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