(In & Out of Hospital)

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