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
21 Days per beneficiary. Limit of R37,352 per beneficiary for treatment of chemical or substance abuse, subject to network facilities
In hospital: R56,960 per family.
In Hospital: 21 Days per beneficiary OR Out of Hospital: 15 consultations per beneficiary. Subject to PMB and DSP. Cover up to 80% if non-DSP is used
Limited to R35,800 at Healthcare Professional Tariff
In & Out of Hospital: R52,400 per beneficiary to max of R69,900 per family Out of hospital benefit applicable to psychiatric treatment only
In Hospital: R46,000 per beneficiary OR Out of Hospital: Sub-limit of 21 days for drug and alcohol rehab, subject to treatment at a preferred provider
Limit of R42,367 per family. Subject to pre-auth and use of DSPN, subject to PMB only
Comprehensive
(High Cover)
BESTMED
Pace 2
BONITAS
BonClassic
DISCOVERY
-
FEDHEALTH
-
MEDIHELP
MedElite
MOMENTUM
Extender
(Associated Hospital,
Any Chronic)
PROFMED
-
21 Days per beneficiary. Limit of R37,352 per beneficiary for treatment of chemical or substance abuse, subject to network facilities
In hospital: R50,070 per family. Subject to use of a DSP or 30% co-payment will apply
–
–
In & Out of Hospital: R42,100 per beneficiary to max of R58,400 per family Out of hospital benefit applicable to psychiatric treatment only
In Hospital: R46,000 per beneficiary OR Out of Hospital: Sub-limit of 21 days for drug and alcohol rehab, subject to treatment at a preferred provider
–
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
21 Days per beneficiary. Limit of R37,352 per beneficiary for treatment of chemical or substance abuse, subject to network facilities
In hospital: R39,150 per family. Subject to use of a DSP or 30% ci-payment will apply
In Hospital: 21 Days per beneficiary OR Out of Hospital: 15 consultations per beneficiary. Subject to PMB and DSP. Cover up to 80% if non-DSP is used
–
In & Out of Hospital: R34,700 per beneficiary to max of R46,800 per family Out of hospital benefit applicable to psychiatric treatment only
In Hospital: R46,000 per beneficiary OR Out of Hospital: Sub-limit of 21 days for drug and alcohol rehab, subject to treatment at a preferred provider
Limit of R28,245 per family. Subject to pre-auth and use of DSPN, subject to PMB only
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
–
In hospital: R49,330 per family.
In Hospital: 21 Days per beneficiary OR Out of Hospital: 15 consultations per beneficiary. Subject to PMB and DSP. Cover up to 80% if non-DSP is used
Limited to R28,000 at Healthcare Professional Tariff
In & Out of Hospital: R34,700 per beneficiary to max of R46,800 per family Out of hospital benefit applicable to psychiatric treatment only
In Hospital: R46,000 per beneficiary OR Out of Hospital: Sub-limit of 21 days for drug and alcohol rehab, subject to treatment at a preferred provider
Limit of R28,245 per family. Subject to pre-auth and use of DSPN, subject to PMB only
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)
–
In Hospital: R49,330 per family. Subject to use of a DSP or 30% co-payment will apply
In Hospital: 21 Days per beneficiary OR Out of Hospital: 15 consultations per beneficiary. Subject to PMB and DSP. Cover up to 80% if non-DSP is used
Limited to R28,000 at Healthcare Professional Tariff
In & Out of Hospital: R34,700 per beneficiary to max of R46,800 per family Out of hospital benefit applicable to psychiatric treatment only
In Hospital: R46,000 per beneficiary OR Out of Hospital: Sub-limit of 21 days for drug and alcohol rehab, subject to treatment at a preferred provider
Limit of R28,245 per family. Subject to pre-auth and use of DSPN, subject to PMB only
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
-
21 Days per beneficiary. Limit of R37,352 per beneficiary for treatment of chemical or substance abuse, subject to network facilities
In hospital: R39,150 per family.
In Hospital: 21 Days per beneficiary OR Out of Hospital: 15 consultations per beneficiary. Subject to PMB and DSP. Cover up to 80% if non-DSP is used
Limited to R28,000 at Healthcare Professional Tariff
In & Out of Hospital: R28,900 per beneficiary to max of R39,900 per family Out of hospital benefit applicable to psychiatric treatment only
In Hospital: R46,000 per beneficiary OR Out of Hospital: Sub-limit of 21 days for drug and alcohol rehab, subject to treatment at a preferred provider
–
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
21 Days per beneficiary. Limit of R37,352 per beneficiary for treatment of chemical or substance abuse, subject to network facilities
In Hospital: R18,120 per family.
In Hospital: 21 Days per beneficiary OR Out of Hospital: 15 consultations per beneficiary. Subject to PMB and DSP. Cover up to 80% if non-DSP is used
Limited to R26,400 at Healthcare Professional Tariff
In & Out of Hospital: R22,900 per beneficiary to max of R34,700 per family Out of hospital benefit applicable to psychiatric treatment only
In Hospital: R46,000 per beneficiary OR Out of Hospital: Sub-limit of 21 days for drug and alcohol rehab, subject to treatment at a preferred provider
Limit of R21,183 per family. Subject to pre-auth and use of DSPN, subject to PMB only
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)
21 Days per beneficiary. Limit of R37,352 per beneficiary for treatment of chemical or substance abuse, subject to network facilities
In Hospital: R18,120 per family. Subject to use of a DSP or 30% co-payment will apply
In Hospital: 21 Days per beneficiary OR Out of Hospital: 15 consultations per beneficiary. Subject to PMB and DSP. Cover up to 80% if non-DSP is used
Limited to R26,400 at Healthcare Professional Tariff
In & Out of Hospital: R28,900 per beneficiary to max of R39,700 per family Out of hospital benefit applicable to psychiatric treatment only
In Hospital: R46,000 per beneficiary OR Out of Hospital: Sub-limit of 21 days for drug and alcohol rehab, subject to treatment at a preferred provider
Limit of R21,183 per family. Subject to pre-auth and use of DSPN, subject to PMB only
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)
–
In hospital: R39,150 per family. Subject to use of a DSP or 30% co-payment will apply
In Hospital: 21 Days per beneficiary OR Out of Hospital: 15 consultations per beneficiary. Subject to PMB and DSP. Cover up to 80% if non-DSP is used
Limited to R26,400 at Healthcare Professional Tariff
In & Out of Hospital: R28,900 per beneficiary to max of R39,700 per family Out of hospital benefit applicable to psychiatric treatment only
In Hospital: R46,000 per beneficiary OR Out of Hospital: Sub-limit of 21 days for drug and alcohol rehab, subject to treatment at a preferred provider
Limit of R21,183 per family. Subject to pre-auth and use of DSPN, subject to PMB only
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 R12,050 co-payment will apply
In Hospital: 21 Days per beneficiary OR Out of Hospital: 15 consultations per beneficiary. Subject to PMB and DSP. Cover up to 80% if non-DSP is used
–
–
Limited to Prescribed Minimum Benefits, 21-day limit applies to drug and alcohol rehabilitation
–
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 R12,050 co-payment will apply
In Hospital: 21 Days per beneficiary OR Out of Hospital: 15 consultations per beneficiary. Subject to PMB and DSP. Cover up to 80% if non-DSP is used
–
Subject to Prescribed Minimum Benefits.
Listed essential cases – clinical guidelines and pre-authorisation apply
Limited to Prescribed Minimum Benefits, 21-day limit applies to drug and alcohol rehabilitation
–
Hospital Plan
(Hospitalization Cover)
BESTMED
-
BONITAS
Hospital Standard
DISCOVERY
Classic Core
FEDHEALTH
-
MEDIHELP
-
MOMENTUM
-
PROFMED
-
–
In hospital: R36,860 per family. Subject to use of a DSP or 30% co-payment will apply
In Hospital: 21 Days per beneficiary OR Out of Hospital: 15 consultations per beneficiary. Subject to PMB and DSP. Cover up to 80% if non-DSP is used
–
–
–
–
Hospital Plan
(Hospitalization Cover)
BESTMED
Beat 1
BONITAS
BonEssential
DISCOVERY
Essential Core
FEDHEALTH
FlexiFed 1
(Network)
No Medivault
MEDIHELP
MediVital
MOMENTUM
Custom
(Any Hospital,
Associated Chronic)
PROFMED
-
21 Days per beneficiary. Limit of R37,352 per beneficiary for treatment of chemical or substance abuse, subject to network facilities
In hospital: R36,860 per family.
In Hospital: 21 Days per beneficiary OR Out of Hospital: 15 consultations per beneficiary. Subject to PMB and DSP. Cover up to 80% if non-DSP is used
Unlimited at cost at PMB level of care
In & Out of Hospital: R22,800 per beneficiary to max of R34,700 per family Out of hospital benefit applicable to psychiatric treatment only
In Hospital: R43,000 per beneficiary OR Out of Hospital: Sub-limit of 21 days for drug and alcohol rehab, subject to treatment at a preferred provider
–
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)
21 Days per beneficiary. Limit of R37,352 per beneficiary for treatment of chemical or substance abuse, subject to network facilities
In hospital: R36,860 per family. Subject to use of a DSP or 30% co-payment will apply
In Hospital: 21 Days per beneficiary OR Out of Hospital: 15 consultations per beneficiary. Subject to PMB and DSP. Cover up to 80% if non-DSP is used
Unlimited at cost at PMB level of care
In & Out of Hospital: R22,800 per beneficiary to max of R34,700 per family Out of hospital benefit applicable to psychiatric treatment only
In Hospital: R43,000 per beneficiary OR Out of Hospital: Sub-limit of 21 days for drug and alcohol rehab, subject to treatment at a preferred provider
Limit of R21,183 per family. Subject to pre-auth and use of DSPN, subject to PMB only
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
-
PMBs only. Subject to network facilities. Limited to 21 days per beneficiary
Subject to PMB and Network Provider, or a 30% co-payment will apply
In Hospital: 21 Days per beneficiary OR Out of Hospital: 15 consultations per beneficiary. Subject to PMB and DSP. Cover up to 80% if non-DSP is used
Unlimited at cost at PMB level of care
In & Out of Hospital: R22,900 per beneficiary to max of R34,700 per family Out of hospital benefit applicable to psychiatric treatment only
Limited to Prescribed Minimum Benefits at State facilities, 21-day sub-limit applies to drug and alcohol rehabilitation
–