,770 co-payment applies
In Hospital: 2 Investigations per family, subject to pre-auth and specialist referral
Out of Hospital: Subject to PMB
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 Hospital: Covered 100% of scheme rate.
Out of Hospital: R6,179 per family, subject to pre-auth
In & Out of Hospital: R15,170 per family. Subject to pre-authorisation. Co-payment of R2,130 applies, if not PMB
In-Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme Rate. If not related to admission or for conservative neck and back scans R3,670 co-pay paid from MSA, balance paid from
Risk
Out-of-Hospital: R3,670 co-pay paid from MSA, balance paid from Risk (Conservative neck and back scans, specific
rules and limits apply)
In & out of Hospital: Unlimited, subject to pre-authorisation. Co-payment of R2,630 applies for non-PMB scans
In & Out of Hospital: Unlimited. *Co- payment applies. Subject to request of a specialist, clinical protocols and pre-auth
In & Out of Hospital: Unlimited. subject to pre-authorisation. R2,770 co-payment applies
In Hospital: 2 Investigations per family, subject to pre-auth and specialist referral
Out of Hospital: Subject to PMB
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 Hospital: R19,530 per family, subject to pre-authorisation. Co-payment of R1,770 applies, if not PMB
Out of Hospital: Subject to Savings
In-Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme Rate. If not related to admission or for conservative neck and back scans R3,670 co-pay paid from MSA, balance paid from
Risk
Out-of-Hospital: R3,670 co-pay paid from MSA, balance paid from Risk (Conservative neck and back scans, specific
rules and limits apply)
In & out of Hospital: Unlimited, subject to pre-authorisation. Co-payment of R2,630 applies for non-PMB scans
In & Out of Hospital: Unlimited. *Co- payment applies. Subject to request of a specialist, clinical protocols and pre-auth
In & Out of Hospital: Unlimited. subject to pre-authorisation. R2,770 co-payment applies
In Hospital: 2 Investigations per family, subject to pre-auth and specialist referral
Out of Hospital: Subject to PMB
Capitation
(Low Cover)
BESTMED
-
BONITAS
BonStart Plus
(Network)
DISCOVERY
Classic Smart
(Network)
FEDHEALTH
-
MEDIHELP
-
MOMENTUM
Evolve
(Network)
PROFMED
-
–
In Hospital: R18,180 per family. Co-payment of R2,130 per scan applies. Subject to pre-authorisation
Out of Hospital: Subject to Specialist Benefit. Both subject to pre-auth
In-Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme
Rate. If not related to you admission or for conservative neck and back scans R3,670 co-pay applies, balance paid from Risk
Out-of-Hospital: R3,670 co-pay applies, balance paid from Risk (Conservative neck and back scans, specific rules and limits apply)
–
–
In & Out of Hospital: Unlimited. subject to pre-authorisation. R3,050 co-payment applies
–
Capitation
(Low Cover)
BESTMED
-
BONITAS
BonStart
(Network)
DISCOVERY
Essential Smart
(Network)
FEDHEALTH
-
MEDIHELP
MedMove
(Network)
MOMENTUM
Evolve
(Network)
PROFMED
-
–
In Hospital: R13,990 per family. Co-payment of R2,660 per scan applies. Subject to pre-authorisation
Out of Hospital: Subject to Specialist Benefit. Both subject to pre-auth
In-Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme Rate. Unrelated event OR as part of admission for conservative neck and back scans – No Benefit
Out-of-Hospital: No Benefit
–
In-Hospital: Subject to Specialised Radiology limit of R13,000 per family, co-payment
applies. Subject to request of a
specialist, clinical protocols and pre-auth
In & Out of Hospital: Unlimited. subject to pre-authorisation. R3,050 co-payment applies
–
Hospital Plan
(Hospitalization Cover)
BESTMED
-
BONITAS
Hospital Standard
DISCOVERY
Classic Core
FEDHEALTH
-
MEDIHELP
-
MOMENTUM
-
PROFMED
-
–
In Hospital: Unlimited
Out of Hospital: 6 Antenatal
GP/Midwife/Gynae visits, 2 2D scans, 1 amniocentesis, 4 post natal visits with a midwife
In-Hospital: Related to approved admission
(subject to pre-auth) up to 100% of Scheme Rate. Unrelated event OR as part of admission for conservative neck and back scans – No Benefit
Out-of-Hospital: No Benefit
–
–
–
–
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: Covered 100% of scheme rate.
Out of Hospital: R6,179 per family, subject to pre-auth
In & Out of Hospital: R15,170 per family. Co-payment of R2,660 per scan applies. Subject to pre-authorisation
In-Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme
Rate. Unrelated event OR as part of admission for conservative neck and back
scans – No Benefit
Out-of-Hospital: No Benefit
In & out of Hospital: Unlimited, subject to pre-authorisation. Co-payment of R3,890 applies for non-PMB scans
In & Out of Hospital: Unlimited. *Copayment applies. Subject to request of a specialist, clinical protocols and pre-auth
In & Out of Hospital: Unlimited. subject to pre-authorisation. R3,050 co-payment applies
–
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: Covered 100% of scheme rate.
Out of Hospital: R6,179 per family, subject to pre-auth
In & Out of Hospital: R15,170 per family. Co-payment of R2,660 per scan applies. Subject to pre-authorisation
In-Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme Rate. Unrelated event OR as part of admission for conservative neck and back scans – No Benefit
Out-of-Hospital: No Benefit
In & out of Hospital: Unlimited, subject to pre-authorisation. Co-payment of R3,890 applies for non-PMB scans
In & Out of Hospital: Unlimited. *Co- payment applies. Subject to request of a specialist, clinical protocols and pre-auth
In & Out of Hospital: Unlimited. subject to pre-authorisation. R3,050 co-payment applies
In Hospital: 2 Investigations per family, subject to pre-auth and specialist referral
Out of Hospital: Subject to PMB
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
-
Approved PMB services only
In Hospital: Limited to R13,550 per family.
R1,170 co-payment per scan event, except PMB
Out of Hospital: Subject to Specialist Benefit. Both subject to pre-auth
In Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme Rate
Out of Hospital: Limited to R5,300 per beneficiary (subject to day-to-day Specialist benefit)
In Hospital: Unlimited at PMB level of care.
Out of Hospital: Subject to Savings or selffunded
In & Out of Hospital: Unlimited. *Co-payment applies. Subject to request of a specialist, clinical protocols and pre-auth
Limited to Prescribed Minimum Benefits at State facilities
–