MRI & CAT Scans
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: R33,050 per family. Subject to pre-authorisation. Co-payment of R1,500 applies
In Hospital: Covered 100% of scheme rate Out of Hospital: 3 MRI/CT scans, 1 PET scans (both pbpa). Subject to pre-auth
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 R3,130 co-pay paid from MSA, balance paid from Risk
Out-of-Hospital: R3,130 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 R2,380 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 R22,200 per case
In & Out of Hospital: Unlimited. subject to pre-authorisation. R2,480 co-payment applies
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: R30,580 per family. Subject to pre-authorisation. Co-payment of R1,500 applies
In Hospital: Covered 100% of scheme rate Out of Hospital: 3 MRI/CT scans, 1 PET scans (both pbpa). Subject to pre-auth
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 R3,130 co-pay paid from MSA, balance paid from Risk
Out-of-Hospital: R3,130 co-pay paid from MSA, balance paid from Risk
(Conservative neck and back scans, specific rules and limits apply)
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. R2,480 co-payment applies
MEDIUM-HIGH LEVEL 1 COVER
BONITAS
2021
BonComplete
BESTMED
2021
Pace 1
DISCOVERY
2021
Classic Priority
FEDHEALTH
MEDIHELP
MOMENTUM
In & Out of Hospital: R24,610 per family. Subject to pre-authorisation. Co-payment of R1,500 applies
In Hospital: Covered 100% of scheme rate Out of Hospital: R14,606 per family, subject to pre-auth
In-Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme Rate. R3,130 co-pay paid from MSA, balance paid from Risk. For conservative neck and back scans, deductible of R3,850 applies
Out-of-Hospital: R3,850 co-pay paid from MSA, balance paid from Risk
(Conservative neck and back scans, specific rules and limits apply)
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: R27,530 per family. Subject to pre-authorisation. Co-payment of R1,500 applies
In Hospital: Covered 100% of scheme rate Out of Hospital: R14,606 per family, subject to pre-auth
In-Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme Rate. R3,130 co-pay paid from MSA, balance paid from Risk. For conservative neck and back scans, deductible of R3,850 applies
Out-of-Hospital: R3,850 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 R2,380 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. R2,480 co-payment applies
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: R27,530 per family. Subject to pre-authorisation. Co-payment of R1,500 applies
In Hospital: Covered 100% of scheme rate Out of Hospital: R14,606 per family, subject to pre-auth
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 R3,130 co-pay paid from MSA, balance paid from Risk
Out-of-Hospital: R3,130 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 R2,380 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. R2,480 co-payment applies
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: R24,610 per family. Subject to pre-authorisation. Co-payment of R1,500 applies
In Hospital: Covered 100% of scheme rate. R3,800 co-payment applies
Out of Hospital: R11,223 per family, subject to pre-auth
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 R3,130 co-pay paid from MSA, balance paid from Risk
Out-of-Hospital: R3,130 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 R2,380 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. R2,480 co-payment applies
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: R13,710 per family. Subject to pre-authorisation. Co-payment of R1,500 applies
In Hospital: Covered 100% of scheme rate. R3,800 co-payment applies
Out of Hospital: R5,343 per family, subject to pre-auth
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 R3,130 co-pay paid from MSA, balance paid from Risk
Out-of-Hospital: R3,130 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 R2,380 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. R2,480 co-payment applies
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: R13,710 per family. Subject to pre-authorisation. Co-payment of R1,500 applies
In Hospital: Covered 100% of scheme rate. R3,800 co-payment applies
Out of Hospital: R5,343 per family, subject to pre-auth
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 R3,130 co-pay paid from MSA, balance paid from Risk
Out-of-Hospital: R3,130 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 R2,380 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. R2,480 co-payment applies
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 Hospital: R16,620 per family, subject to pre-authorisation. Co-payment of R1,500 applies
Out of Hospital: Subject to Savings
In Hospital: Covered 100% of scheme rate. R3,800 co-payment applies
Out of Hospital: R11,223 per family, subject to pre-auth
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 R3,130 co-pay paid from MSA, balance paid from Risk
Out-of-Hospital: R3,130 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 R2,380 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. R2,480 co-payment applies
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 & Out of Hospital: R27,530 per family. Co-payment of R1,500 per scan applies. Subject to pre-authorisation
In Hospital: Covered 100% of scheme rate. R3,800 co-payment applies
Out of Hospital: R5,343 per family, 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 & Out of Hospital: Unlimited. subject to pre-authorisation. R2,740 co-payment applies
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 & Out of Hospital: R16,620 per family. Co-payment of R1,500 per scan applies. Subject to pre-authorisation
In Hospital: Covered 100% of scheme rate. R3,800 co-payment applies
Out of Hospital: R5,343 per family, 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 & 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. R2,740 co-payment applies
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 & Out of Hospital: R16,620 per family. Co-payment of R1,500 per scan applies. Subject to pre-authorisation
In Hospital: Covered 100% of scheme rate. R3,800 co-payment applies
Out of Hospital: R5,343 per family, 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 & out of Hospital: Unlimited, subject to pre-authorisation. Co-payment of R3,310 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. R2,740 co-payment applies
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: Limited to R12,240 per family Out of Hospital: Subject to Specialist Benefit. Both subject to pre-auth
In Hospital: Covered 100% of scheme rate
Out of Hospital:No Benefit
In Hospital: Related to approved admission (subject to pre-auth) up to 100% of Scheme Rate
Out of Hospital: Limited to R4,530 per beneficiary (subject to day-to-day Specialist benefit)
In Hospital: R14,700 per beneficiary, subject to overall limit of R29,200 per family per year
Out of Hospital: No Benefit
In & Out of Hospital: Subject to Specialised Radiology limit of R17,100 per family, as requested by Specialist on referral by Network GP
Limited to Prescribed Minimum Benefits at State facilities