Oncology/Cancer
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
R618,500 per family, subject to DSP (ICON), pre-authorisation and registration on the Oncology programme. Sublimit of R245,400 for specialised/biological drugs, R44,220 for Brachytherapy
Unlimited. Subject to registration on Oncology programme. DSP: ICON
Oncology Programme covers first R400,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment
Limited to R600,600 and R187,300 for specialised medications at ICON, subject to level 2 treatment protocols. 40% co-payment for use of non-DSP
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
HIGH COVER LEVEL 2
BONITAS
2021
BonClassic
BESTMED
2021
Page
DISCOVERY
2021
Essential Comprehensive
FEDHEALTH
MEDIHELP
2021
Elite
MOMENTUM
2021
Extender: Any (Chronic: Any)
R410,400 per family, subject to DSP (ICON), pre-authorisation and registration on the Oncology programme. Sublimit of R44,220 for Brachytherapy
Unlimited. Subject to registration on Oncology programme. DSP: ICON
Oncology Programme covers first R400,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment
PMB Unlimited
Non-PMB limit of R415,600 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
MEDIUM-HIGH LEVEL 1 COVER
BONITAS
2021
BonComplete
BESTMED
2021
Pace 1
DISCOVERY
2021
Classic Priority
FEDHEALTH
MEDIHELP
MOMENTUM
R344,500 per family, subject to DSP (ICON), pre-authorisation and registration on the Oncology programme. Sublimit of R44,220 for Brachytherapy
PMB only. Subject to registration on Oncology programme. DSP: ICON
Oncology Programme covers first R200,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment
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
R344,500 per family, subject to DSP (ICON), pre-authorisation and registration on the Oncology programme. Sublimit of R44,220 for Brachytherapy
PMB only. Subject to registration on Oncology programme. DSP: ICON
Oncology Programme covers first R200,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment
Limited to R480,400 at ICON, subject to level 1 treatment protocols. 40% co-payment for use of non-DSP
PMB Unlimited
Non-PMB limit of R273,700 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
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
R344,500 per family, subject to DSP (ICON), pre-authorisation and registration on the Oncology programme. Sublimit of R44,220 for Brachytherapy
PMB only. Subject to registration on Oncology programme. DSP: ICON
Oncology Programme covers first R400,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment
Limited to R480,400 at ICON, subject to level 1 treatment protocols. 40% co-payment for use of non-DSP
PMB Unlimited
Non-PMB limit of R273,700 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
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
R344,500 per family, subject to DSP (ICON), pre-authorisation and registration on the Oncology programme. Sublimit of R44,220 for Brachytherapy
PMB only. Subject to registration on Oncology programme. DSP: ICON
Oncology Programme covers first R200,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment
Limited to R300,200 at ICON, subject to level 1 treatment protocols. 40% co-payment for use of non-DSP
PMB Unlimited
Non-PMB limit of R240,840 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
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
R165,500 per family, subject to DSP (ICON), pre-authorisation and registration on the Oncology programme. Sublimit of R44,220 for Brachytherapy
PMB only. Subject to registration on Oncology programme. DSP: ICON
Oncology Programme covers first R200,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment
Limited to R300,200 at ICON, subject to level 1 treatment protocols. 40% co-payment for use of non-DSP
PMB Unlimited
Non-PMB limit of R240,840 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
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
R165,500 per family, subject to DSP (ICON), pre-authorisation and registration on the Oncology programme. Sublimit of R44,220 for Brachytherapy
PMB only. Subject to registration on Oncology programme. DSP: ICON
Oncology Programme covers first R200,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment
Limited to R300,200 at ICON, subject to level 1 treatment protocols. 40% co-payment for use of non-DSP
PMB Unlimited
Non-PMB limit of R240,840 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
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
R165,500 per family, subject to DSP (ICON), pre-authorisation and registration on the Oncology programme. Sublimit of R44,220 for Brachytherapy
PMB only. Subject to registration on Oncology programme. DSP: ICON
Oncology Programme covers first R200,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment
In & out of Hospital: Unlimited, subject to pre-authorisation. Co-payment of R2,380 applies for non-PMB scans
PMB Unlimited
Non-PMB limit of R240,840 pfpa Protocols and DSP (ICON) apply. Co- payments apply to voluntary non-network services (10%) and/or deviating from protocol (20%)
In & Out of Hospital: Unlimited. subject to pre-authorisation. R2,480 co-payment aR400,000 per beneficiary per year, thereafter a 20% co-payment applies. Treatment must be obtained from an oncologist authorised by the Scheme
HOSPITAL COVER 1
BONITAS
2021
Hospital Standard
BESTMED
2021
Beat 1
DISCOVERY
2021
Essential Core
FEDHEALTH
MEDIHELP
MOMENTUM
2021
Custom – Any Hospital, Associated Chronic
R165,500 per family, subject to DSP (ICON), pre-authorisation and registration on the Oncology programme. Sublimit of R44,220 for Brachytherapy
PMB only. Subject to registration on Oncology programme. DSP: ICON
Oncology Programme covers first R200,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment
R300,000 per beneficiary per year, thereafter a 20% co-payment applies. Treatment must be obtained from an oncologist authorised by the Scheme
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
Subject to PMB and DSP (ICON), pre- authorisation and registration on the Oncology programme. Sublimit of R44,220 for Brachytherapy
PMB only. Subject to registration on Oncology programme. DSP: ICON
Oncology Programme covers first R200,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment
PMB Unlimited
Non-PMB limit of R220,000 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 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
Subject to PMB and DSP (ICON), pre- authorisation and registration on the Oncology programme. Sublimit of R44,220 for Brachytherapy
PMB only. Subject to registration on Oncology programme. DSP: ICON
Oncology Programme covers first R200,000 of approved cancer treatment over 12 month period. Unlimited thereafter, with a 20% co- payment
Covered up to PMB level of care at ICON, subject to level 1 treatment protocols. 40% co-payment for use of non-DSP
PMB Unlimited
Non-PMB limit of R220,000 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
Primary Care Network
BONITAS
2021
BonCap
BESTMED
2021
Pulse 1
DISCOVERY
2021
KeyCare Plus
FEDHEALTH
MyFed
MEDIHELP
Ingwe Network
MOMENTUM
2021
Necesse Network
Subject to PMB and Network Provider
PMB only. Subject to registration on Oncology programme. DSP: ICON
Subject to PMB, use of Network cancer specialist and registration on Oncology Programme
Covered up to PMB level of care at ICON, subject to level 1 treatment protocols. 40% co-payment for use of non-DSP
PMB Unlimited
Protocols and DSP (ICON) apply. Co- payments apply to voluntary non-network services (10%) and/or deviating from protocol (25%)
Limited to Prescribed Minimum Benefits at State facilities