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
Oncology programme at 100% of Scheme tariff.
Subject to pre-authorisation and DSP (ICON).
Biologicals and other high-cost medicine Limited to R384,507 per beneficiary.
Unlimited PMBs. Limited to R426,000 per family for non-PMBs.
Paid at 80% at a DSP and no cover at a non-DSP, once limit is reached. 30% co-payment applies for use of non-DSP.
Sub-limit of R57,680 pb for Brachytherapy and sub-limit of R426,000 for specialised drugs.
Medicine according to preferred provider list. DSP or 20% co-pay.
Oncology Programme covers first R500,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co-payment.
Limited to R624,000 at DSPs. Subject to Core protocol at ICON. 25% co-payment for use of non-DSP.
Unlimited. ICON enhanced protocols apply.
Co-payments apply to voluntary non-network services (10%) and/or deviating from protocol (10%).
R500,000 per beneficiary per year, thereafter a 20% co-payment applies.
Treatment must be obtained from an oncologist authorised by the Scheme.
Limit of R718,112 per beneficiary, thereafter PMB only.
Subject to pre-auth and registration on Oncology Programme (Co-payment applies for use of non-DSP)
Comprehensive
(High Cover)
BESTMED
Pace 2
BONITAS
BonClassic
DISCOVERY
-
FEDHEALTH
-
MEDIHELP
MedElite
MOMENTUM
Extender
(Associated Hospital,
Any Chronic)
PROFMED
-
Oncology programme at 100% of Scheme tariff.
Subject to pre-authorisation and DSP (ICON).
Biologicals and other high-cost medicine Limited to R192,126 per beneficiary.
Unlimited PMBs. Limited to R319,500 per family for non-PMBs.
Paid at 80% at a DSP
and no cover at a non-DSP, once limit is reached. 30% co-payment applies for use of non-DSP.
Sub-limit of R150,000 for specialised drugs/biologicals. Sub-limit of R57,680 pb for Brachytherapy.
Medicine according to preferred provider list. DSP or 20% co-pay.
–
–
PMB Unlimited
Non-PMB limit of R476,700 pfpa. Protocols and DSP (ICON) apply.
Co-payments apply to voluntary non-network services (10%) and/or deviating from protocol (15%).
R500,000 per beneficiary per year, thereafter a 20% co-payment applies.
Treatment must be obtained from an oncologist authorised by the Scheme.
–
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
Oncology programme at 100% of Scheme tariff.
Subject to pre-authorisation and DSP (ICON)
Unlimited PMBs. Limited to R266,300 per family for non-PMBs.
Paid at 80% at a DSP and no cover at a non-DSP, once limit is reached. 30% co-payment applies for use of non-DSP.
Sub-limit of R57,680 pb for Brachytherapy. Pre-auth required.
Medicine according to preferred provider list. DSP or 20% co-pay.
Oncology Programme covers first R250,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment.
–
PMB Unlimited
Non-PMB limit of R313,900 pfpa.
Protocols and DSP (ICON) apply.
Co-payments
apply to voluntary non-network
services (10%) and/or deviating from protocol (20%).
R400,000 per beneficiary per year, thereafter a 20% co-payment applies.
Treatment must be obtained from an oncologist authorised by the Scheme.
Limit of R478,741 per beneficiary, thereafter PMB only.
Subject to pre-auth and registration on Oncology Programme (Co-payment applies for use of non-DSP)
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
–
Unlimited PMBs. Limited to R266,300 per family for non-PMBs.
Paid at 80% at a DSP and no cover at a non-DSP, once limit is reached. 30% co-payment applies for use of non-DSP.
Sub-limit of R150,000 for specialised drugs/biologicals. Sub-limit of R57,680 pb for Brachytherapy.
Medicine according to preferred provider list. DSP or 20% co-pay.
Oncology Programme covers first R250,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment.
Limited to R499,100 at DSPs. Subject to Essential protocol at ICON. 25% co-payment for use of non-DSP.
PMB Unlimited
Non-PMB limit of R313,900 pfpa.
Protocols and DSP (ICON) apply.
Co-payments
apply to voluntary non-network
services (10%) and/or deviating from protocol (20%).
R400,000 per beneficiary per year, thereafter a 20% co-payment applies.
Treatment must be obtained from an oncologist authorised by the Scheme.
Limit of R478,741 per beneficiary, thereafter PMB only.
Subject to pre-auth and registration on Oncology Programme (Co-payment applies for use of non-DSP)
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)
–
Unlimited PMBs. Limited to R266,300 per family for non-PMBs.
Paid at 80% at a DSP and no cover at a non-DSP, once limit is reached. 30% co-payment applies for use of non-DSP.
Sub-limit of R150,000 for specialised drugs/biologicals. Sub-limit of R57,680 pb for Brachytherapy.
Medicine according to preferred provider list. DSP or 20% co-pay.
Oncology Programme covers first R250,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment.
Limited to R499,100 at DSPs. Subject to Essential protocol at ICON. 25% co-payment for use of non-DSP.
PMB Unlimited
Non-PMB limit of R313,700 pfpa Protocols and DSP (ICON) apply.
Co- payments apply to voluntary non-network services (10%) and/or deviating from protocol (20%).
R400,000 per beneficiary per year, thereafter a 20% co-payment applies.
Treatment must be obtained from an oncologist authorised by the Scheme.
Limit of R478,741 per beneficiary, thereafter PMB only.
Subject to pre-auth and registration on Oncology Programme (Co-payment applies for use of non-DSP)
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
-
Oncology programme at 100% of Scheme tariff.
Subject to pre-authorisation and DSP (ICON)
Unlimited PMBs. Limited to R213,000 per family for non-PMBs.
Paid at 80% at a DSP
and no cover at a non-DSP, once limit is reached. 30% co-payment applies for use of non-DSP.
Sub-limit of R57,680 pb for Brachytherapy. Pre-auth required.
Medicine according to preferred provider list. DSP or 20% co-pay
Oncology Programme covers first R250,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment.
Limited to R311,900 at DSPs. Subject to Essential protocol at ICON. 25% co-payment for use of non-DSP.
PMB Unlimited
Non-PMB limit of R275,100 pfpa. Protocols and DSP (ICON) apply.
Co- payments apply to voluntary non-network services (10%) and/or deviating from protocol (20%).
R400,000 per beneficiary per year, thereafter a 20% co-payment applies.
Treatment must be obtained from an oncologist authorised by the Scheme.
–
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
Oncology programme at 100% of Scheme tariff.
Subject to pre-authorisation and DSP (ICON)
Unlimited PMBs. Limited to R213,000 per family for non-PMBs.
Paid at 80% at a DSP and no cover at a non-DSP, once limit is reached. 30% co-payment applies for use of non-DSP.
Sub-limit of R57,680 pb for
Brachytherapy. Pre-auth required.
Medicine according to preferred provider list. DSP or 20% co-pay.
Oncology Programme covers first R250,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment.
Limited to R311,900 at DSPs. Subject to Essential protocol at ICON. 25% co-payment for use of non-DSP.
PMB Unlimited
Non-PMB limit of R242,500 pfpa Protocols and DSP (ICON) apply.
Co- payments apply to voluntary non-network services (10%) and/or deviating from protocol (20%).
R400,000 per beneficiary per year, thereafter a 20% co-payment applies.
Treatment must be obtained from an oncologist authorised by the Scheme.
Limit of R239,371 per beneficiary, thereafter PMB only.
Subject to pre-auth and registration on Oncology Programme (Co-payment applies for use of non-DSP)
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)
Oncology programme at 100% of Scheme tariff.
Subject to pre-authorisation and DSP (ICON)
Unlimited PMBs. Limited to R213,000 per family for non-PMBs.
Paid at 80% at a DSP and no cover at a non-DSP, once limit is reached. 30% co-payment applies for use of non-DSP.
Sub-limit of R57,680 pb for Brachytherapy. Pre-auth required.
Medicine according to preferred provider list. DSP or 20% co-pay.
Oncology Programme covers first R250,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment.
Limited to R311,900 at DSPs. Subject to Essential protocol at ICON. 25% co-payment for use of non-DSP.
PMB Unlimited
Non-PMB limit of R275,100 pfpa. Protocols and DSP (ICON) apply.
Co- payments apply to voluntary non-network services (10%) and/or deviating from protocol (20%).
R400,000 per beneficiary per year, thereafter a 20% co-payment applies.
Treatment must be obtained from an oncologist authorised by the Scheme.
Limit of R239,371 per beneficiary, thereafter PMB only.
Subject to pre-auth and registration on Oncology Programme (Co-payment applies for use of non-DSP)
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)
–
Unlimited PMBs. Limited to R213,000 per family for non-PMBs.
Paid at 80% at a DSP and no cover at a non-DSP, once limit is reached. 30% co-payment applies for use of non-DSP.
Sub-limit of R57,680 pb for Brachytherapy. Pre-auth required.
Medicine according to preferred provider list. DSP or 20% co-pay.
Oncology Programme covers first R250,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment.
Limited to R311,900 at DSPs. Subject to Essential protocol at ICON. 25% co-payment for use of non-DSP.
PMB Unlimited
Non-PMB limit of R275,100 pfpa. Protocols and DSP (ICON) apply.
Co- payments apply to voluntary non-network services (10%) and/or deviating from protocol (20%).
R400,000 per beneficiary per year, thereafter a 20% co-payment applies.
Treatment must be obtained from an oncologist authorised by the Scheme.
Limit of R239,371 per beneficiary, thereafter PMB only.
Subject to pre-auth and registration on Oncology Programme (Co-payment applies for use of non-DSP)
Capitation
(Low Cover)
BESTMED
-
BONITAS
BonStart Plus
(Network)
DISCOVERY
Classic Smart
(Network)
FEDHEALTH
-
MEDIHELP
-
MOMENTUM
Evolve
(Network)
PROFMED
-
–
Subject to PMB and Network Provider, or a 30% co-payment applies. Pre-auth required.
Medicine according to preferred provider list. DSP or 20% co-pay.
Oncology Programme covers first R250,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment.
–
–
R200,000 per beneficiary per year, thereafter a 20% co-payment applies.
Treatment must be obtained from Evolve Network of Oncologists.
–
Capitation
(Low Cover)
BESTMED
-
BONITAS
BonStart
(Network)
DISCOVERY
Essential Smart
(Network)
FEDHEALTH
-
MEDIHELP
MedMove
(Network)
MOMENTUM
Evolve
(Network)
PROFMED
-
–
Subject to PMB and Network Provider, or a 30% co-payment applies. Pre-auth required.
Medicine according to preferred provider list. DSP or 20% co-pay.
Oncology Programme covers first R250,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment.
–
Subject to Prescribed Minimum Benefits. Listed essential cases – clinical guidelines and pre-authorisation apply.
R200,000 per beneficiary per year, thereafter a 20% co-payment applies.
Treatment must be obtained from Evolve Network of Oncologists.
–
Hospital Plan
(Hospitalization Cover)
BESTMED
-
BONITAS
Hospital Standard
DISCOVERY
Classic Core
FEDHEALTH
-
MEDIHELP
-
MOMENTUM
-
PROFMED
-
–
Unlimited PMBs. Limited to R159,800 per family for non-PMBs.
Paid at 80% at a DSP
and no cover at a non-DSP, once limit is reached. 30% co-payment applies for use of non-DSP.
Sub-limit of R57,680 pb for Brachytherapy. Pre-auth required.
Medicine according to preferred provider list. DSP or 20% co-pay.
Oncology Programme covers first R250,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment.
–
–
–
–
Hospital Plan
(Hospitalization Cover)
BESTMED
Beat 1
BONITAS
BonEssential
DISCOVERY
Essential Delta Core
FEDHEALTH
FlexiFed 1
(Network)
No Medivault
MEDIHELP
MediVital
MOMENTUM
Custom
(Any Hospital,
Associated Chronic)
PROFMED
-
Oncology programme at 100% of Scheme tariff.
Subject to pre-authorisation and DSP (ICON)
Subject to PMB and Network Provider, or a 30% co-payment applies.
Sub-limit of R57,680 pb for Brachytherapy. Pre-auth
required.
Medicine according to preferred
provider list. DSP or 20% co-pay.
Oncology Programme covers first R250,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment.
Covered up to PMB level of care at DSPs. Subject to Essential protocol at ICON. 25% co-payment for use of non-DSP.
PMB Unlimited
Non-PMB limit of R254,100 pfpa. Protocols and DSP (ICON) apply.
Co-payments apply to voluntary non-network services (10%) and/or deviating from protocol (20%).
R300,000 per beneficiary per year, thereafter a 20% co-payment applies.
Treatment must be obtained from an oncologist authorised by the Scheme.
–
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)
Oncology programme at 100% of Scheme tariff.
Subject to pre-authorisation and DSP (ICON)
Subject to PMB and Network Provider, or a 30% co-payment applies.
Sub-limit of R57,680 pb for Brachytherapy. Pre-auth required.
Medicine according to preferred
provider list. DSP or 20% co-pay.
Oncology Programme covers first R250,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment.
Covered up to PMB level of care at DSPs. Subject to Essential protocol at ICON. 25% co-payment for use of non-DSP
PMB Unlimited
Non-PMB limit of R254,100 pfpa. Protocols and DSP (ICON) apply.
Co- payments apply to voluntary non-network services (10%) and/or deviating from protocol (20%).
R300,000 per beneficiary per year, thereafter a 20% co-payment applies.
Treatment must be obtained from an oncologist authorised by the Scheme
Limit of R239,371 per beneficiary, thereafter PMB only.
Subject to pre-auth and registration on Oncology Programme (Co-payment applies for use of non-DSP)
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 PMBs at DSPs
Subject to PMB and Network Provider, or a 30% co-payment applies. Pre-auth required.
Medicine according to preferred provider list. DSP or 20% co-pay.
Subject to PMB, use of Network cancer specialist and registration on Oncology Programme.
Covered up to PMB level of care at DSPs. Subject to Essential protocol at ICON.
PMB Unlimited
Non-PMB limit of R242,500 pfpa. Protocols and DSP (ICON) apply.
Co- payments apply to voluntary non-network services (10%) and/or deviating from protocol (20%).
Limited to Prescribed Minimum Benefits at State facilities
–