Comprehensive
(High Cover)
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)
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
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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
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Comprehensive
(Medium to High Cover)
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
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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)
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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)
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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)
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
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Hospital & Savings
(Low to Medium Cover)
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)
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)
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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)
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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
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Limited to Prescribed Minimum Benefits, 21-day limit applies to drug and alcohol rehabilitation
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Capitation
(Low Cover)
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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
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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
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Hospital Plan
(Hospitalization Cover)
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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
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Hospital Plan
(Hospitalization Cover)
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
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Hospital Plan
(Hospitalization Cover)
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)
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
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