Compare out-of-hospital benefits, by cost of plan


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Makoti Primary A 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • Chosen network GP: Unlimited
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R225 R225 R147
Children: Pay for all children
Income limit: R0-R3,000 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Specialists consultations:
  • PMBs only, in state hospitals
3. Pathology:
  • Basic pathology covered by scheme
4. General radiology:
  • Basic radiology covered by scheme
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Makoti Primary B 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • Chosen network GP: Unlimited
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R239 R239 R159
Children: Pay for all children
Income limit: R3,001-R6,450 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Specialists consultations:
  • PMBs only, in state hospitals
3. Pathology:
  • Basic pathology covered by scheme
4. General radiology:
  • Basic radiology covered by scheme
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Compcare Networx ED Plus A 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some exclusions apply. Private Network hospitals. Annual limit of R1,100,000 per family. Scheme pays for: GPs, medicine, radiology, pathology, maternity and preventative benefits. Limits apply. All else paid from out of fund or from out of pocket, unless PMB.
1. GP consultations:
  • Selected network GP: Unlimited
  • Non-network GP: 2 consultswith 20% co-payment
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R283 R279 R154
Children: Pay for all children
Income limit: R0-R500 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Specialists consultations:
  • 2 consults per person and 3 consults per family
  • Paid from day-to-day benefit
3. Pathology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
4. General radiology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Topmed Network A 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: scopes, medicine, dentistry, optometry, supplementary services, radiology, pathology. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Network GPs: Basic primary care
  • Non-Network GPs: 3 visits per year, R1,236 per family, for emergencies only
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R319 R319 R319
Children: Pay for all children
Income limit: R0-R1,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: scopes, medicine, dentistry, optometry, supplementary services, radiology, pathology. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Specialists consultations:
  • Network: R1,500 per family
3. Pathology:
  • Basic blood tests covered if requested by GP
4. General radiology:
  • Basic x-rays covered if requested by GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Compcare Networx ED A 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some exclusions apply. Private and public Network hospitals. Annual limit of R1,100,000 per family. Scheme pays for: GPs, medicine, radiology, pathology, maternity and preventative benefits. Limits apply. All else paid from out of fund or from out of pocket, unless PMB.
1. GP consultations:
  • Selected network GP: Unlimited
  • Non-network GP: 2 consultswith 20% co-payment
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R330 R330 R330
Children: Pay for all children
Income limit: R0-R500 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Specialists consultations:
  • 2 consults per person and 3 consults per family
  • Paid from day-to-day benefit
3. Pathology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
4. General radiology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Momentum Ingwe A 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. R1,190,000 per family limit. Income based plan. Scheme pays out-of-hospital claims for: dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Ingwe Primary Care Network: Unlimited
  • Non-network: 1 consult per person and 2 per family with 10% co-payment
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R335 R335 R210
Children: Pay for all children
Income limit: R0-R650 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Specialists consultations:
  • 2 consults per family with R100 co-payment
3. Pathology:
  • Some specific pathology covered by scheme
4. General radiology:
  • Some specific x-rays covered by scheme
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Momentum Ingwe Network A 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals. R1,190,000 per family limit. Income based plan. Scheme pays out-of-hospital claims for: dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Ingwe Primary Care Network: Unlimited
  • Non-network: 1 consult per person and 2 per family with 10% co-payment
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R335 R335 R210
Children: Pay for all children
Income limit: R0-R650 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • 2 consults per family with R100 co-payment
3. Pathology:
  • Some specific pathology covered by scheme
4. General radiology:
  • Some specific x-rays covered by scheme
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Momentum Ingwe State A 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. State hospitals. Network hospitals. R1,190,000 per family limit. Income based plan. Scheme pays out-of-hospital claims for: dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Ingwe Primary Care Network: Unlimited
  • Non-network: 1 consult per person and 2 per family with 10% co-payment
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R335 R335 R210
Children: Pay for all children
Income limit: R0-R650 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • 2 consults per family with R100 co-payment
3. Pathology:
  • Some specific pathology covered by scheme
4. General radiology:
  • Some specific x-rays covered by scheme
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Sizwe Primary Care A 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • M =4 consults; M1 =9 consults; M2 =12 consults; M3 =14 consults etc
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R407 R407 R407
Children: Pay for all children
Income limit: R0-R530 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Day-to-day limit: M =R5,390 M1 =R7,980 M2 =R9,330 M3 =R10,670 M4 =R12,020 M5 =R13,370 M6+ =R14,720
2. Specialists consultations:
  • Must be referred. Limited consults to: M =2 consults; M1 =6; M2 =7; M3 =8; M4 =9; M5 =10; M6+ =11
  • Paid from day-to-day benefit
3. Pathology:
  • M =R1,000 and M1+ =R1,900
  • Shared with radiology benefit
  • Paid from day-to-day benefit
4. General radiology:
  • M =R1,000 and M1+ =R1,900
  • Shared with pathology benefit
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R17,710 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • Physio: from day-to-day benefit
  • Otherwise: R960 per person and and R1,550 per family, paid by scheme

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Compcare Networx ED Plus B 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some exclusions apply. Private Network hospitals. Annual limit of R1,100,000 per family. Scheme pays for: GPs, medicine, radiology, pathology, maternity and preventative benefits. Limits apply. All else paid from out of fund or from out of pocket, unless PMB.
1. GP consultations:
  • Selected network GP: Unlimited
  • Non-network GP: 2 consultswith 20% co-payment
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R413 R405 R204
Children: Pay for all children
Income limit: R501-R4,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Specialists consultations:
  • 2 consults per person and 3 consults per family
  • Paid from day-to-day benefit
3. Pathology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
4. General radiology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Medihelp Necesse A 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Plan aimed at students. Network hospitals only. Income based plan. Scheme pays out-of-hospital claims for: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Network GP: 9 consults per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R438 R438 R438
Children: Pay for all children
Income limit: R0-R400 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Specialists consultations:
  • M =R2,800 and M+ =R3,900
  • This benefit covers specialist consultations, surgical and non-surgical procedures, endoscopic procedures, radiology interventions, pathology, acute medicine
3. Pathology:
  • Paid by scheme
4. General radiology:
  • Paid by scheme
5. Specialised radiology:
  • R17,500 per family, in and out of hospital
  • Paid From Overall Annual Limit (OAL)
6. Supplementary Services: (Physio, etc)
  • Physiotherapy and Occupational therapy: R1,800 per person and R2,800 per family

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Compcare Networx ED Plus D 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some exclusions apply. Private Network hospitals. Annual limit of R1,100,000 per family. Scheme pays for: GPs, medicine, radiology, pathology, maternity and preventative benefits. Limits apply. All else paid from out of fund or from out of pocket, unless PMB.
1. GP consultations:
  • Selected network GP: Unlimited
  • Non-network GP: 2 consultswith 20% co-payment
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R529 R502 R251
Children: Pay for all children
Income limit: R5,001-R6,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Specialists consultations:
  • 2 consults per person and 3 consults per family
  • Paid from day-to-day benefit
3. Pathology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
4. General radiology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Makoti Primary C 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • Chosen network GP: Unlimited
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R530 R438 R195
Children: Pay for all children
Income limit: R6,451-R9,000 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • PMBs only, in state hospitals
3. Pathology:
  • Basic pathology covered by scheme
4. General radiology:
  • Basic radiology covered by scheme
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Momentum Ingwe State B 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. State hospitals. Network hospitals. R1,190,000 per family limit. Income based plan. Scheme pays out-of-hospital claims for: dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Ingwe Primary Care Network: Unlimited
  • Non-network: 1 consult per person and 2 per family with 10% co-payment
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R560 R560 R302
Children: Pay for all children
Income limit: R651-R6,100 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • 2 consults per family with R100 co-payment
3. Pathology:
  • Some specific pathology covered by scheme
4. General radiology:
  • Some specific x-rays covered by scheme
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Makoti Primary D 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • Chosen network GP: Unlimited
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R569 R461 R210
Children: Pay for all children
Income limit: R9,001-R12,000 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • PMBs only, in state hospitals
3. Pathology:
  • Basic pathology covered by scheme
4. General radiology:
  • Basic radiology covered by scheme
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Makoti Primary E 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • Chosen network GP: Unlimited
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R611 R490 R223
Children: Pay for all children
Income limit: R12,001-R16,000 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • PMBs only, in state hospitals
3. Pathology:
  • Basic pathology covered by scheme
4. General radiology:
  • Basic radiology covered by scheme
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Compcare Networx ED Plus F 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some exclusions apply. Private Network hospitals. Annual limit of R1,100,000 per family. Scheme pays for: GPs, medicine, radiology, pathology, maternity and preventative benefits. Limits apply. All else paid from out of fund or from out of pocket, unless PMB.
1. GP consultations:
  • Selected network GP: Unlimited
  • Non-network GP: 2 consultswith 20% co-payment
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R631 R599 R300
Children: Pay for all children
Income limit: R8,001-R9,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Specialists consultations:
  • 2 consults per person and 3 consults per family
  • Paid from day-to-day benefit
3. Pathology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
4. General radiology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Momentum Ingwe State C 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. State hospitals. Network hospitals. R1,190,000 per family limit. Income based plan. Scheme pays out-of-hospital claims for: dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Ingwe Primary Care Network: Unlimited
  • Non-network: 1 consult per person and 2 per family with 10% co-payment
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R641 R1,282 R950
Children: Pay for all children
Income limit: R6,101-R8,200 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • 2 consults per family with R100 co-payment
3. Pathology:
  • Some specific pathology covered by scheme
4. General radiology:
  • Some specific x-rays covered by scheme
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Discovery KeyCare Access A 2017: Out Of Hospital Benefits
In brief: Unlimited cover in state facilities, or Access network for some procedures. Scheme pays out-of-hospital claims for: maternity, specialists. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Chosen network GP: Unlimited
  • Non-network GP 4 consults per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R644 R644 R281
Children: Pay for maximum 3 children
Income limit: R0-R5,050 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Specialists consultations:
  • Emergencies, trauma, childbirth and cover for baby: R3,570 per person
3. Pathology:
  • Some blood, urine and other fluid and tissue tests, as asked for by GP
4. General radiology:
  • Basic X-rays covered, if done at a network provider and asked for by the GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Makoti Primary F 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • Chosen network GP: Unlimited
Overall Annual Limit (OAL):
PMBs only, in state hospitals
Contributions:
Main: Adult: Child:
Total Cost: R656 R510 R235
Children: Pay for all children
Income limit: R16,001+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Specialists consultations:
  • PMBs only, in state hospitals
3. Pathology:
  • Basic pathology covered by scheme
4. General radiology:
  • Basic radiology covered by scheme
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Compcare Networx ED B 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some exclusions apply. Private and public Network hospitals. Annual limit of R1,100,000 per family. Scheme pays for: GPs, medicine, radiology, pathology, maternity and preventative benefits. Limits apply. All else paid from out of fund or from out of pocket, unless PMB.
1. GP consultations:
  • Selected network GP: Unlimited
  • Non-network GP: 2 consultswith 20% co-payment
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R665 R632 R233
Children: Pay for all children
Income limit: R501-R4,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Specialists consultations:
  • 2 consults per person and 3 consults per family
  • Paid from day-to-day benefit
3. Pathology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
4. General radiology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Compcare Networx ED Plus G 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some exclusions apply. Private Network hospitals. Annual limit of R1,100,000 per family. Scheme pays for: GPs, medicine, radiology, pathology, maternity and preventative benefits. Limits apply. All else paid from out of fund or from out of pocket, unless PMB.
1. GP consultations:
  • Selected network GP: Unlimited
  • Non-network GP: 2 consultswith 20% co-payment
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R668 R636 R318
Children: Pay for all children
Income limit: R9,001-R10,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

Compare with these plans:

2. Specialists consultations:
  • 2 consults per person and 3 consults per family
  • Paid from day-to-day benefit
3. Pathology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
4. General radiology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

View this plan

Compcare Networx ED C 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some exclusions apply. Private and public Network hospitals. Annual limit of R1,100,000 per family. Scheme pays for: GPs, medicine, radiology, pathology, maternity and preventative benefits. Limits apply. All else paid from out of fund or from out of pocket, unless PMB.
1. GP consultations:
  • Selected network GP: Unlimited
  • Non-network GP: 2 consultswith 20% co-payment
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R687 R652 R240
Children: Pay for all children
Income limit: R4,001-R5,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

Compare with these plans:

2. Specialists consultations:
  • 2 consults per person and 3 consults per family
  • Paid from day-to-day benefit
3. Pathology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
4. General radiology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

View this plan

Momentum Ingwe Network B 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals. R1,190,000 per family limit. Income based plan. Scheme pays out-of-hospital claims for: dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Ingwe Primary Care Network: Unlimited
  • Non-network: 1 consult per person and 2 per family with 10% co-payment
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R701 R701 R321
Children: Pay for all children
Income limit: R651-R6,100 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • 2 consults per family with R100 co-payment
3. Pathology:
  • Some specific pathology covered by scheme
4. General radiology:
  • Some specific x-rays covered by scheme
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Discovery KeyCare Core A 2017: Out Of Hospital Benefits
In brief: Unlimited cover in KeyCare networks. Scheme pays out-of-hospital claims for: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • No benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R731 R731 R190
Children: Pay for maximum 3 children
Income limit: R0-R8,100 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • R3,570 per person
3. Pathology:
  • No benefit, unless PMB
4. General radiology:
  • No benefit, unless PMB
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Momentum Ingwe State D 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. State hospitals. Network hospitals. R1,190,000 per family limit. Income based plan. Scheme pays out-of-hospital claims for: dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Ingwe Primary Care Network: Unlimited
  • Non-network: 1 consult per person and 2 per family with 10% co-payment
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R748 R748 R324
Children: Pay for all children
Income limit: R8,201-R11,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • 2 consults per family with R100 co-payment
3. Pathology:
  • Some specific pathology covered by scheme
4. General radiology:
  • Some specific x-rays covered by scheme
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Fedhealth Blue Door A: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: prescribed medication, GP consults, dentistry, optometry. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Contracted GP: Unlimited
  • Not contracted GP: 2 consults
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R776 R644 R369
Children: Pay for all children
Income limit: R0-R5,200 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: prescribed medication, GP consults, dentistry, optometry. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • 2 consults per family with network specialist
3. Pathology:
  • Unlimited subject to referral and basic protocols
4. General radiology:
  • Unlimited subject to referral and basic protocols
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Compcare Networx ED D 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some exclusions apply. Private and public Network hospitals. Annual limit of R1,100,000 per family. Scheme pays for: GPs, medicine, radiology, pathology, maternity and preventative benefits. Limits apply. All else paid from out of fund or from out of pocket, unless PMB.
1. GP consultations:
  • Selected network GP: Unlimited
  • Non-network GP: 2 consultswith 20% co-payment
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R821 R779 R289
Children: Pay for all children
Income limit: R5,001-R6,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

Compare with these plans:

2. Specialists consultations:
  • 2 consults per person and 3 consults per family
  • Paid from day-to-day benefit
3. Pathology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
4. General radiology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

View this plan

Commed Roots A 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some-co-payments. Network hospitals. Annual limit of R400k per person and R800k per family. Scheme pays out-of-hospital claims for:GPs, specialits, dentistry, medicine, optometry, radiology, pathology, external applianes, alternative to hopitalisation. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Network GP: Unlimited
  • Non-network GP: 3 consults per family limited to R1,000 per family
Overall Annual Limit (OAL):
R400k per person, R800k per family
Contributions:
Main: Adult: Child:
Total Cost: R822 R822 R342
Children: Pay for all children
Income limit: R0-R6,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some:GPs, specialits, dentistry, medicine, optometry, radiology, pathology, external applianes, alternative to hopitalisation. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • R2,500 per person and R5,000 per family
3. Pathology:
  • Paid from day-to-day benefit
4. General radiology:
  • Paid from day-to-day benefit
5. Specialised radiology:
  • Paid from day-to-day benefit
6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

View this plan

Selfmed Selfnet Essential 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • No benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R850 R850 R300
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • No benefit, unless PMB
3. Pathology:
  • No benefit, unless PMB
4. General radiology:
  • No benefit, unless PMB
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

View this plan

Compcare Networx ED E 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some exclusions apply. Private and public Network hospitals. Annual limit of R1,100,000 per family. Scheme pays for: GPs, medicine, radiology, pathology, maternity and preventative benefits. Limits apply. All else paid from out of fund or from out of pocket, unless PMB.
1. GP consultations:
  • Selected network GP: Unlimited
  • Non-network GP: 2 consultswith 20% co-payment
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R859 R817 R301
Children: Pay for all children
Income limit: R6,001-R8,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

Compare with these plans:

2. Specialists consultations:
  • 2 consults per person and 3 consults per family
  • Paid from day-to-day benefit
3. Pathology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
4. General radiology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

View this plan

Discovery KeyCare Access B 2017: Out Of Hospital Benefits
In brief: Unlimited cover in state facilities, or Access network for some procedures. Scheme pays out-of-hospital claims for: maternity, specialists. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Chosen network GP: Unlimited
  • Non-network GP 4 consults per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R859 R859 R309
Children: Pay for maximum 3 children
Income limit: R5,051-R8,100 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • Emergencies, trauma, childbirth and cover for baby: R3,570 per person
3. Pathology:
  • Some blood, urine and other fluid and tissue tests, as asked for by GP
4. General radiology:
  • Basic X-rays covered, if done at a network provider and asked for by the GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Suremed Explorer A 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: medication, appliances, dentistry, GPs and specialists, maternity, optometry, pathology, radiology, specialised radiology, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
1. GP consultations:
  • 12 consults per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R860 R770 R400
Children: Pay for all children
Income limit: R0-R7,500 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, optometry, pathology, radiology, specialised radiology, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • R3,000 per person, if referred
3. Pathology:
  • Unlimited if referred by GP
4. General radiology:
  • Unlimited if referred by GP
5. Specialised radiology:
  • 2 scans per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

View this plan

Momentum Ingwe Network C 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals. R1,190,000 per family limit. Income based plan. Scheme pays out-of-hospital claims for: dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Ingwe Primary Care Network: Unlimited
  • Non-network: 1 consult per person and 2 per family with 10% co-payment
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R892 R892 R334
Children: Pay for all children
Income limit: R6,101-R8,200 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • 2 consults per family with R100 co-payment
3. Pathology:
  • Some specific pathology covered by scheme
4. General radiology:
  • Some specific x-rays covered by scheme
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Resolution Fundation A 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • Network GP: Unlimited
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R907 R907 R273
Children: Pay for all children
Income limit: R0-R4,600 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • No benefit, unless PMB
3. Pathology:
  • No benefit, unless PMB
4. General radiology:
  • No benefit, unless PMB
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

View this plan

Momentum Ingwe B 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. R1,190,000 per family limit. Income based plan. Scheme pays out-of-hospital claims for: dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Ingwe Primary Care Network: Unlimited
  • Non-network: 1 consult per person and 2 per family with 10% co-payment
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R911 R911 R342
Children: Pay for all children
Income limit: R651-R6,100 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • 2 consults per family with R100 co-payment
3. Pathology:
  • Some specific pathology covered by scheme
4. General radiology:
  • Some specific x-rays covered by scheme
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Discovery KeyCare Core B 2017: Out Of Hospital Benefits
In brief: Unlimited cover in KeyCare networks. Scheme pays out-of-hospital claims for: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • No benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R912 R912 R224
Children: Pay for maximum 3 children
Income limit: R8,101-R11,550 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • R3,570 per person
3. Pathology:
  • No benefit, unless PMB
4. General radiology:
  • No benefit, unless PMB
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Discovery KeyCare Plus A 2017: Out Of Hospital Benefits
In brief: Unlimited cover in KeyCare networks. Scheme pays out-of-hospital claims for: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Chosen network GP: Unlimited
  • Non-network GP 4 consults per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R914 R914 R331
Children: Pay for maximum 3 children
Income limit: R0-R8,100 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • Strong>R3,570 per person
3. Pathology:
  • Some blood, urine and other fluid and tissue tests, as asked for by GP
4. General radiology:
  • Basic X-rays covered, if done at a network provider and asked for by the GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Topmed Network B 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: scopes, medicine, dentistry, optometry, supplementary services, radiology, pathology. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Network GPs: Basic primary care
  • Non-Network GPs: 3 visits per year, R1,236 per family, for emergencies only
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R915 R915 R331
Children: Pay for all children
Income limit: R1,000-R8,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: scopes, medicine, dentistry, optometry, supplementary services, radiology, pathology. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • Network: R1,500 per family
3. Pathology:
  • Basic blood tests covered if requested by GP
4. General radiology:
  • Basic x-rays covered if requested by GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

View this plan

Commed Roots B 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some-co-payments. Network hospitals. Annual limit of R400k per person and R800k per family. Scheme pays out-of-hospital claims for:GPs, specialits, dentistry, medicine, optometry, radiology, pathology, external applianes, alternative to hopitalisation. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Network GP: Unlimited
  • Non-network GP: 3 consults per family limited to R1,000 per family
Overall Annual Limit (OAL):
R400k per person, R800k per family
Contributions:
Main: Adult: Child:
Total Cost: R950 R950 R458
Children: Pay for all children
Income limit: R6,001-R18,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some:GPs, specialits, dentistry, medicine, optometry, radiology, pathology, external applianes, alternative to hopitalisation. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • R2,500 per person and R5,000 per family
3. Pathology:
  • Paid from day-to-day benefit
4. General radiology:
  • Paid from day-to-day benefit
5. Specialised radiology:
  • Paid from day-to-day benefit
6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

View this plan

Compcare Networx ED F 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some exclusions apply. Private and public Network hospitals. Annual limit of R1,100,000 per family. Scheme pays for: GPs, medicine, radiology, pathology, maternity and preventative benefits. Limits apply. All else paid from out of fund or from out of pocket, unless PMB.
1. GP consultations:
  • Selected network GP: Unlimited
  • Non-network GP: 2 consultswith 20% co-payment
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R978 R931 R343
Children: Pay for all children
Income limit: R8,001-R9,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

Compare with these plans:

2. Specialists consultations:
  • 2 consults per person and 3 consults per family
  • Paid from day-to-day benefit
3. Pathology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
4. General radiology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

View this plan

Fedhealth Blue Door B: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: prescribed medication, GP consults, dentistry, optometry. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Contracted GP: Unlimited
  • Not contracted GP: 2 consults
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R984 R813 R475
Children: Pay for all children
Income limit: R5,201-R8,500 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: prescribed medication, GP consults, dentistry, optometry. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • 2 consults per family with network specialist
3. Pathology:
  • Unlimited subject to referral and basic protocols
4. General radiology:
  • Unlimited subject to referral and basic protocols
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

View this plan

Genesis Private Choice 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. R50,000 in-hospital limit for cancer, stroke, motor-neuron disease and organ transplant. Scheme pays out-of-hospital claims for: dentistry. Limits apply. All else paid out of pocket, unless PMB.
1. GP consultations:
  • Surgical procedures in doctor's rooms: covered for qualifying procedures that would otherwise necessitate admission to hospital
  • Otherwise, no benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,000 R1,000 R325
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: dentistry. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Specialists consultations:
  • No benefit, unless PMB
3. Pathology:
  • No benefit, unless PMB
4. General radiology:
  • No benefit, unless PMB
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Medimed Alpha 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Scheme pays in and out of hospital benefits, but with a 25% or 40% co-payment from member for most claims. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • R3,300 per person and R7,900 per family with 25% co-payment
  • Shared with specialist benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,020 R1,020 R400
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: out-of-hospital claims but with a 25% or 40% co-payment from member. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Specialists consultations:
  • See GP benefit, above
3. Pathology:
  • 25% co-payment for non-PMBs
4. General radiology:
  • 25% co-payment for non-PMBs
5. Specialised radiology:
  • 25% co-payment for non-PMBs
6. Supplementary Services: (Physio, etc)
  • 40% co-payment for non-PMBs
  • R4,500 per family, for in and out-of-hospital

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Compcare Networx ED G 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some exclusions apply. Private and public Network hospitals. Annual limit of R1,100,000 per family. Scheme pays for: GPs, medicine, radiology, pathology, maternity and preventative benefits. Limits apply. All else paid from out of fund or from out of pocket, unless PMB.
1. GP consultations:
  • Selected network GP: Unlimited
  • Non-network GP: 2 consultswith 20% co-payment
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R1,037 R987 R364
Children: Pay for all children
Income limit: R9,001-R10,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Specialists consultations:
  • 2 consults per person and 3 consults per family
  • Paid from day-to-day benefit
3. Pathology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
4. General radiology:
  • Unlimited when clinically appropriate within Universal Network and referred to by network GP
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Medshield MediPhila 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. R1,000,000 per family limit. Scheme pays out-of-hospital claims for: specialised radiology, maternity, optometry, some non-surgical procedures including scopes, preventative benefits. Limits apply. All else paid from extended fund or out of pocket, unless PMB.
1. GP consultations:
  • Network GP: M= 8 consults, M1= 9 consults, M2+=11 consults. Thereafter, only with authorisation
  • Non-network GP: 2 consults . Thereafter, 40% co-payment subject to above GP consult limits
  • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
  • Scopes: most paid by scheme if done in rooms
Overall Annual Limit (OAL):
R500,000 per person, R1 million per family for non-PMB
Contributions:
Main: Adult: Child:
Total Cost: R1,041 R1.041 R261
Children: Pay for three children only
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, optometry, preventative benefits. Limits apply. All else paid from extended fund or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,500 per family R R

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2. Specialists consultations:
  • Two consultations per family, then from day-to-day benefit
3. Pathology:
  • Covered if referred by GP
4. General radiology:
  • Covered if referred by GP
5. Specialised radiology:
  • 1 scan per family, with 10% co-payment and subject to overall hospital limit. In and out of hospital.
6. Supplementary Services: (Physio, etc)

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Resolution Fundation B 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • Network GP: Unlimited
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,056 R1,056 R364
Children: Pay for all children
Income limit: R4,601-R7,100 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Specialists consultations:
  • No benefit, unless PMB
3. Pathology:
  • No benefit, unless PMB
4. General radiology:
  • No benefit, unless PMB
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Suremed Explorer B 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: medication, appliances, dentistry, GPs and specialists, maternity, optometry, pathology, radiology, specialised radiology, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
1. GP consultations:
  • 12 consults per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,080 R960 R480
Children: Pay for all children
Income limit: R7,501-R11,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, optometry, pathology, radiology, specialised radiology, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Specialists consultations:
  • R3,000 per person, if referred
3. Pathology:
  • Unlimited if referred by GP
4. General radiology:
  • Unlimited if referred by GP
5. Specialised radiology:
  • 2 scans per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Discovery Essential Smart 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: GP consults, eye and dental check up. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • GP in Smart Plan Network: Unlimited
  • R100 co-payment per consult, excluding video call consults, which are covered in full
  • Sports related injuries: basic x-rays, two specialist consults, and four other consults when referred by a Smart Network GP, with a R100 co-payment for each consult
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,100 R1,100 R1,100
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GP consults, eye and dental check up. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Specialists consultations:
  • No benefit, unless PMB
3. Pathology:
  • No benefit, unless PMB
4. General radiology:
  • No benefit, unless PMB
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Medimed Essential A 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals. Income based plan. Over and above the savings, scheme pays out-of-hospital claims for: specialised radiology, GPs, specialists, medication, dentistry, optometry, radiology and pathology. Limits apply. All else paid from savings or out of pocket, unless PMB.
1. GP consultations:
  • Network GPs: Unlimited, paid by scheme
  • Non-network GPs: 6 consults per person, paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,110 R1,110 R380
Children: Pay for all children
Income limit: R0-R7,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, GPs, specialists, medication, dentistry, optometry, radiology and pathology. Limits apply. All else paid from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R1,332 R1,332 R456

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2. Specialists consultations:
  • R3,000 per person and R6,000 per family
  • Paid by scheme
3. Pathology:
  • Unlimited
  • Paid by scheme
4. General radiology:
  • Unlimited
  • Paid by scheme
5. Specialised radiology:
  • 3 scans per family, up to R10,000 per family, in and out of hospital.
  • Paid by scheme
6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
  • View this plan

    Bestmed Beat 1 Network 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Some co-payments. Scheme pays out-of-hospital claims for: wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, but sub-limits can apply
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,131 R879 R476
    Children: Pay for maximum 4 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • R4,200 per family paid by scheme
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

    View this plan

    Bestmed Pulse 1 A 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: GP and specialist consults, dentistry, optometry, maternity, radiology and pathology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • GP Network: unlimited GP consults
    • Out-of-network: R1,100 per family
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,131 R1,075 R679
    Children: Pay for maximum 4 children
    Income limit: R0-R6,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GP and specialist consults, dentistry, optometry, maternity, radiology and pathology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Three network specialist visits, up to R1,100 per visit per family
    3. Pathology:
    • Cover from network, subject to protocols
    4. General radiology:
    • Cover from network, subject to protocols
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Selfmed Selfnet 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • Network GP: Unlimited
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,185 R1,185 R418
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • R1,070 per person and R2,140 per family from network specialist, including radiology, pathology and medication
    3. Pathology:
    • Unlimited subject to network protocol, formulary and referral ny network GP
    4. General radiology:
    • Unlimited subject to network protocol, formulary and referral ny network GP
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

    View this plan

    Hosmed Essential A 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. In-hospital, PMBs only. Scheme pays out-of-hospital claims for: GPs, specialists, medicine, pathology, radiology, specialised radiology, optometry, dentistry, appliances, maternity benefits, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Network GP: Unlimited
    Overall Annual Limit (OAL):
    PMBs only
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,196 R1,092 R410
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GPs, specialists, medicine, pathology, radiology, specialised radiology, optometry, dentistry, appliances, maternity benefits, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • Network: 3 consults per family
    3. Pathology:
    • R740 per person
    4. General radiology:
    • R740 per person
    5. Specialised radiology:
    • 2 scans per person
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

    View this plan

    Medimed Essential B 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Income based plan. Over and above the savings, scheme pays out-of-hospital claims for: specialised radiology, GPs, specialists, medication, dentistry, optometry, radiology and pathology. Limits apply. All else paid from savings or out of pocket, unless PMB.
    1. GP consultations:
    • Network GPs: Unlimited, paid by scheme
    • Non-network GPs: 6 consults per person, paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,200 R1,200 R390
    Children: Pay for all children
    Income limit: R7,001-R8,500 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, GPs, specialists, medication, dentistry, optometry, radiology and pathology. Limits apply. All else paid from savings or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R1,440 R1,440 R468

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    2. Specialists consultations:
    • R3,000 per person and R6,000 per family
    • Paid by scheme
    3. Pathology:
    • Unlimited
    • Paid by scheme
    4. General radiology:
    • Unlimited
    • Paid by scheme
    5. Specialised radiology:
    • 3 scans per family, up to R10,000 per family, in and out of hospital.
    • Paid by scheme
    6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
  • View this plan

    Spectramed Aqua 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,208 R1,099 R427
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Momentum Ingwe Network D 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. R1,190,000 per family limit. Income based plan. Scheme pays out-of-hospital claims for: dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Ingwe Primary Care Network: Unlimited
    • Non-network: 1 consult per person and 2 per family with 10% co-payment
    Overall Annual Limit (OAL):
    R1,190,000 per family
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,241 R1,241 R365
    Children: Pay for all children
    Income limit: R8,201-R11,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • 2 consults per family with R100 co-payment
    3. Pathology:
    • Some specific pathology covered by scheme
    4. General radiology:
    • Some specific x-rays covered by scheme
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Discovery KeyCare Access C 2017: Out Of Hospital Benefits
    In brief: Unlimited cover in state facilities, or Access network for some procedures. Scheme pays out-of-hospital claims for: maternity, specialists. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Chosen network GP: Unlimited
    • Non-network GP 4 consults per person
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,241 R1,241 R348
    Children: Pay for maximum 3 children
    Income limit: R8,101-R11,550 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • Emergencies, trauma, childbirth and cover for baby: R3,570 per person
    3. Pathology:
    • Some blood, urine and other fluid and tissue tests, as asked for by GP
    4. General radiology:
    • Basic X-rays covered, if done at a network provider and asked for by the GP
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Bestmed Beat 1 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Scheme pays out-of-hospital claims for: wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, but sub-limits can apply
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,257 R976 R529
    Children: Pay for maximum 4 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • R4,200 per family paid by scheme
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Medihelp Dimension Prime 1 Network 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), GP, specialists, physio, medication, maternity, infant paediatrics, medical appliances. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • M =R1,050 and M+ =R2,100
    • Shared with GPs, Specialists, Physio, Acute medicine and over the counter medication
    • 2 consults for babies under 1yr old, paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,260 R1,026 R378
    Children: Pay for maximum 2 children under 18yrs.
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), GP, specialists, physio, medication, maternity, infant paediatrics, medical appliances. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • See GP benefit, above
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • Paid by scheme, with a R1,500 co-payment, in or out of hospital
    6. Supplementary Services: (Physio, etc)
    • See GP benefit, above
    • Also, speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge following hospital admission. Limited to R1,650 per person and R2,200 per family

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    Compcare Axis ED 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Netcare hospitals. Some exclusions apply. Most out-of-hospital benefits covered only if PMBs.
    1. GP consultations:
    • 2 consults and one ER visit (limited to R1,000) per child younger than 6yrs
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,260 R1,260 R396
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: preventative benefits. Limits apply. All else paid out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • Post-operative rehab: physio, OT and biokinetics R3,100 for 14 days, for PMBs only.

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    Momentum Custom Associate (and State provider for chronic) 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. State hospitals. Chronic benefits at State facilities. Scheme pays out-of-hospital claims for: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Paediatrician: 2 consults for infants up to 1yr
    • Otherwise, no benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,266 R957 R448
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • Unlimited with a R2,030 co-payment
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Momentum Ingwe C 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. R1,190,000 per family limit. Income based plan. Scheme pays out-of-hospital claims for: dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Ingwe Primary Care Network: Unlimited
    • Non-network: 1 consult per person and 2 per family with 10% co-payment
    Overall Annual Limit (OAL):
    R1,190,000 per family
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,273 R1,273 R385
    Children: Pay for all children
    Income limit: R6,101-R8,200 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • 2 consults per family with R100 co-payment
    3. Pathology:
    • Some specific pathology covered by scheme
    4. General radiology:
    • Some specific x-rays covered by scheme
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Keyhealth Essence 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Some co-payments. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), maternity, medical appliances, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,278 R1,013 R427
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, medical appliances, oncology, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • MRI and CT scans: R13,900 per family with R1,400 co-payment, in and out of hospital
    • PET scans: No benefit
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Discovery KeyCare Plus B 2017: Out Of Hospital Benefits
    In brief: Unlimited cover in KeyCare networks. Scheme pays out-of-hospital claims for: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Chosen network GP: Unlimited
    • Non-network GP 4 consults per person
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,280 R1,280 R358
    Children: Pay for maximum 3 children
    Income limit: R8,101-R11,550 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • Strong>R3,570 per person
    3. Pathology:
    • Some blood, urine and other fluid and tissue tests, as asked for by GP
    4. General radiology:
    • Basic X-rays covered, if done at a network provider and asked for by the GP
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Topmed Network C 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: scopes, medicine, dentistry, optometry, supplementary services, radiology, pathology. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Network GPs: Basic primary care
    • Non-Network GPs: 3 visits per year, R1,236 per family, for emergencies only
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,282 R1,282 R359
    Children: Pay for all children
    Income limit: R8,001-R11,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: scopes, medicine, dentistry, optometry, supplementary services, radiology, pathology. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Network: R1,500 per family
    3. Pathology:
    • Basic blood tests covered if requested by GP
    4. General radiology:
    • Basic x-rays covered if requested by GP
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Momentum Ingwe State E 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. State hospitals. Network hospitals. R1,190,000 per family limit. Income based plan. Scheme pays out-of-hospital claims for: dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Ingwe Primary Care Network: Unlimited
    • Non-network: 1 consult per person and 2 per family with 10% co-payment
    Overall Annual Limit (OAL):
    R1,190,000 per family
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,291 R1,291 R389
    Children: Pay for all children
    Income limit: R11,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • 2 consults per family with R100 co-payment
    3. Pathology:
    • Some specific pathology covered by scheme
    4. General radiology:
    • Some specific x-rays covered by scheme
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Discovery Essential Delta Core 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Most day-to-day claims paid from out of pocket, unless PMB.
    1. GP consultations:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,317 R989 R528
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Most claims paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Compcare Networx ED Plus H 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some exclusions apply. Private Network hospitals. Annual limit of R1,100,000 per family. Scheme pays for: GPs, medicine, radiology, pathology, maternity and preventative benefits. Limits apply. All else paid from out of fund or from out of pocket, unless PMB.
    1. GP consultations:
    • Selected network GP: Unlimited
    • Non-network GP: 2 consultswith 20% co-payment
    Overall Annual Limit (OAL):
    R1,100,000 per family
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,318 R1,186 R585
    Children: Pay for all children
    Income limit: R10,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-
    Extended Fund: R2,800 (main) R4,170 (family) R

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    2. Specialists consultations:
    • 2 consults per person and 3 consults per family
    • Paid from day-to-day benefit
    3. Pathology:
    • Unlimited when clinically appropriate within Universal Network and referred to by network GP
    4. General radiology:
    • Unlimited when clinically appropriate within Universal Network and referred to by network GP
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Suremed Shuttle 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
    1. GP consultations:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,320 R980 R540
    Children: Pay for all children
    Day-to-Day Benefit:
    Scheme pays out-of-hospital claims for: specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • 3 scans per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Medshield MediValue 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate. Scheme pays out-of-hospital claims for: specialised radiology, maternity, alternative to hospitalisation, optometry, some non-surgical procedures including scopes,preventative benefits. Limits apply. All else paid from extended fund or out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
    • Scopes: most paid by scheme if done in rooms
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,521 R1,323 R414
    Children: Pay for three children only
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, alternative to hospitalisation, optometry, some non-surgical procedures including scopes,preventative benefits. Limits apply. All else paid from extended fund or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-
    Extended Fund: RM= R4,815
    M1= R5,240
    M2= R5,900
    M3= R6,660
    M4+ =R7,600
    R R

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    2. Specialists consultations:
    • Three consultations per family, then from day-to-day benefit
    • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
    • Scopes: most paid by scheme if done in rooms
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Bone densitometry scan: one per person
    • Otherwise, from day-to-day benefit
    5. Specialised radiology:
    • R5,560 per family, with 8% co-payment for non-PMBs, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

    View this plan

    Fedhealth Maxima EntryZone 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: post hospitalisation treatment (30 days), casualty visits, specialised radiology, contraceptives, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Network GP: 1 consult per person
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,326 R991 R446
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: post hospitalisation treatment (30 days), casualty visits, specialised radiology, contraceptives, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • Paid by scheme, with a R2,500 co-payment
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Resolution Fundation C 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • Network GP: Unlimited
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,338 R1,338 R427
    Children: Pay for all children
    Income limit: R7,101-R9,700 (other limits)
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

    View this plan

    Bestmed Pulse 1 B 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: GP and specialist consults, dentistry, optometry, maternity, radiology and pathology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • GP Network: unlimited GP consults
    • Out-of-network: R1,100 per family
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,357 R1,290 R814
    Children: Pay for maximum 4 children
    Income limit: R6,001-R10,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GP and specialist consults, dentistry, optometry, maternity, radiology and pathology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • Three network specialist visits, up to R1,100 per visit per family
    3. Pathology:
    • Cover from network, subject to protocols
    4. General radiology:
    • Cover from network, subject to protocols
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Fedhealth Blue Door C: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: prescribed medication, GP consults, dentistry, optometry. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Contracted GP: Unlimited
    • Not contracted GP: 2 consults
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,380 R1,145 R522
    Children: Pay for all children
    Income limit: R8,501-R10,500 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: prescribed medication, GP consults, dentistry, optometry. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • 2 consults per family with network specialist
    3. Pathology:
    • Unlimited subject to referral and basic protocols
    4. General radiology:
    • Unlimited subject to referral and basic protocols
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Medimed Essential C 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Income based plan. Over and above the savings, scheme pays out-of-hospital claims for: specialised radiology, GPs, specialists, medication, dentistry, optometry, radiology and pathology. Limits apply. All else paid from savings or out of pocket, unless PMB.
    1. GP consultations:
    • Network GPs: Unlimited, paid by scheme
    • Non-network GPs: 6 consults per person, paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,390 R1,390 R400
    Children: Pay for all children
    Income limit: R8,501-R13,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, GPs, specialists, medication, dentistry, optometry, radiology and pathology. Limits apply. All else paid from savings or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R1,668 R1,668 R480

    Compare with these plans:

    2. Specialists consultations:
    • R3,000 per person and R6,000 per family
    • Paid by scheme
    3. Pathology:
    • Unlimited
    • Paid by scheme
    4. General radiology:
    • Unlimited
    • Paid by scheme
    5. Specialised radiology:
    • 3 scans per family, up to R10,000 per family, in and out of hospital.
    • Paid by scheme
    6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
  • View this plan

    Bestmed Beat 2 Network 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Some co-payments. Scheme pays out-of-hospital claims for: preventative dentistry, wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, but sub-limits can apply
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,399 R1,087 R589
    Children: Pay for maximum 4 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Preventative dentistry, wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R2,856 R2,220 R1,220

    Compare with these plans:

    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R4,200 per family paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Medihelp Necesse B 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals only. Income based plan. Scheme pays out-of-hospital claims for: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Network GP: 9 consults per person
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,404 R1,110 R600
    Children: Pay for all children
    Income limit: R401-R5,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • M =R2,800 and M+ =R3,900
    • This benefit covers specialist consultations, surgical and non-surgical procedures, endoscopic procedures, radiology interventions, pathology, acute medicine
    3. Pathology:
    • Paid by scheme
    4. General radiology:
    • Paid by scheme
    5. Specialised radiology:
    • R17,500 per family, in and out of hospital
    • Paid From Overall Annual Limit (OAL)
    6. Supplementary Services: (Physio, etc)
    • Physiotherapy and Occupational therapy: R1,800 per person and R2,800 per family

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    Discovery KeyCare Core C 2017: Out Of Hospital Benefits
    In brief: Unlimited cover in KeyCare networks. Scheme pays out-of-hospital claims for: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,408 R1,408 R318
    Children: Pay for maximum 3 children
    Income limit: R11,551+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • R3,570 per person
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Commed Roots C 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some-co-payments. Network hospitals. Annual limit of R400k per person and R800k per family. Scheme pays out-of-hospital claims for:GPs, specialits, dentistry, medicine, optometry, radiology, pathology, external applianes, alternative to hopitalisation. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Network GP: Unlimited from GP Network
    • Non-network GP: 3 consults per family or R1,000 per family
    Overall Annual Limit (OAL):
    R400k per person, R800k per family
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,454 R1,454 R620
    Children: Pay for all children
    Income limit: R18,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some:GPs, specialits, dentistry, medicine, optometry, radiology, pathology, external applianes, alternative to hopitalisation. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • R2,500 per person and R5,000 per family
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Topmed Essential 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Hospital plan. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), maternity, scopes, alternatives to hospital, extended rehab benefits, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,458 R1,174 R592
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, scopes, alternatives to hospital, extended rehab benefits, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • R2,500 co-payment per scan
    6. Supplementary Services: (Physio, etc)
    • Post-operative benefits hip and knee replacement (trauma only), heart attack, post crime trauma, stroke
    • Otherwise, no benefit

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    Hosmed Essential B 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. In-hospital, PMBs only. Scheme pays out-of-hospital claims for: GPs, specialists, medicine, pathology, radiology, specialised radiology, optometry, dentistry, appliances, maternity benefits, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Network GP: Unlimited
    Overall Annual Limit (OAL):
    PMBs only
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,460 R1,333 R368
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GPs, specialists, medicine, pathology, radiology, specialised radiology, optometry, dentistry, appliances, maternity benefits, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • Network: 3 consults per family
    3. Pathology:
    • R740 per person
    4. General radiology:
    • R740 per person
    5. Specialised radiology:
    • 2 scans per person
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Medihelp Necesse C 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals only. Income based plan. Scheme pays out-of-hospital claims for: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Network GP: 9 consults per person
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,464 R1,170 R660
    Children: Pay for all children
    Income limit: R5,001-R7,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • M =R2,800 and M+ =R3,900
    • This benefit covers specialist consultations, surgical and non-surgical procedures, endoscopic procedures, radiology interventions, pathology, acute medicine
    3. Pathology:
    • Paid by scheme
    4. General radiology:
    • Paid by scheme
    5. Specialised radiology:
    • R17,500 per family, in and out of hospital
    • Paid From Overall Annual Limit (OAL)
    6. Supplementary Services: (Physio, etc)
    • Physiotherapy and Occupational therapy: R1,800 per person and R2,800 per family

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    Makoti Comprehensive A 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • Chosen network GP: Unlimited
    Overall Annual Limit (OAL):
    PMBs only, in private hospitals
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,469 R1,266 R488
    Children: Pay for all children
    Income limit: R0-R9,250 (other limits)
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Subject to pre-authorisation
    3. Pathology:
    • Basic pathology covered by scheme
    4. General radiology:
    • Basic radiology covered by scheme
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • Physio and occupational therapy: 20 consults per family

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    Bonitas Essential 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Scheme pays out-of-hospital claims for: maternity and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • GP: 1 consult per child aged 2yrs-12 yrs
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,473 R1,127 R432
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: maternity and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Discovery Coastal Core 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Most day-to-day claims paid from out of pocket, unless PMB.
    1. GP consultations:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,496 R1,122 R596
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Most claims paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Commed Shina A 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some-co-payments. Network hospitals. Annual limit of R600,000 per person and R1,200,000 per family. Scheme pays out-of-hospital claims for: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    R600k per person, R1,200,000 per family
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,498 R1,274 R300
    Children: Pay for all children
    Income limit: R0-R6,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R1,798 R1,529 R360

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Genesis Private 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. R50,000 in-hospital limit for cancer, stroke, motor-neuron disease and organ transplant. Scheme pays out-of-hospital claims for: dentistry. Limits apply. All else paid out of pocket, unless PMB.
    1. GP consultations:
    • Surgical procedures in doctor's rooms: covered for qualifying procedures that would otherwise necessitate admission to hospital
    • Otherwise, no benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,500 R1,500 R365
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: dentistry. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • Scheme pays 50% of scheme rate, limited to R6,000 per person
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Topmed Active Saver 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: maternity, scopes, extended rehab benefits, birth control, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,512 R1,512 R500
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: maternity, scopes, extended rehab benefits, birth control, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R2,904 R2,904 R960

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Discovery Classic Smart 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: GP consults, acute meds, eye and dental check up and sport related injuries, specialised radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • GP in Smart Plan Network: Unlimited
    • R50 co-payment per consult, excluding video call consults, which are covered in full
    • Sports related injuries: basic x-rays, two specialist consults, and four other consults when referred by a Smart Network GP, with a R100 co-payment for each consult
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,535 R1,209 R612
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GP consults, acute meds, eye and dental check up and sport related injuries, specialised radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • R2,750 co-payment
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Discovery Classic Delta Core 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Network hospitals. Most day-to-day claims paid from out of pocket, unless PMB.
    1. GP consultations:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,535 R1,209 R612
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Most claims paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Cape Medical Premium 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • GP consult: One per person
    • Paediatric consults: R 1,655 per child
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,548 R1,548 R271
    Children: Pay for all children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • Covered if Lancet or Pathcare is used
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • R10,220 per person with a R1,500 co-payment, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Bestmed Beat 2 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Scheme pays out-of-hospital claims for: preventative dentistry, wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, but sub-limits can apply
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,554 R1,208 R655
    Children: Pay for maximum 4 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Preventative dentistry, wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R3,168 R2,460 R1,332

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R4,200 per family paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Resolution Hospital 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,565 R1,335 R585
    Children: Pay for all children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • R7,502 per family with R1,892 co-payment. In and out of hospital
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Momentum Custom Associate (and Network provider for chronic) 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Chronic benefits at Network provider. Scheme pays out-of-hospital claims for: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Paediatrician: 2 consults for infants up to 1yr
    • Otherwise, no benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,573 R1,219 R556
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • Unlimited with a R2,030 co-payment
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Selfmed MexXXI 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,599 R1,592 R818
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • Some day procedures covered
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • R1,600 co-payment. In and out of hospital
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Medihelp Dimension Prime 1 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), GP, specialists, physio, medication, maternity, infant paediatrics, medical appliances. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • M =R1,050 and M+ =R2,100
    • Shared with GPs, Specialists, Physio, Acute medicine and over the counter medication
    • 2 consults for babies under 1yr old, paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,608 R1,320 R486
    Children: Pay for maximum 2 children under 18yrs.
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), GP, specialists, physio, medication, maternity, infant paediatrics, medical appliances. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • See GP benefit, above
    3. Pathology:
    • No benefit
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • Paid by scheme, with a R1,500 co-payment, in or out of hospital
    6. Supplementary Services: (Physio, etc)
    • See GP benefit, above
    • Also, speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge following hospital admission. Limited to R1,650 per person and R2,200 per family

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    Momentum Custom (State for chronic) 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Chronic benefits at State facilities. Scheme pays out-of-hospital claims for: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Paediatrician: 2 consults for infants up to 1yr
    • Otherwise, no benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,610 R1,215 R590
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • Unlimited with a R2,030 co-payment
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Bestmed Pulse 1 C 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: GP and specialist consults, dentistry, optometry, maternity, radiology and pathology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • GP Network: unlimited GP consults
    • Out-of-network: R1,100 per family
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,630 R1,466 R814
    Children: Pay for maximum 4 children
    Income limit: R10,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GP and specialist consults, dentistry, optometry, maternity, radiology and pathology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Three network specialist visits, up to R1,100 per visit per family
    3. Pathology:
    • Cover from network, subject to protocols
    4. General radiology:
    • Cover from network, subject to protocols
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Discovery Essential Delta Saver 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Over and above the savings fund, scheme pays out-of-hospital claims for: GP consults if savings run out. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • GP in Premier Plus network: M =2 consults and M+ =4 consults. Face-to-face or video call.
    • Otherwise, paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,634 R1,230 R655
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GP consults if savings run out. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R2,940 R2,208 R1,176

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Fedhealth Maxima EntrySaver 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: post hospitalisation treatment (30 days), casualty visits, GP visits, specialised radiology, contraceptives, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Network GPs: Unlimited, from day-to-day or by scheme
    • Non-network GPs: paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,640 R1,181 R524
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: post hospitalisation treatment (30 days), casualty visits, GP visits, specialised radiology, contraceptives, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R3,168 R2,280 R1,008

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid by scheme, with a R2,500 co-payment
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Discovery Essential Core 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Most day-to-day claims paid from out of pocket, unless PMB.
    1. GP consultations:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,648 R1,234 R661
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Most claims paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Medihelp Necesse D 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals only. Income based plan. Scheme pays out-of-hospital claims for: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Network GP: 9 consults per person
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,656 R1,290 R726
    Children: Pay for all children
    Income limit: R7,001-R11,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • M =R2,800 and M+ =R3,900
    • This benefit covers specialist consultations, surgical and non-surgical procedures, endoscopic procedures, radiology interventions, pathology, acute medicine
    3. Pathology:
    • Paid by scheme
    4. General radiology:
    • Paid by scheme
    5. Specialised radiology:
    • R17,500 per family, in and out of hospital
    • Paid From Overall Annual Limit (OAL)
    6. Supplementary Services: (Physio, etc)
    • Physiotherapy and Occupational therapy: R1,800 per person and R2,800 per family

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    Medimed Essential D 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Income based plan. Over and above the savings, scheme pays out-of-hospital claims for: specialised radiology, GPs, specialists, medication, dentistry, optometry, radiology and pathology. Limits apply. All else paid from savings or out of pocket, unless PMB.
    1. GP consultations:
    • Network GPs: Unlimited, paid by scheme
    • Non-network GPs: 6 consults per person, paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,660 R1,660 R420
    Children: Pay for all children
    Income limit: R13,001-R17,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, GPs, specialists, medication, dentistry, optometry, radiology and pathology. Limits apply. All else paid from savings or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R1,992 R1,992 R504

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    2. Specialists consultations:
    • R3,000 per person and R6,000 per family
    • Paid by scheme
    3. Pathology:
    • Unlimited
    • Paid by scheme
    4. General radiology:
    • Unlimited
    • Paid by scheme
    5. Specialised radiology:
    • 3 scans per family, up to R10,000 per family, in and out of hospital.
    • Paid by scheme
    6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
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    Medimed Standard A 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Income based plan. Over and above the savings and extended fund, scheme pays out-of-hospital claims for: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R9,000 per family) or out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,660 R1,660 R390
    Children: Pay for all children
    Income limit: R0-R8,500 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R9,000 per family) or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R9,480 R9,480 R1,170
    Extended Fund: R4,500 pp R9,000 pf R

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • 3 scans per family, up to R15,000 per family
    • In and out-of-hospital
    • Paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Sizwe Gomomo A 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate. Scheme pays out-of-hospital claims for: maternity. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Chosen GP: Unlimited if pre-authorised
    • Other GP: 4 consults if pre-authorised
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,666 R1,546 R410
    Children: Pay for all children
    Income limit: R0-R10,112 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some:maternity. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Covered if referred by GP
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • R6,770 per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • R2,400 per family

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    Medihelp Dimension Prime 2 Network 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Some co-payments. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), GPs, optometry, dentistry, maternity, infant paediatrics, medical appliances. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • GP consults: M =2 consults and M+ =4 consults, paid by scheme
    • 2 consults for babies under 1yr old, paid by scheme
    • Otherwise, paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,668 R1,368 R498
    Children: Pay for maximum 2 children under 18yrs.
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), GPs, optometry, dentistry, maternity, infant paediatrics, medical appliances. Limits apply. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R2,448 R2,016 R720

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid by scheme, with a R1,500 co-payment, in or out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit
    • Also, speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge following hospital admission. Limited to R1,650 per person and R2,200 per family

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    Makoti Comprehensive B 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • Chosen network GP: Unlimited
    Overall Annual Limit (OAL):
    PMBs only, in private hospitals
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,699 R1,415 R554
    Children: Pay for all children
    Income limit: R9,251-R12,250 (other limits)
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Subject to pre-authorisation
    3. Pathology:
    • Basic pathology covered by scheme
    4. General radiology:
    • Basic radiology covered by scheme
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • Physio and occupational therapy: 20 consults per family

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    Momentum Incentive Network hospital (and State provider for chronic) 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Network hospitals. Chronic benefits at State facilities. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paediatrician: 2 consults for infants up to 1yr
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,700 R1,333 R883
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R2,040 R2,040 R1,600

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Unlimited with a R2,030 co-payment
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Cape Medical Silver 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • GP consults: 2 per person paid by scheme. Thereafter, from day-to-day benefit
    • Paediatric consults: R 780 per child. Thereafter, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,704 R1,704 R258
    Children: Pay for all children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R3,000 R3,000 R456

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Covered if Lancet or Pathcare is used
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R10,220 per person with a R1,500 co-payment in and out of hospital
    • Thereafter, from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Fedhealth Maxima Core Grid 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: post hospitalisation treatment (30 days), casualty visits, GP visit, specialised radiology, contraceptives, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Network GP: 1 consult per person
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,716 R1,454 R600
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some:post hospitalisation treatment (30 days), casualty visits, GP visit, specialised radiology, contraceptives, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • Paid by scheme, with a R1,900 co-payment
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Suremed Explorer C 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: medication, appliances, dentistry, GPs and specialists, maternity, optometry, pathology, radiology, specialised radiology, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
    1. GP consultations:
    • 12 consults per person
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,720 R1,720 R500
    Children: Pay for all children
    Income limit: R11,001-R15,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, optometry, pathology, radiology, specialised radiology, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • R3,000 per person, if referred
    3. Pathology:
    • Unlimited if referred by GP
    4. General radiology:
    • Unlimited if referred by GP
    5. Specialised radiology:
    • 2 scans per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Spectramed Cyan A 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Gastroscopies, colonoscopies, plantar wart removal, removal of ingrown toenail, varicose vein injection/drainage: paid by scheme
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,730 R1,669 R692
    Children: Pay for maximum 3 children
    Income limit: R0-R8,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R2,904 R2,808 R1,164

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R4,500 per family with a R1,500 co-payment
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Momentum Ingwe D 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. R1,190,000 per family limit. Income based plan. Scheme pays out-of-hospital claims for: dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Ingwe Primary Care Network: Unlimited
    • Non-network: 1 consult per person and 2 per family with 10% co-payment
    Overall Annual Limit (OAL):
    R1,190,000 per family
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,734 R1,734 R406
    Children: Pay for all children
    Income limit: R8,201-R11,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • 2 consults per family with R100 co-payment
    3. Pathology:
    • Some specific pathology covered by scheme
    4. General radiology:
    • Some specific x-rays covered by scheme
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Compcare Axis 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some exclusions apply. Most out-of-hospital benefits covered only if PMBs.
    1. GP consultations:
    • 2 consults and one ER visit (limited to R1,000) per child younger than 6yrs
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,734 R1,734 R534
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: preventative benefits. Limits apply. All else paid out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • Post-operative rehab: physio, OT and biokinetics R3,100 for 14 days, for PMBs only.

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    Topmed Network D 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: scopes, medicine, dentistry, optometry, supplementary services, radiology, pathology. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Network GPs: Basic primary care
    • Non-Network GPs: 3 visits per year, R1,236 per family, for emergencies only
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,734 R1,734 R464
    Children: Pay for all children
    Income limit: R11,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: scopes, medicine, dentistry, optometry, supplementary services, radiology, pathology. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Network: R1,500 per family
    3. Pathology:
    • Basic blood tests covered if requested by GP
    4. General radiology:
    • Basic x-rays covered if requested by GP
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Momentum Custom Associate (and any provider for chronic) 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Chronic benefits at any provider. Scheme pays out-of-hospital claims for: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Paediatrician: 2 consults for infants up to 1yr
    • Otherwise, no benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,742 R1,374 R614
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • Unlimited with a R2,030 co-payment
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Fedhealth Blue Door D: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: prescribed medication, GP consults, dentistry, optometry. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Contracted GP: Unlimited
    • Not contracted GP: 2 consults
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,754 R1,375 R677
    Children: Pay for all children
    Income limit: R10,501-R12,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: prescribed medication, GP consults, dentistry, optometry. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • 2 consults per family with network specialist
    3. Pathology:
    • Unlimited subject to referral and basic protocols
    4. General radiology:
    • Unlimited subject to referral and basic protocols
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Momentum Ingwe Network E 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. R1,190,000 per family limit. Income based plan. Scheme pays out-of-hospital claims for: dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Ingwe Primary Care Network: Unlimited
    • Non-network: 1 consult per person and 2 per family with 10% co-payment
    Overall Annual Limit (OAL):
    R1,190,000 per family
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,758 R1,758 R518
    Children: Pay for all children
    Income limit: R11,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • 2 consults per family with R100 co-payment
    3. Pathology:
    • Some specific pathology covered by scheme
    4. General radiology:
    • Some specific x-rays covered by scheme
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Medimed Standard B 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Income based plan. Over and above the savings and extended fund, scheme pays out-of-hospital claims for: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R9,000 per family) or out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,760 R1,760 R410
    Children: Pay for all children
    Income limit: R8,501-R13,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R9,000 per family) or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R9,780 R9,780 R1,230
    Extended Fund: R4,500 pp R9,000 pf R

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • 3 scans per family, up to R15,000 per family
    • In and out-of-hospital
    • Paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Bonitas BonFit 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Over and above the savings fund, scheme pays out-of-hospital claims for: maternity, infant paediatrics, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paediatric consults: Two per infant under 1yr; one per child 1-2yrs; one GP consult per child 2-12yrs
    • All else: paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,789 R1,385 R535
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R3,228 R2,496 R960

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Commed Shina B 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some-co-payments. Network hospitals. Annual limit of R600,000 per person and R1,200,000 per family. Scheme pays out-of-hospital claims for: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    R600k per person, R1,200,000 per family
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,803 R1,532 R361
    Children: Pay for all children
    Income limit: R6,001-R18,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R2,164 R1,838 R433

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Keyhealth Equilibrium 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Some co-payments. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), dentistry, maternity, medical appliances, preventative benefits. Limits apply. All else paid from savings, from fund or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,817 R1,096 R556
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, medical appliances, preventative benefits. Limits apply. All else paid from savings, from fund or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R1,584 R960 R480
    Extended Fund: R2,070 R1,150 R625

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • MRI and CT scans: R13,900 per family with R1,400 co-payment, in and out of hospital
    • PET scans: No benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Hosmed Essential C 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. In-hospital, PMBs only. Scheme pays out-of-hospital claims for: GPs, specialists, medicine, pathology, radiology, specialised radiology, optometry, dentistry, appliances, maternity benefits, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Network GP: Unlimited
    Overall Annual Limit (OAL):
    PMBs only
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,826 R1,666 R707
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GPs, specialists, medicine, pathology, radiology, specialised radiology, optometry, dentistry, appliances, maternity benefits, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Network: 3 consults per family
    3. Pathology:
    • R740 per person
    4. General radiology:
    • R740 per person
    5. Specialised radiology:
    • 2 scans per person
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Makoti Comprehensive C 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • Chosen network GP: Unlimited
    Overall Annual Limit (OAL):
    PMBs only, in private hospitals
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,832 R1,537 R594
    Children: Pay for all children
    Income limit: R12,251-R16,250 (other limits)
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Subject to pre-authorisation
    3. Pathology:
    • Basic pathology covered by scheme
    4. General radiology:
    • Basic radiology covered by scheme
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • Physio and occupational therapy: 20 consults per family

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    Momentum Access 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Network GPs: 10 consults per person, otherwise subject to authorisation
    • Non-network: 1 consult per person, 2 per family with R100 co-payment
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,842 R1,842 R552
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • 3 consults per person and 5 consults per family
    3. Pathology:
    • Some specific pathology covered by scheme
    4. General radiology:
    • Some specific x-rays covered by scheme
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Discovery KeyCare Access D 2017: Out Of Hospital Benefits
    In brief: Unlimited cover in state facilities, or Access network for some procedures. Scheme pays out-of-hospital claims for: maternity, specialists. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Chosen network GP: Unlimited
    • Non-network GP 4 consults per person
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,863 R1,863 R503
    Children: Pay for maximum 3 children
    Income limit: R11,551+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Emergencies, trauma, childbirth and cover for baby: R3,570 per person
    3. Pathology:
    • Some blood, urine and other fluid and tissue tests, as asked for by GP
    4. General radiology:
    • Basic X-rays covered, if done at a network provider and asked for by the GP
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Fedhealth Maxima Saver Grid 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: post hospitalisation treatment (30 days), casualty visits, GP visits, specialised radiology, contraceptives, some dentistry, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    • Once that is depleted, consults with nominated GP: unlimited
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,871 R1,524 R540
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: post hospitalisation treatment (30 days), casualty visits, GP visits, specialised radiology, contraceptives, some dentistry, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R3,372 R2,748 R972

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid by scheme, with a R1,900 co-payment
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Momentum Custom (Network for chronic) 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Chronic benefits at Network provider. Scheme pays out-of-hospital claims for: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Paediatrician: 2 consults for infants up to 1yr
    • Otherwise, no benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,899 R1,483 R689
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • Unlimited with a R2,030 co-payment
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Genesis Private Plus 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. R50,000 in-hospital limit for cancer, stroke, motor-neuron disease and organ transplant. Scheme pays out-of-hospital claims for: dentistry. Limits apply. All else paid out of pocket, unless PMB.
    1. GP consultations:
    • Surgical procedures in doctor's rooms: covered for qualifying procedures that would otherwise necessitate admission to hospital
    • Otherwise, paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,900 R1,900 R365
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: dentistry. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R4,140 R4,140 R

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Scheme pays 50% of scheme rate, limited to R6,000 per person
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Discovery KeyCare Plus C 2017: Out Of Hospital Benefits
    In brief: Unlimited cover in KeyCare networks. Scheme pays out-of-hospital claims for: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Chosen network GP: Unlimited
    • Non-network GP 4 consults per person
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,906 R1,906 R510
    Children: Pay for maximum 3 children
    Income limit: R11,551+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Strong>R3,570 per person
    3. Pathology:
    • Some blood, urine and other fluid and tissue tests, as asked for by GP
    4. General radiology:
    • Basic X-rays covered, if done at a network provider and asked for by the GP
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Sizwe Primary Care B 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • M =4 consults; M1 =9 consults; M2 =12 consults; M3 =14 consults etc
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,907 R1,488 R480
    Children: Pay for all children
    Income limit: R531-R8,766 (other limits)
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    Day-to-day limit: M =R5,390 M1 =R7,980 M2 =R9,330 M3 =R10,670 M4 =R12,020 M5 =R13,370 M6+ =R14,720
    2. Specialists consultations:
    • Must be referred. Limited consults to: M =2 consults; M1 =6; M2 =7; M3 =8; M4 =9; M5 =10; M6+ =11
    • Paid from day-to-day benefit
    3. Pathology:
    • M =R1,000 and M1+ =R1,900
    • Shared with radiology benefit
    • Paid from day-to-day benefit
    4. General radiology:
    • M =R1,000 and M1+ =R1,900
    • Shared with pathology benefit
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R17,710 per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Physio: from day-to-day benefit
    • Otherwise: R960 per person and and R1,550 per family, paid by scheme

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    Fedhealth Maxima Core 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: post hospitalisation treatment (30 days), casualty visits, GP visit, specialised radiology, contraceptives, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Network GP: 1 consult per person
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,907 R1,616 R667
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some:post hospitalisation treatment (30 days), casualty visits, GP visit, specialised radiology, contraceptives, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • Paid by scheme, with a R1,900 co-payment
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Compcare Networx ED H 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some exclusions apply. Private and public Network hospitals. Annual limit of R1,100,000 per family. Scheme pays for: GPs, medicine, radiology, pathology, maternity and preventative benefits. Limits apply. All else paid from out of fund or from out of pocket, unless PMB.
    1. GP consultations:
    • Selected network GP: Unlimited
    • Non-network GP: 2 consultswith 20% co-payment
    Overall Annual Limit (OAL):
    R1,100,000 per family
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,908 R1,718 R669
    Children: Pay for all children
    Income limit: R10,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-
    Extended Fund: R2,800 (main) R4,170 (family) R

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    2. Specialists consultations:
    • 2 consults per person and 3 consults per family
    • Paid from day-to-day benefit
    3. Pathology:
    • Unlimited when clinically appropriate within Universal Network and referred to by network GP
    4. General radiology:
    • Unlimited when clinically appropriate within Universal Network and referred to by network GP
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Discovery Classic Core 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Most day-to-day claims paid from out of pocket, unless PMB.
    1. GP consultations:
    • No benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,918 R1,510 R767
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Most claims paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Suremed Explorer D 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: medication, appliances, dentistry, GPs and specialists, maternity, optometry, pathology, radiology, specialised radiology, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
    1. GP consultations:
    • 12 consults per person
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,920 R1,920 R600
    Children: Pay for all children
    Income limit: R15,000+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, optometry, pathology, radiology, specialised radiology, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • R3,000 per person, if referred
    3. Pathology:
    • Unlimited if referred by GP
    4. General radiology:
    • Unlimited if referred by GP
    5. Specialised radiology:
    • 2 scans per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Bonitas Primary 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Over and above the fund, scheme pays out-of-hospital claims for: GPs, mental health, specialised radiology, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
    1. GP consultations:
    • Paediatric consults: One per child 2yr; one GP consult per child 2-12yrs
    • Otherwise, GP consults limited as below, for network GPs. Some of the funds may be used for non-network GPs
    Network GPs:
    MainM+1M+2M+3M4+
    R1,800 R3,300 R3,900 R4,200 R4,750
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,924 R1,505 R613
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GPs, mental health, specialised radiology, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    Fund:
    Main M+1 M+2 M+3 M4+
    R1,900 R3,400 R4,000 R4,300 R4,650
    Specialists, medicine, radiology, pathology, etc
    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R11,700 per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Medshield MediCore 2017: Out Of Hospital Benefits
    In brief: Up to 200% scheme rate for specialists. This is hospital plan. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), alternatives to hospitalisation, some non-surgical procedures including scopes, maternity, preventative benefits, in-hospital dentistry for under 6yr olds. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
    • Scopes: most paid by scheme if done in rooms
    • Otherwise, no benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,926 R1,623 R438
    Children: Pay for three children only
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, optometry, some non-surgical procedures including scopes, preventative benefits. Limits apply. All else paid from extended fund or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
    • Scopes: most paid by scheme if done in rooms
    • Otherwise, no benefit
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Medihelp Necesse E 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals only. Income based plan. Scheme pays out-of-hospital claims for: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Network GP: 9 consults per person
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,932 R1,506 R834
    Children: Pay for all children
    Income limit: R11,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • M =R2,800 and M+ =R3,900
    • This benefit covers specialist consultations, surgical and non-surgical procedures, endoscopic procedures, radiology interventions, pathology, acute medicine
    3. Pathology:
    • Paid by scheme
    4. General radiology:
    • Paid by scheme
    5. Specialised radiology:
    • R17,500 per family, in and out of hospital
    • Paid From Overall Annual Limit (OAL)
    6. Supplementary Services: (Physio, etc)
    • Physiotherapy and Occupational therapy: R1,800 per person and R2,800 per family

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    Medihelp Unify 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments.Scheme pays out-of-hospital claims for: specialised radiology (co-payment). Limits apply. All else paid from savings or from out-of-pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,944 R1,602 R588
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment). Limits apply. All else paid from savings or from out-of-pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R5,832 R4,824 R1,800

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid by scheme, with a R1,500 co-payment, in or out of hospital
    6. Supplementary Services: (Physio, etc)
    • Physio: paid from day-to-day benefit
    • Also, speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge following hospital admission. Limited to R1,650 per person and R2,200 per family

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    Compcare Unisave 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments, incl R3,500 for each hospital admission. Over and above the savings fund, scheme pays out-of-hospital claims for): specialised radiology, maternity, appliances, preventative benefits. Limits apply.
    1. GP consultations:
      Paid
    • Paid from day-to-day benefit
    • If day-to-day benefit is depleted: 2 additional consults and one ER visit (limited to R1,000) per child younger than 6yrs, paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,974 R1,680 R594
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, appliances, preventative benefits. Limits apply. . Limits apply. All else paid out of savings or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R5,904 R5,040 R1,800

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    2. Specialists consultations:
    • Paid from day-to-day benefit.
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit.
    5. Specialised radiology:
    • R18,000 per family, in and out of hospital
    • No benefit for screening purposes
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Medimed Essential E 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Income based plan. Over and above the savings, scheme pays out-of-hospital claims for: specialised radiology, GPs, specialists, medication, dentistry, optometry, radiology and pathology. Limits apply. All else paid from savings or out of pocket, unless PMB.
    1. GP consultations:
    • Network GPs: Unlimited, paid by scheme
    • Non-network GPs: 6 consults per person, paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R1,990 R1,990 R440
    Children: Pay for all children
    Income limit: R17,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, GPs, specialists, medication, dentistry, optometry, radiology and pathology. Limits apply. All else paid from savings or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R2,388 R2,388 R528

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    2. Specialists consultations:
    • R3,000 per person and R6,000 per family
    • Paid by scheme
    3. Pathology:
    • Unlimited
    • Paid by scheme
    4. General radiology:
    • Unlimited
    • Paid by scheme
    5. Specialised radiology:
    • 3 scans per family, up to R10,000 per family, in and out of hospital.
    • Paid by scheme
    6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
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    Spectramed Capri 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Gastroscopies, colonoscopies, plantar wart removal, removal of ingrown toenail, varicose vein injection/drainage: paid by scheme
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,003 R1,609 R909
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R2,400 R1,932 R1,092

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R8,900 per family with a R1,500 co-payment
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Discovery Coastal Saver 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Over and above the savings fund, scheme pays out-of-hospital claims for: GP consults if savings run out. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • GP in Premier Plus network: M =2 consults and M+ =4 consults. Face-to-face or video call.
    • Otherwise, paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,007 R1,506 R808
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GP consults if savings run out. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R4,812 R3,612 R1,932

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Makoti Comprehensive D 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • Chosen network GP: Unlimited
    Overall Annual Limit (OAL):
    PMBs only, in private hospitals
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,008 R1,722 R653
    Children: Pay for all children
    Income limit: R16,251+ (other limits)
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Subject to pre-authorisation
    3. Pathology:
    • Basic pathology covered by scheme
    4. General radiology:
    • Basic radiology covered by scheme
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • Physio and occupational therapy: 20 consults per family

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    Sizwe Savings Care A 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate. Scheme pays out-of-hospital claims for: radiology, pathology, maternity. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,015 R1,742 R490
    Children: Pay for all children
    Income limit: R0-R15,052 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GPs, specialists, medication, radiology, physio, pathology, standard dentistry, optometry, maternity. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R3,627 R3,136 R882

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R23,960 per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Resolution Fundation D 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • Network GP: Unlimited
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,022 R2,022 R694
    Children: Pay for all children
    Income limit: R9,701+ (other limits)
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Discovery Essential Saver 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Over and above the savings fund, scheme pays out-of-hospital claims for: GP consults if savings run out. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • GP in Premier Plus network: M =2 consults and M+ =4 consults. Face-to-face or video call.
    • Otherwise, paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,047 R1,536 R819
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GP consults if savings run out. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R3,684 R2,760 R1,464

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Medimed Standard C 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Income based plan. Over and above the savings and extended fund, scheme pays out-of-hospital claims for: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R9,000 per family) or out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,050 R2,050 R440
    Children: Pay for all children
    Income limit: R13,001-R17,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R9,000 per family) or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R10,650 R10,650 R1,320
    Extended Fund: R4,500 pp R9,000 pf R

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • 3 scans per family, up to R15,000 per family
    • In and out-of-hospital
    • Paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Compcare Mumed ED 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Netcare hospitals. Some co-payments. Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
    1. GP consultations:
    • Paid from day-to-day benefit, and then by scheme
    • M= 6 visits, M+1 =8 visits, M+2 =10 visits, M+3+ =11 visits
    • If day-to-day benefit is depleted: 2 additional consults and one ER visit (limited to R1,000) per child younger than 6yrs, paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,054 R1,600 R572
    Children: Pay for all children
    Day-to-Day Benefit:
    Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-
    Extended Fund: R5,376 R3,372 R1,338

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    2. Specialists consultations:
    • Paid from day-to-day benefit.
    3. Pathology:
    • Paid from day-to-day benefit.
    4. General radiology:
    • Paid from day-to-day benefit.
    5. Specialised radiology:
    • R22,000 per family, in and out of hospital
    • No benefit for screening purposes
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit and R1,800 per person and R2,850 per family

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    Discovery Classic Delta Saver 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Network Hospitals. Over and above the savings fund, scheme pays out-of-hospital claims for: GP consults, maternity, kids' casualty if savings run out. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • GP in Premier Plus network: M =3 consults and M+ =6 consults. Face-to-face or video call.
    • Kids under 10 years: 2 casualty visits per year and video call consults with a pediatrician with whom Discovery has payment arrangement
    • Otherwise, paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,058 R1,623 R826
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GP consults, maternity, kids' casualty if savings run out. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R6,168 R4,860 R2,472

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Momentum Custom (Any provider for chronic) 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Chronic benefits at any provider. Scheme pays out-of-hospital claims for: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Paediatrician: 2 consults for infants up to 1yr
    • Otherwise, no benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,059 R1,653 R735
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • No benefit, unless PMB
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • Unlimited with a R2,030 co-payment
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Sizwe Gomomo B 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate. Scheme pays out-of-hospital claims for: GPs, specialists, medication, radiology, physio, pathology, standard dentistry, optometry, maternity. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Chosen GP: Unlimited if pre-authorised
    • Other GP: 4 consults if pre-authorised
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,060 R1,623 R420
    Children: Pay for all children
    Income limit: R10,113+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GPs, specialists, medication, radiology, physio, pathology, standard dentistry, optometry, maternity. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Covered if referred by GP
    3. Pathology:
    • No benefit, unless PMB
    4. General radiology:
    • No benefit, unless PMB
    5. Specialised radiology:
    • R6,770 per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • R2,400 per family

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    Fedhealth Maxima Saver 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: post hospitalisation treatment (30 days), casualty visits, GP visits, specialised radiology, contraceptives, some dentistry, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    • Once that is depleted, consults with nominated GP: unlimited
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,079 R1,693 R600
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: post hospitalisation treatment (30 days), casualty visits, GP visits, specialised radiology, contraceptives, some dentistry, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R3,744 R3,048 R1,080

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid by scheme, with a R1,900 co-payment
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Momentum Incentive (State provider for chronic) 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Chronic benefits at State facilities. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,088 R1,646 R984
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R2,506 R2,506 R1,975

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Unlimited with a R2,030 co-payment
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Bestmed Beat 3 Network 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Some co-payments. Scheme pays out-of-hospital claims for: preventative dentistry, optometry, maternity, wound care, specialised radiology, contraceptives, some medicine and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, but sub-limits can apply
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,123 R1,509 R820
    Children: Pay for maximum 4 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Preventative dentistry, optometry, maternity, wound care, specialised radiology, contraceptives, some medicine and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R4,332 R3,084 R1,668

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R8,750 per family paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Hosmed Access 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. R1,250,000 per family limit. Scheme pays out-of-hospital claims for: GPs, specialists, medicine, pathology, radiology, specialised radiology, optometry, dentistry, appliances, supplementary services, maternity benefits, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Network GP: Unlimited
    • Non-network: 3 consults per person and 5 consults per family
    Overall Annual Limit (OAL):
    R1,250,000
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,124 R1,829 R413
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GPs, specialists, medicine, pathology, radiology, specialised radiology, optometry, dentistry, appliances, supplementary services, maternity benefits, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Network: 3 consults per person and 5 consults per family
    3. Pathology:
    • R1,800 per person
    • Shared with radiology benefit
    4. General radiology:
    • R1,800 per person
    • Shared with pathology benefit
    5. Specialised radiology:
    • 2 scans per person
    6. Supplementary Services: (Physio, etc)
    • R1,590 per person and R5,300 per family

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    Bonitas BonSave 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Over and above the savings fund, scheme pays out-of-hospital claims for: specialised radiology, mental health, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paediatric consults: Two per infant under 1yr; one per child 1-2yrs; one GP consult per child 2-12yrs
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,135 R1,654 R640
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, mental health, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R4,104 R3,180 R1,236

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R21,000 per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Medihelp Dimension Prime 2 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), GPs, optometry, dentistry, maternity, infant paediatrics, medical appliances. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • GP consults: M =2 consults and M+ =4 consults, paid by scheme
    • 2 consults for babies under 1yr old, paid by scheme
    • Otherwise, paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,136 R1,746 R642
    Children: Pay for maximum 2 children under 18yrs.
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), GPs, optometry, dentistry, maternity, infant paediatrics, medical appliances. Limits apply. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R3,096 R2,520 R936

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid by scheme, with a R1,500 co-payment, in or out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit
    • Also, speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge following hospital admission. Limited to R1,650 per person and R2,200 per family

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    Resolution Progressive Flex 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • M =4 consults, M1 =7 consults, M2+ =9 consults
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,154 R2,017 R666
    Children: Pay for all children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • M =2 consults, M1+ =3 consults
    3. Pathology:
    • From limit below
    • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
    MM1+
    R2,268R2,878
    4. General radiology:
    • From limit below
    • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
    MM1+
    R2,268R2,878
    5. Specialised radiology:
    • R9,438 per family with R1,892 co-payment. In and out of hospital
    6. Supplementary Services: (Physio, etc)
    • From limit below
    • Physio, speech therapy, audiology: from limit below
    • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
    MM1+
    R2,268R2,878

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    Medihelp Dimension Prime 3 Network 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Some co-payments. Scheme pays out-of-hospital claims for: radiology (co-payment), pathology, GPs, specialists, supplementary services, medicine, optometry, dentistry, maternity, infant paediatrics, medical appliances. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Shared with: GPs, specialists, psychology, physiotherapy, supplementary health services, acute medicine and over the counter
    Main M1 M2 M3+
    R5,700 R9,550 R11,700 R12,600
    • 2 consultations for babies under 1yr old, paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,184 R1,848 R636
    Children: Pay for maximum 2 children under 18yrs.
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • See GP benefit, above
    3. Pathology:
    • M =R2,450 and M+ =R3,450
    • Shared with basic radiology
    4. General radiology:
    • M =R2,450 and M+ =R3,450
    • Shared with pathology benefit
    5. Specialised radiology:
    • Paid by scheme, with a R1,500 co-payment, in or out of hospital
    6. Supplementary Services: (Physio, etc)
    • See GP benefit, above
    • Also, speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge following hospital admission. Limited to R1,650 per person and R2,200 per family

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    Genesis Private Comprehensive 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. R50,000 in-hospital limit for cancer, stroke, motor-neuron disease and organ transplant. Scheme pays out-of-hospital claims for: dentistry, consults, medicine. Limits apply. All else paid out of pocket, unless PMB.
    1. GP consultations:
    • Surgical procedures in doctor's rooms: covered for qualifying procedures that would otherwise necessitate admission to hospital
    • 4 consultations per adult with a registered provider, up to R400 per consult. Balance from day-to-day benefit.
    • Benefit applies to GPs, specialists, psychologists, chiropractors, dieticians, social workers, physio, biokinetics, optometrist, alternative treatments, homeopathy
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,200 R2,200 R365
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: dentistry, consults and medicine. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R1,740 R1,740 R

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    2. Specialists consultations:
    • Surgical procedures in doctor's rooms: covered for qualifying procedures that would otherwise necessitate admission to hospital
    • 4 consultations per adult with a registered provider, up to R400 per consult. Balance from day to day benefit.
    • Benefit applies to GPs, specialists, psychologists, chiropractors, dieticians, social workers, physio, biokinetics, optometrist, alternative treatments, homeopathy
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • 50% of scheme rate, limited to R6,000 per person
    • Paid from Overall Annual Limit (OAL)
    6. Supplementary Services: (Physio, etc)
    • 4 consultations per adult with a registered provider, up to R400 per consult. Balance from day-to-day benefit.
    • Benefit applies to GPs, specialists, psychologists, chiropractors, dieticians, social workers, physio, biokinetics, optometrist, alternative treatments, homeopathy

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    Momentum Ingwe E 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. R1,190,000 per family limit. Income based plan. Scheme pays out-of-hospital claims for: dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Ingwe Primary Care Network: Unlimited
    • Non-network: 1 consult per person and 2 per family with 10% co-payment
    Overall Annual Limit (OAL):
    R1,190,000 per family
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,225 R2,225 R646
    Children: Pay for all children
    Income limit: R11,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • 2 consults per family with R100 co-payment
    3. Pathology:
    • Some specific pathology covered by scheme
    4. General radiology:
    • Some specific x-rays covered by scheme
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Medimed Standard D 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Income based plan. Over and above the savings and extended fund, scheme pays out-of-hospital claims for: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R9,000 per family) or out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,230 R2,230 R470
    Children: Pay for all children
    Income limit: R17,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R9,000 per family) or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R11,190 R11,190 R1,410
    Extended Fund: R4,500 pp R9,000 pf R

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • 3 scans per family, up to R15,000 per family
    • In and out-of-hospital
    • Paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Topmed Limited 2017: Out Of Hospital Benefits
    In brief: R1,000,000 limit per person in private hospitals. Unlimited in public hospitals. Co-payment for private hospital stays, and 20% co-payment for all healthcare providers. Scheme pays most out-of-hospital benefits with 20% co-payment. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • R6,708 per family, including specialists with 20% co-payment
    Overall Annual Limit (OAL):
    R1,000,000 per person
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,245 R600 R260
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: most out-of-hospital claims, with 20% co-payment. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • See GP benefit, above
    3. Pathology:
    • R4,824 per family, for radiology, pathology and histology
    • 20% co-payment
    4. General radiology:
    • R4,824 per family, for radiology, pathology and histology
    • 20% co-payment
    5. Specialised radiology:
    • 3 scans per family, R15,000
    • 20% co-payment
    6. Supplementary Services: (Physio, etc)
    • Physiotherapist, Chiropractor and Biokineticist: R2,856 per family
    • Audiologist, Dietician, Occupational Therapist, Speech Therapist, Social Worker: R2,268 per family
    • Chiropodist, Homeopath, Naturopath, Osteopath, Podiatrist and Orthoptist: R2,268 per family
    • 20% co-payment

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    Fedhealth Maxima Basis Grid 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: post hospitalisation treatment (30 days), casualty visits, GP visits, specialised radiology, contraceptives, some dentistry and maternity, optometry, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    • Once that is depleted, consults with nominated GP: unlimited
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,251 R1,916 R679
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: post hospitalisation treatment (30 days), casualty visits, GP visits, specialised radiology, contraceptives, some dentistry and maternity, optometry, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R4,056 R3,444 R1,224

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid by scheme, with a R1,900 co-payment
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Fedhealth Maxima Standard Elect 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Comprehensive plan with extended fund and threshold benefits (with 20% co-payment) that can be used for most out-of-hospital claims.
    1. GP consultations:
    • Depending on the GP, paid from day-to-day benefit, or paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,316 R1,974 R694
    Children: Pay for all children
    Day-to-Day Benefit:
    Comprehensive plan with extended fund and threshold benefits (with 20% co-payment) that can be used for most out-of-hospital claims.
    Main: Adult: Child:
    (S) Savings: R5,004 R4,260 R1,500
    (SP) Self Payment: R6,196 R4,340 R1,380
    Threshold (S+SP): R11,200 R8,600 R2,880
    Above Threshold: No limit, with 20% co-payment No limit, with 20% co-payment No limit, with 20% co-payment

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid by scheme, with a R1,900 co-payment
    6. Supplementary Services: (Physio, etc)
    • Audiology, dietetics, genetic counselling, occupational therapy, orthoptics, podiatry, psychologists, speech therapy, social workers, physio, biokinetics and chiropractics: R10,500 per family, from day-to-day benefit for in and out of hospital
    • Alternative healthcare: paid from day-to-day benefit, but not from threshold

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    Topmed Savings 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: specialised radiology (with co-payment), maternity, scopes, alternatives to hospitalisation, extended rehab benefits, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,317 R1,850 R698
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (with co-payment), maternity, scopes, alternatives to hospitalisation, extended rehab benefits, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R4,452 R3,552 R1,344

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R2,500 co-payment per scan
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Momentum Incentive Network hospital (and Network provider for chronic) 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Network hospitals. Chronic benefits at Network provider. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,323 R1,848 R949
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R2,788 R2,788 R2,218

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Unlimited with a R2,030 co-payment
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Sizwe Primary Care C 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • M =4 consults; M1 =9 consults; M2 =12 consults; M3 =14 consults etc
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,326 R1,519 R480
    Children: Pay for all children
    Income limit: R8,767+ (other limits)
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    Day-to-day limit: M =R5,390 M1 =R7,980 M2 =R9,330 M3 =R10,670 M4 =R12,020 M5 =R13,370 M6+ =R14,720
    2. Specialists consultations:
    • Must be referred. Limited consults to: M =2 consults; M1 =6; M2 =7; M3 =8; M4 =9; M5 =10; M6+ =11
    • Paid from day-to-day benefit
    3. Pathology:
    • M =R1,000 and M1+ =R1,900
    • Shared with radiology benefit
    • Paid from day-to-day benefit
    4. General radiology:
    • M =R1,000 and M1+ =R1,900
    • Shared with pathology benefit
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R17,710 per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Physio: from day-to-day benefit
    • Otherwise: R960 per person and and R1,550 per family, paid by scheme

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    Bestmed Beat 3 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Scheme pays out-of-hospital claims for: preventative dentistry, optometry, maternity, wound care, specialised radiology, contraceptives, some medicine and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, but sub-limits can apply
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,359 R1,676 R911
    Children: Pay for maximum 4 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Preventative dentistry, optometry, maternity, wound care, specialised radiology, contraceptives, some medicine and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R4,812 R3,420 R1,860

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R8,750 per family paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Resolution Progressive Flex Plus 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • M =4 consults, M1 =7 consults, M2+ =9 consults
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,369 R2,219 R733
    Children: Pay for all children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • M =2 consults, M1+ =3 consults
    3. Pathology:
    • From limit below
    • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
    MM1+
    R2,268R2,878
    4. General radiology:
    • From limit below
    • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
    MM1+
    R2,268R2,878
    5. Specialised radiology:
    • R9,438 per family with R1,892 co-payment. In and out of hospital
    6. Supplementary Services: (Physio, etc)
    • From limit below
    • Physio, speech therapy, audiology: from limit below
    • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
    MM1+
    R2,268R2,878

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    Fedhealth Blue Door E: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: prescribed medication, GP consults, dentistry, optometry. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Contracted GP: Unlimited
    • Not contracted GP: 2 consults
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,378 R2,061 R895
    Children: Pay for all children
    Income limit: R12,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: prescribed medication, GP consults, dentistry, optometry. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • 2 consults per family with network specialist
    3. Pathology:
    • Unlimited subject to referral and basic protocols
    4. General radiology:
    • Unlimited subject to referral and basic protocols
    5. Specialised radiology:
    • No benefit, unless PMB
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Spectramed Cyan B 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Gastroscopies, colonoscopies, plantar wart removal, removal of ingrown toenail, varicose vein injection/drainage: paid by scheme
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,396 R2,296 R960
    Children: Pay for maximum 3 children
    Income limit: R8,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R4,020 R3,852 R1,608

    Compare with these plans:

    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R4,500 per family with a R1,500 co-payment
    6. Supplementary Services: (Physio, etc)
    • No benefit, unless PMB

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    Suremed Navigator 2017: Out Of Hospital Benefits
    In brief: 125% scheme rate for specialists. Scheme pays out-of-hospital claims for: medication, appliances, dentistry, GPs and specialists, maternity, non surgical procedures, optometry, supplementary services, pathology, radiology, specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of savings or out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,400 R1,900 R720
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, non surgical procedures, optometry, supplementary services, pathology, radiology, specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of savings or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R3,960 R3,180 R1,200
    Extended Fund: R8,500 pp R17,680 pf R

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R14,800 per family, in and out of hospital. Paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Commed Shina C 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some-co-payments. Network hospitals. Annual limit of R600,000 per person and R1,200,000 per family. Scheme pays out-of-hospital claims for: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    R600k per person, R1,200,000 per family
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,441 R2,075 R488
    Children: Pay for all children
    Income limit: R18,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R2,929 R2,490 R586

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Selfmed Selfsure 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,456 R2,451 R836
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • R4,900 per person or R6,900 per family
    • Shared with radiology, pathology, standard dentistry, physio and biokinetics
    4. General radiology:
    • R4,900 per person or R6,900 per family
    • Shared with radiology, pathology, standard dentistry, physio and biokinetics
    5. Specialised radiology:
    • R1,600 co-payment. In and out of hospital
    6. Supplementary Services: (Physio, etc)
      Physio and biokinetics:
    • R4,900 per person or R6,900 per family. Shared with radiology, pathology, standard dentistry, physio and biokinetics
    • Otherwise, from day-to-day benefits

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    Fedhealth Maxima Basis 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: post hospitalisation treatment (30 days), casualty visits, GP visits, specialised radiology, contraceptives, some dentistry and maternity, optometry, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    • Once that is depleted, consults with nominated GP: unlimited
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,501 R2,129 R754
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: post hospitalisation treatment (30 days), casualty visits, GP visits, specialised radiology, contraceptives, some dentistry and maternity, optometry, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R4,500 R3,828 R1,356

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid by scheme, with a R1,900 co-payment
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Momentum Incentive (Network provider for chronic) 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Chronic benefits at Network provider. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,506 R2,010 R1,089
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R3,007 R3,007 R2,412

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Unlimited with a R2,030 co-payment
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Momentum Incentive Network hospital (and any provider for chronic) 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Network hospitals. Chronic benefits at any provider. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,529 R2,034 R826
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R3,035 R3,035 R2,441

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Unlimited with a R2,030 co-payment
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Compcare Mumed 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
    1. GP consultations:
    • Paid from day-to-day benefit, and then by scheme
    • M= 6 visits, M+1 =8 visits, M+2 =10 visits, M+3+ =11 visits
    • If day-to-day benefit is depleted: 2 additional consults and one ER visit (limited to R1,000) per child younger than 6yrs, paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,532 R1,974 R714
    Children: Pay for all children
    Day-to-Day Benefit:
    Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-
    Extended Fund: R5,376 R3,372 R1,338

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    2. Specialists consultations:
    • Paid from day-to-day benefit.
    3. Pathology:
    • Paid from day-to-day benefit.
    4. General radiology:
    • Paid from day-to-day benefit.
    5. Specialised radiology:
    • R22,000 per family, in and out of hospital
    • No benefit for screening purposes
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit and R1,800 per person and R2,850 per family

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    Medshield MediPlus 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate. Scheme pays out-of-hospital claims for: specialised radiology, maternity, alternative to hospitalisation, optometry, some non-surgical procedures including scopes,preventative benefits. Limits apply. All else paid from extended fund or out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
    • Scopes: most paid by scheme if done in rooms
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,544 R1,797 R558
    Children: Pay for three children only
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, alternative to hospitalisation, optometry, some non-surgical procedures including scopes,preventative benefits. Limits apply. All else paid from extended fund or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-
    Extended Fund: RM=R6,750
    M1 =R9,420
    M2 =R10,600
    M3 = R11,910
    M4+ +R13,050
    R R

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    2. Specialists consultations:
    • One consultation per family, then from day-to-day benefit
    • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
    • Scopes: most paid by scheme if done in rooms
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R10,200 per family, with 10% co-payment for non-PMBs
    • In and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Discovery Essential Priority 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Comprehensive cover with savings, extended fund, and limited above threshold benefits that cover most out-of-hospital benefits (with sub limits). Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,551 R2,004 R1,012
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Comprehensive cover that covers most out-of-hospital benefits (with sub limits) with limited above threshold benefit. Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R4,584 R3,600 R1,824
    (SP) Self Payment: R8,566 R6,250 R2,476
    Threshold (S+SP): R13,150 R9,850 R4,300
    Above Threshold: 11,150 7,950 3,850

    Compare with these plans:

    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefits. Includes allied, therapeutic and psychology services
    Main M1 M2 M3+
    R6,250 R9,450 R11,750 R14,150

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    Medshield MediSaver 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), alternatives to hospitalisation, some non-surgical procedures including scopes, maternity, preventative benefits, dentistry. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
    • Scopes: most paid by scheme if done in rooms
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,571 R2,151 R615
    Children: Pay for three children only
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), alternatives to hospitalisation, some non-surgical procedures including scopes, maternity, preventative benefits, dentistry. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R6,192 R5,184 R1,476

    Compare with these plans:

    2. Specialists consultations:
    • Paid from day-to-day benefit
    • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
    • Scopes: most paid by scheme if done in rooms
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Bone densitometry scan: one per person
    • Otherwise, from day-to-day benefit
    5. Specialised radiology:
    • R15,880 per family, with 10% co-payment for non-PMBs
    • In and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Discovery Classic Saver 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Over and above the savings fund, scheme pays out-of-hospital claims for: GP consults, maternity, kids' casualty if savings run out. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • GP in Premier Plus network: M =3 consults and M+ =6 consults. Face-to-face or video call.
    • Kids under 10 years: 2 casualty visits per year and video call consults with a pediatrician with whom Discovery has payment arrangement
    • Otherwise, paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,577 R2,029 R1,031
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GP consults, maternity, kids' casualty if savings run out. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R7,728 R6,084 R3,084

    Compare with these plans:

    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Bonitas Standard Select 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Over and above the fund, scheme pays out-of-hospital claims for: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
    1. GP consultations:
    • Paediatric consults: Two per child under 2yr; one GP consult per child 2-12yrs
    • Otherwie, GP consults limited to sub-limits below, for network GPs. Some of the funds may be used for non-network GPs
    Network GPs:
    Main M+1 M+2 M+3 M4+
    R3,750 R5,500 R6,100 R6,400 R6,950
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,597 R2,247 R760
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    Fund:
    Main M+1 M+2 M+3 M4+
    R5,232 R7,970 R9,214 R10,062 R10,966
    Specialists, medicine, radiology, pathology, etc
    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R23,500 per family
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Compcare Symmetry ED 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Netcare hospitals. Some co-payments. Scheme offers extended fund once savings are depleted, and also pays for: specialised radiology, GPs (unlimited), medical appliances and preventative benefits. Limits apply.
    1. GP consultations:
      Paid
    • Paid from day-to-day benefit
    • If day-to-day benefit is depleted: 2 additional consults and one ER visit (limited to R1,000) per child younger than 6yrs, paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,598 R2,022 R732
    Children: Pay for all children
    Day-to-Day Benefit:
    Scheme offers extended fund for claims once savings are depleted, and also pays for: specialised radiology, GPs, medical appliances and preventative benefits. Limits apply. All else paid from savings, fund or out of pocket.
    Main: Adult: Child:
    (S) Savings: R3,118 R2,426 R878
    Extended Fund: R3,118 R2,426 R878

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit and R30,000 per family for in and out of hospital
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R25,000 per family with first R1,500 paid out of savings
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit and R2,800 per person

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    Medihelp Dimension Prime 3 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Scheme pays out-of-hospital claims for: radiology (co-payment), pathology, GPs, specialists, supplementary services, medicine, optometry, dentistry, maternity, infant paediatrics, medical appliances. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Shared with: GPs, specialists, psychology, physiotherapy, supplementary health services, acute medicine and over the counter
    Main M1 M2 M3+
    R5,700 R9,550 R11,700 R12,600
    • 2 consultations for babies under 1yr old, paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,730 R2,316 R798
    Children: Pay for maximum 2 children under 18yrs.
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    2. Specialists consultations:
    • See GP benefit, above
    3. Pathology:
    • M =R2,450 and M+ =R3,450
    • Shared with basic radiology
    4. General radiology:
    • M =R2,450 and M+ =R3,450
    • Shared with pathology benefit
    5. Specialised radiology:
    • Paid by scheme, with a R1,500 co-payment, in or out of hospital
    6. Supplementary Services: (Physio, etc)
    • See GP benefit, above
    • Also, speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge following hospital admission. Limited to R1,650 per person and R2,200 per family

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    Sizwe Affordable Care A 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • M =7 consults; M1 =14 consults; M2 =16 consults; M3 =18 consults etc
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,733 R2,511 R630
    Children: Pay for all children
    Income limit: R0-R15,052 (other limits)
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    Day-to-day limit: M =R9,330 M1 =R13,370 M2 =R15,390 M3 =R16,740 M4 =R18,760 M5 =R20,790 M6+ =R22,690
    2. Specialists consultations:
    • Must be referred. Limited consults to: M =4 consults; M1 =8; M2 =9; M3 =10; M4 =11; M5 =12; M6+ =13
    • Paid from day-to-day benefit
    3. Pathology:
    • M =R1,100 and M1+ =R2,200
    • Shared with radiology benefit
    • Paid from day-to-day benefit
    4. General radiology:
    • M =R1,100 and M1+ =R2,200
    • Shared with pathology benefit
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R26,920 per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Physio: from day-to-day benefit
    • Otherwise, R1,440 per person and R2,510 per family, paid by scheme

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    Momentum Incentive (Any provider for chronic) 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Chronic benefits at any provider. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,794 R2,270 R389
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R3,288 R3,288 R2,724

    Compare with these plans:

    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Unlimited with a R2,030 co-payment
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Sizwe Savings Care B 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,800 R2,243 R555
    Children: Pay for all children
    Income limit: R15,053+ (other limits)
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R5,040 R4,037 R999

    Compare with these plans:

    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R23,960 per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Medimed Max A 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Income based plan. Over and above the savings and extended fund, scheme pays out-of-hospital claims for: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,810 R2,810 R500
    Children: Pay for all children
    Income limit: R0-R10,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R13,430 R13,430 R1,500
    Extended Fund: R5,000 pp R10,000 pf R

    Compare with these plans:

    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • 4 scans per family, up to R20,000 per family
    • In and out-of-hospital
    • Paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Sizwe Affordable Care B 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • M =7 consults; M1 =14 consults; M2 =16 consults; M3 =18 consults etc
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,843 R2,610 R660
    Children: Pay for all children
    Income limit: R15,053-R18,444 (other limits)
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    Day-to-day limit: M =R9,330 M1 =R13,370 M2 =R15,390 M3 =R16,740 M4 =R18,760 M5 =R20,790 M6+ =R22,690
    2. Specialists consultations:
    • Must be referred. Limited consults to: M =4 consults; M1 =8; M2 =9; M3 =10; M4 =11; M5 =12; M6+ =13
    • Paid from day-to-day benefit
    3. Pathology:
    • M =R1,100 and M1+ =R2,200
    • Shared with radiology benefit
    • Paid from day-to-day benefit
    4. General radiology:
    • M =R1,100 and M1+ =R2,200
    • Shared with pathology benefit
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R26,920 per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Physio: from day-to-day benefit
    • Otherwise, R1,440 per person and R2,510 per family, paid by scheme

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    Bonitas BonComplete 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Over and above the savings/threshold fund, scheme pays out-of-hospital claims for: specialised radiology, mental health, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings, or from above threshold benefit or from out of pocket, unless PMB.
    1. GP consultations:
    • Paediatric consults: Two per infant under 1yr; one per child 1-2yrs; one GP consult per child 2-12yrs
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,923 R2,340 R794
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, mental health, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings, or from above threshold benefit or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R5,256 R4,200 R1,428
    (SP) Self Payment: R1,568 R1,326 R336
    Threshold (S+SP): R6,824 R5,526 R1,764
    Above Threshold: R4,150 R2,450 R1,060

    Compare with these plans:

    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R21,000 per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Commed Standard A 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some-co-payments. Network hospitals. Annual limit of R760,000 per person and R1,460,000 per family. Scheme pays out-of-hospital claims for: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    R730k per person, R1,460,000 per family
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,946 R2,413 R591
    Children: Pay for all children
    Income limit: R0-R6,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R4,419 R3,620 R887

    Compare with these plans:

    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Hosmed Value 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: GPs, specialists, medicine, pathology, radiology, specialised radiology, optometry, dentistry, appliances, mental health, supplementary services, maternity benefits, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • 10 consults per person, and 20 consults per family
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,964 R2,144 R482
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GPs, specialists, medicine, pathology, radiology, specialised radiology, optometry, dentistry, appliances, mental health, supplementary services, maternity benefits, preventative benefits. Limits apply. All else paid out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    Overall out-of-hospital annual limit for : Acute medicine, advanced dentistry, alternative services, biokinetics, physio, remedial and other therapies and mental health:
    Main M+1 M+2 M+3
    R8,500 R17,950 R19,525 R21,625
    2. Specialists consultations:
    • M =3 visit, M+1= 5 visits, M2+ =7 visits
    • Applies to GPs and Outpatient Facilities
    3. Pathology:
    • R2,385 per person
    4. General radiology:
    • R1,855 per person
    5. Specialised radiology:
    • 2 scans per person
    6. Supplementary Services: (Physio, etc)
    • Alternative services: R3,220 per family
    • Remedial and other therapies: R3,110 per family
    • Physiotherapy and Biokinetics: R1,460 per person limited to R2,420 per family

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    Discovery Classic Priority 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Comprehensive cover with savings, extended fund, and limited above threshold benefits that cover most out-of-hospital benefits (with sub limits). Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    • While in the Self Payment Gap, face-to-face and video call consultations with a GP in Premier Plus Network are paid by scheme
    • While in the Self Payment Gap, kids under 10 years have access to two casualty visits per year and video call consults with a pediatrician with whom Discovery has payment arrangement
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,968 R2,337 R1,187
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Comprehensive cover that covers most out-of-hospital benefits (with sub limits) with limited above threshold benefit. Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R8,904 R7,008 R3,552
    (SP) Self Payment: R4,246 R2,842 R748
    Threshold (S+SP): R13,150 R9,850 R4,300
    Above Threshold: 11,150 7,950 3,850

    Compare with these plans:

    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    • While in the Self Payment Gap, scheme will still pay for blood tests at their partner clinic pharmacies
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefits. Includes allied, therapeutic and psychology services
    Main M1 M2 M3+
    R9,450 R13,350 R17,300 R20,400

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    Keyhealth Silver 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), dentistry, medicine, optometry, maternity, medical appliances, preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    • After day-to-day benefit is depleted, an additional 3 consults with GP/Paediatrician for children under 21yrs. (Max one paediatrician consult)
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,977 R1,601 R620
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), dentistry, medicine, optometry, maternity, medical appliances, preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-
    Extended Fund: R6,485 R4,710 R1,305

    Compare with these plans:

    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • 30% co-payment
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • MRI and CT scans: R13,900 per family with R1,400 co-payment, in and out of hospital
    • PET scans: No benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Bonitas Standard 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Over and above the fund, scheme pays out-of-hospital claims for: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
    1. GP consultations:
    • Paediatric consults: Two per child under 2yr; one GP consult per child 2-12yrs
    • Otherwise, GP consults limited as below, for network GPs. Some of the funds may be used for non-network GPs
    Network GPs:
    Main M+1 M+2M+3M4+
    R3,750 R5,500 R6,100 R6,400 R6,950
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,998 R2,600 R880
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    Fund:
    Main M+1 M+2 M+3 M4+
    R5,232 R7,970 R9,214 R10,062 R10,966
    Specialists, medicine, radiology, pathology, etc
    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R23,500 per family
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Fedhealth Maxima Standard 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Comprehensive plan with extended fund and threshold benefits (with 20% co-payment) that can be used for most out-of-hospital claims.
    1. GP consultations:
    • Depending on the GP, paid from day-to-day benefit, or paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,032 R2,583 R907
    Children: Pay for all children
    Day-to-Day Benefit:
    Comprehensive plan with extended fund and threshold benefits (with 20% co-payment) that can be used for most out-of-hospital claims.
    Main: Adult: Child:
    (S) Savings: R6,552 R5,580 R1,956
    (SP) Self Payment: R4,648 R3,020 R924
    Threshold (S+SP): R11,200 R8,600 R2,880
    Above Threshold: No limit, with 20% co-payment No limit, with 20% co-payment No limit, with 20% co-payment

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid by scheme, with a R1,900 co-payment
    6. Supplementary Services: (Physio, etc)
    • Audiology, dietetics, genetic counselling, occupational therapy, orthoptics, podiatry, psychologists, speech therapy, social workers, physio, biokinetics and chiropractics: R10,500 per family, from day-to-day benefit for in and out of hospital
    • Alternative healthcare: paid from day-to-day benefit, but not from threshold

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    Medimed Max B 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Income based plan. Over and above the savings and extended fund, scheme pays out-of-hospital claims for: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,050 R3,050 R530
    Children: Pay for all children
    Income limit: R10,001-R17,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R14,150 R14,150 R1,590
    Extended Fund: R5,000 pp R10,000 pf R

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • 4 scans per family, up to R20,000 per family
    • In and out-of-hospital
    • Paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Bestmed Pace 1 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: preventative dentistry, optometry, maternity, specialised radiology, contraceptives, some medicine and preventative benefits. Limits apply. All else paid from savings, from extended fund or from out of pocket, unless PMB.
    1. GP consultations:
    • Limited to M =R1,750 and M1+ =R3,550
    • Paid from day-to-day benefit
    • Shared with specialist benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,055 R2,145 R711
    Children: Pay for maximum 4 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: preventative dentistry, optometry, maternity, specialised radiology, contraceptives, some medicine and preventative benefits. Limits apply. All else paid from savings, from extended fund or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R7,332 R5,148 R1,848
    Extended Fund: R8,500 (main) R17,000 (family) R

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    2. Specialists consultations:
    • Shared with GP benefits, see above
    3. Pathology:
    • Limited to M =R2,550 and M1+ =R5,100
    • Paid from day-to-day benefit
    • Shared with radiology benefit
    4. General radiology:
    • Limited to M =R2,550 and M1+ =R5,100
    • Paid from day-to-day benefit
    • Shared with pathology benefit
    5. Specialised radiology:
    • R11,450 per family, paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Limited to M =R3,450 and M1+ =R7,150
    • Paid from day-to-day benefit
    • Shared with radiology benefit

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    Commed Standard B 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some-co-payments. Network hospitals. Annual limit of R760,000 per person and R1,460,000 per family. Scheme pays out-of-hospital claims for: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    R730k per person, R1,460,000 per family
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,181 R2,607 R638
    Children: Pay for all children
    Income limit: R6,001-R7,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R4,772 R3,911 R957

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Compcare Symmetry 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Scheme offers extended fund once savings are depleted, and also pays for: specialised radiology, GPs (unlimited), medical appliances and preventative benefits. Limits apply.
    1. GP consultations:
      Paid
    • Paid from day-to-day benefit
    • If day-to-day benefit is depleted: 2 additional consults and one ER visit (limited to R1,000) per child younger than 6yrs, paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,186 R2,484 R900
    Children: Pay for all children
    Day-to-Day Benefit:
    Scheme offers extended fund for claims once savings are depleted, and also pays for: specialised radiology, GPs, medical appliances and preventative benefits. Limits apply. All else paid from savings, fund or out of pocket.
    Main: Adult: Child:
    (S) Savings: R3,816 R2,952 R1,080
    Extended Fund: R3,816 R2,952 R1,080

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit and R30,000 per family for in and out of hospital
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R25,000 per family with first R1,500 paid out of savings
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit and R2,800 per person

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    Medimed Max C 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Income based plan. Over and above the savings and extended fund, scheme pays out-of-hospital claims for: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,210 R3,210 R560
    Children: Pay for all children
    Income limit: R17,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R14,630 R14,630 R1,680
    Extended Fund: R5,000 pp R10,000 pf R

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • 4 scans per family, up to R20,000 per family
    • In and out-of-hospital
    • Paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Fedhealth Maxima Advanced 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: post hospitalisation treatment (30 days), casualty visits, specialised radiology, contraceptives, some medication, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,251 R2,756 R968
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: post hospitalisation treatment (30 days), casualty visits, specialised radiology, contraceptives, some medication, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R3,900 R3,312 R1,164

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid by scheme, with a R1,900 co-payment
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Compcare Dynamix ED 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Netcare hospitals. Some co-payments. Comprehensive cover with savings, and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
    1. GP consultations:
      Paid
    • Paid from day-to-day benefit
    • If day-to-day benefit is depleted: 2 additional consults and one ER visit (limited to R1,000) per child younger than 6yrs, paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,306 R2,580 R930
    Children: Pay for all children
    Day-to-Day Benefit:
    Comprehensive cover with savings, extended fund, and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
    Main: Adult: Child:
    (S) Savings: R5,976 R4,680 R1,656
    Extended Fund: R1,984 R1,548 R558
    (SP) Self Payment: R5,000 R3,878 R1,402
    Threshold (S+SP): R12,960 R10,106 R3,616
    Above Threshold: R5,800 pb
    R11,600 pf
    11,600 pf

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    • Above-threshold sub-limit of R3,600 per family applies
    3. Pathology:
    • Paid from day-to-day benefit
    • Above-threshold sub-limit of R2,780 per family
    • Combined with radiology benefit
    4. General radiology:
    • Paid from day-to-day benefit
    • Above-threshold sub-limit of R2,780 per family
    • Combined with pathology benefit
    5. Specialised radiology:
    • First R2,250 paid from available day-to-day benefit, but not from above threshold benefit. Balance paid by scheme.
    6. Supplementary Services: (Physio, etc)
    • R4,835 per family
    • Only physio, biokinetics and OT are payable from above-threshold, and only up to R2,750 per family subject to sub-limits

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    Spectramed Azure A 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: mental health, specialised dentistry and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Gastroscopies, colonoscopies, plantar wart removal, removal of ingrown toenail, varicose vein injection/drainage: paid by scheme
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,371 R1,875 R1,016
    Children: Pay for max 3 children, with 2nd child=R616 and 3rd child=R415pm
    Income limit: R0-R8,000 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: mental health, specialised dentistry and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R7,488 R4,164 R2,256

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R14,600 per family with a R1,500 co-payment
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Discovery Classic Comprehensive Zero MSA 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Comprehensive cover with no savings, a self-payment gap and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,380 R3,199 R674
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Comprehensive cover with no savings, a self-payment gap and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-
    (SP) Self Payment: R#VALUE! R#VALUE! R#VALUE!
    Threshold (S+SP): R15,500 R15,500 R2,950
    Above Threshold: No limit No limit No limit

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Only covered once Annual Threshold is reached
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefits. Includes allied, therapeutic and psychology services
    • Main M1 M2 M3+
      R15,560 R21,200 R25,900 R30,000
    • For a defined list of conditions you get unlimited cover for biokineticists, acousticians, physiotherapists, occupational therapists, and speech and language therapists. Speak to Discovery directly

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    Discovery Essential Delta Comprehensive 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Network hospitals. Comprehensive cover with savings, extended fund, and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    • While in the Self Payment Gap, face-to-face and video call consultations with a GP in Premier Plus Network are paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,410 R3,221 R684
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Comprehensive cover that covers most out-of-hospital benefits (with sub limits). Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R6,132 R5,796 R1,224
    (SP) Self Payment: R9,368 R9,704 R1,726
    Threshold (S+SP): R15,500 R15,500 R2,950
    Above Threshold: No limit No limit No limit

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • The first R2,750 from day-to-day benefit, balance paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefits. Includes allied, therapeutic and psychology services
    • Main M1 M2 M3+
      R9,450 R13,350 R17,300 R20,400
    • For a defined list of conditions you get unlimited cover for biokineticists, acousticians, physiotherapists, occupational therapists, and speech and language therapists. Speak to Discovery directly

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    Commed Standard C 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some-co-payments. Network hospitals. Annual limit of R760,000 per person and R1,460,000 per family. Scheme pays out-of-hospital claims for: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    R730k per person, R1,460,000 per family
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,434 R2,815 R690
    Children: Pay for all children
    Income limit: R7,001+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R5,151 R4,223 R1,035

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Topmed Family 2017: Out Of Hospital Benefits
    In brief: 150% scheme rate. Scheme pays out-of-hospital claims for: specialised radiology (with co-payment), maternity, scopes, alternatives to hospitalisation, extended rehab benefits, preventative benefits. In addition, there is a limited above threshold benefit. Limits apply. All else paid from savings, or from above threshold(limited) or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,490 R2,790 R954
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (with co-payment), maternity, scopes, alternatives to hospitalisation, extended rehab benefits, preventative benefits. Limits apply. All else paid from savings, or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R8,376 R6,696 R2,292

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • R4,056 per family from day-to-day benefit
    4. General radiology:
    • R3,624 per family from day-to-day benefit
    5. Specialised radiology:
    • R2,500 co-payment per scan
    6. Supplementary Services: (Physio, etc)
    • R4,032 per family from day-to-day benefit

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    Spectramed Azure B 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: mental health, specialised dentistry and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Gastroscopies, colonoscopies, plantar wart removal, removal of ingrown toenail, varicose vein injection/drainage: paid by scheme
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,501 R2,206 R1,137
    Children: Pay for max 3 children, with 2nd child=R865 and 3rd child=R604pm
    Income limit: R8,001- R11,500 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: mental health, specialised dentistry and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R7,776 R4,896 R2,520

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