Comprehensive
(High Cover)
Subject to Savings first, then limited to Acute:
M=R2,000 | M1+R4,500 and OTC: R1,057 pfpa.
Subject to overall day-to-day limit
Subject to Savings and ATB. Limit of R16,970 pf in ATB
Subject to Savings and Threshold. Limited to R7,940 per beneficiary and R14,700 per family before and after Threshold
Limited to R7,850 per beneficiary per year, pooled per family
Subject to available Savings & Threshold (Extender Cover limit of R21,100 pb and
R407,000 pf). OTC meds subject to available Savings (does not accumulate to
Threshold)
Subject to day-to-day benefit. Limits apply.
OTC meds limit of R2,156 per family. 20% co-pay applies
Comprehensive
(High Cover)
Subject to Savings first, then limited to Acute:
M=R3,000 | M1+R6,000 and OTC: R1,057 pfpa.
Subject to overall day-to-day limit
Subject to Savings
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M: R4,600 |
M+1: R5,750 |
M+2: R6,900 |
M+3+: R8,050 Subject to Day-to- Day Benefits after Savings is depleted
Subject to available Savings & Threshold (Extender Cover limit of R21,100 pb and
R407,000 pf). OTC meds subject to available Savings (does not accumulate to Threshold)
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Comprehensive
(Medium to High Cover)
Subject to Savings first, then limited to Acute:
M=R2,591 | M1+R5,363 and OTC: R1,057 pfpa.
Subject to overall day-to-day limit
Subject to Savings and ATB
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Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
Subject to day-to-day benefit. Limits apply.
OTC meds limit of R1,745 per family. 20% co-pay applies
Comprehensive
(Medium to High Cover)
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Subject to Day-to-Day Benefits. Sub-limits:
M=R3,200 | M+1=R4,790 | M+2=R5,330 |
M+3+=R6,390. DSP and formulary (else 20% co-pay applies). OTC Meds limit:
M=R850 | M+=R2,660
Subject to Savings or self-funded and Threshold. Limited to R6,330 pbpa and R12,770 pfpa before and after Threshold
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
Subject to day-to-day benefit. Limits apply.
OTC meds limit of R1,745 per family. 20% co-pay applies
Comprehensive
(Medium to High Cover)
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Subject to Day-to-Day Benefits. Sub-limits:
M=R3,200 | M+1=R4,790 | M+2=R5,330 |
M+3+=R6,390. DSP and formulary (else 20% co-pay applies). OTC Meds limit:
M=R850 | M+=R2,660
Subject to Savings or self-funded and Threshold. Limited to R6,330 pbpa and R12,770 pfpa before and after Threshold
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
Subject to day-to-day benefit. Limits apply.
OTC meds limit of R1,745 per family. 20% co-pay applies
Hospital & Savings
(Low to Medium Cover)
Subject to Savings
Subject to Savings
Subject to available Savings
Subject to Savings/ Wallet or self-funded
Subject to Savings
Subject to Savings, if available
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Hospital & Savings
(Low to Medium Cover)
Subject to Savings
Subject to Day-to-Day Benefits. Sub-limits:
M=R1,600 | M+1=R2,660 | M+2+=R3,200.
DSP and formulary (else 20% co-pay applies). OTC Meds limit: M=R535 |
M+=R2,130
Subject to available Savings
Subject to Savings/ Wallet or self-funded
Subject to Day-to-Day Benefits. Selfmedication limit of R560 pbpa and R1,650 pfpa
Subject to Savings, if available
80% Single Exit Price plus dispensing fee.
Limits apply
Hospital & Savings
(Low to Medium Cover)
Subject to Savings
Subject to Day-to-Day Benefits. Sub-limits:
M=R1,600 | M+1=R2,660 | M+2+=R3,200.
DSP and formulary (else 20% co-pay applies). OTC Meds limit: M=R535 |
M+=R2,130
Subject to available Savings
Subject to Savings/ Wallet or self-funded
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
80% Single Exit Price plus dispensing fee.
Limits apply
Hospital & Savings
(Low to Medium Cover)
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Subject to Savings
Subject to available Savings
Subject to Savings/ Wallet or self-funded
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
80% Single Exit Price plus dispensing fee.
Limits apply
Capitation
(Low Cover)
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Limited to R3,160 per family per annum.
Cover for acute medicine (20% co-payment applies), x-rays and blood tests. Subject to GP referral and medicine formulary (else 40% co-pay applies)
OTC meds limit R785 pfpa (R165 per script)
Limit of R1,820 pbpa and R3,030 pfpa for schedule 3 and above. Subject to network formulary and use of a network pharmacy (Clicks and Dis-Chem). OCT meds limit of R835 pfpa
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Subject to Health Saver, if available
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Capitation
(Low Cover)
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Limited to R1,690 per family per annum.
Cover for acute medicine (20% co-payment applies), x-rays and blood tests. Subject to GP referral and medicine formulary (else 40% co-pay applies)
OTC meds limit R520 pfpa (R105 per script)
OTC meds ONLY. Limit of R560 pfpa, subject to network pharmacy
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Limited to R1,575 per family per year. OTC meds: R100 per event, R475 per family per year.
Subject to Health Saver, if available
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Hospital Plan
(Hospitalization Cover)
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No Benefit
No Benefit
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Hospital Plan
(Hospitalization Cover)
No Benefit
Subject to BENEFIT BOOSTER
No Benefit
Subject to Savings/ Wallet or self-funded
Subject to Day-to-Day Benefits
Subject to Health Saver, if available
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Hospital Plan
(Hospitalization Cover)
No Benefit
Subject to BENEFIT BOOSTER
No Benefit
Subject to Savings/ Wallet or self-funded
Subject to Day-to-Day Benefits
Subject to Health Saver, if available
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Primary Care
(Network & Income Based)
Unlimited. Subject to Provider Network formulary (prescribed by Network GP)
Limits: M=R2,190 | M+1=R3,650 |
M+2=R4,370 | M+3=R4,770 | M+4=R5,290.
Cover for acute medicine, x-rays and blood tests. Subject to GP referral, DSP and medicine formulary OTC meds limit R315 pbpa (R110 per script)
Unlimited. Subject to the Network Acute Medicine Formulary prescribed by KeyCare Network GP
Subject to Savings or self-funded
Subject to Day-to-Day Benefits. Self-medication limit of R560 pbpa and R1,650 pfpa
Subject to prescribed formulary. OTC medication not covered
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