Comprehensive
(High Cover)
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)
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
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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
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Comprehensive
(Medium to High Cover)
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)
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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)
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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)
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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)
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)
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)
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)
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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)
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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)
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In & Out of Hospital: Unlimited. subject to pre-authorisation. R3,050 co-payment applies
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Capitation
(Low Cover)
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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
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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
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Hospital Plan
(Hospitalization Cover)
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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
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Hospital Plan
(Hospitalization Cover)
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
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Hospital Plan
(Hospitalization Cover)
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)
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
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