(In and 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

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