Compare in-hospital benefits, by cost of plan

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Makoti Primary A 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • State hospitals
3. Specialised Radiology:
  • PMBs only, in state hospitals
4. Supplementary Services: (Physio, etc)
  • PMBs only, in state hospitals
5. Transplants:
  • PMBs only, in state hospitals
6. Co-payments: None
7. Alternatives to hospitals:

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Makoti Primary B 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • State hospitals
3. Specialised Radiology:
  • PMBs only, in state hospitals
4. Supplementary Services: (Physio, etc)
  • PMBs only, in state hospitals
5. Transplants:
  • PMBs only, in state hospitals
6. Co-payments: None
7. Alternatives to hospitals:

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Compcare Networx ED Plus A 2017: In-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. Payout Rate:
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

Compare with these plans:
2. Hospital Choice:
  • Network (Private)
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
7. Alternatives to hospitals:
  • Step down nursing facilities, hospice and rehabilitation: subject to OAL
  • Private nursing at home: PMBs only

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Topmed Network A 2017: In-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. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Network
3. Specialised Radiology:
  • R2,500 co-payment per scan
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Hysterectomy: R3,500
  • Cholecystectomy: R2,500
  • Tonsils, adenoids, grommets: R500
  • Specialised radiology: R2,500 per scan
7. Alternatives to hospitals:

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Compcare Networx ED A 2017: In-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. Payout Rate:
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

Compare with these plans:
2. Hospital Choice:
  • Network (Private and State)
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
7. Alternatives to hospitals:
  • Step down nursing facilities, hospice and rehabilitation: subject to OAL
  • Private nursing at home: PMBs only

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Momentum Ingwe A 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Unlimited
3. Specialised Radiology:
  • PMBs only, at state facilities
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMBs only, at state facilities
6. Co-payments: n/a
7. Alternatives to hospitals:
  • Medical rehabilitation and step-down facilities: R11,260 per family
  • Private nursing and hospice: no benefit

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Momentum Ingwe Network A 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Ingwe Network
3. Specialised Radiology:
  • PMBs only, at state facilities
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMBs only, at state facilities
6. Co-payments: n/a
7. Alternatives to hospitals:
  • Medical rehabilitation and step-down facilities: R11,260 per family
  • Private nursing and hospice: no benefit

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Momentum Ingwe State A 2017: In-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. Payout Rate:
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. Hospital Choice:
  • State Hospitals
3. Specialised Radiology:
  • PMBs only, at state facilities
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMBs only, at state facilities
6. Co-payments: n/a
7. Alternatives to hospitals:
  • Medical rehabilitation and step-down facilities: R11,260 per family
  • Private nursing and hospice: no benefit

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Sizwe Primary Care A 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Unlimited
3. Specialised Radiology:
  • R17,710 per family
4. Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Dietician, speech therapy, occupational therapy: subject to PMBs
5. Transplants:
6. Co-payments:
7. Alternatives to hospitals:
  • R4,310 per family

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Compcare Networx ED Plus B 2017: In-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. Payout Rate:
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

Compare with these plans:
2. Hospital Choice:
  • Network (Private)
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
7. Alternatives to hospitals:
  • Step down nursing facilities, hospice and rehabilitation: subject to OAL
  • Private nursing at home: PMBs only

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Medihelp Necesse A 2017: In-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. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Network
3. Specialised Radiology:
  • R14,200 per family, in and out of hospital
4. Supplementary Services: (Physio, etc)
  • Physiotherapy and occupational therapy: R8,500 per family
5. Transplants:
  • Cornea implants: R24,750 per implant
  • Otherwise, PMBs only
6. Co-payments:
7. Alternatives to hospitals:
  • Private nursing and sub-acute care: R19,200 per family, subject to authorisation.

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Compcare Networx ED Plus D 2017: In-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. Payout Rate:
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

Compare with these plans:
2. Hospital Choice:
  • Network (Private)
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
7. Alternatives to hospitals:
  • Step down nursing facilities, hospice and rehabilitation: subject to OAL
  • Private nursing at home: PMBs only

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Makoti Primary C 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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. Hospital Choice:
  • State hospitals
3. Specialised Radiology:
  • PMBs only, in state hospitals
4. Supplementary Services: (Physio, etc)
  • PMBs only, in state hospitals
5. Transplants:
  • PMBs only, in state hospitals
6. Co-payments: None
7. Alternatives to hospitals:

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Momentum Ingwe State B 2017: In-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. Payout Rate:
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. Hospital Choice:
  • State Hospitals
3. Specialised Radiology:
  • PMBs only, at state facilities
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMBs only, at state facilities
6. Co-payments: n/a
7. Alternatives to hospitals:
  • Medical rehabilitation and step-down facilities: R11,260 per family
  • Private nursing and hospice: no benefit

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Makoti Primary D 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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. Hospital Choice:
  • State hospitals
3. Specialised Radiology:
  • PMBs only, in state hospitals
4. Supplementary Services: (Physio, etc)
  • PMBs only, in state hospitals
5. Transplants:
  • PMBs only, in state hospitals
6. Co-payments: None
7. Alternatives to hospitals:

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Makoti Primary E 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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. Hospital Choice:
  • State hospitals
3. Specialised Radiology:
  • PMBs only, in state hospitals
4. Supplementary Services: (Physio, etc)
  • PMBs only, in state hospitals
5. Transplants:
  • PMBs only, in state hospitals
6. Co-payments: None
7. Alternatives to hospitals:

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Compcare Networx ED Plus F 2017: In-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. Payout Rate:
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

Compare with these plans:
2. Hospital Choice:
  • Network (Private)
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
7. Alternatives to hospitals:
  • Step down nursing facilities, hospice and rehabilitation: subject to OAL
  • Private nursing at home: PMBs only

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Momentum Ingwe State C 2017: In-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. Payout Rate:
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. Hospital Choice:
  • State Hospitals
3. Specialised Radiology:
  • PMBs only, at state facilities
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMBs only, at state facilities
6. Co-payments: n/a
7. Alternatives to hospitals:
  • Medical rehabilitation and step-down facilities: R11,260 per family
  • Private nursing and hospice: no benefit

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Discovery KeyCare Access A 2017: In-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. Payout Rate:
  • Covered in full at network hospitals
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-

Compare with these plans:
2. Hospital Choice:
  • Emergencies, trauma, childbirth and care for newborn in KeyCare Access Network
  • Traumas covered: injuries at work, burns, injuries from a crime, sexual assault, injuries from a car accident, injuries from a fall, loss of arm, leg or foot, near drowning, head injuries, poisoning or serious allergic reaction that may cause death
  • Other conditions in contracted state facilities
3. Specialised Radiology:
  • If related to approved hospital admission, covered in full
  • If not, Discovery will pay up to R3,250 per person
  • No cover for conservative back or neck treatments
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • Covered
6. Co-payments:
7. Alternatives to hospitals:
  • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
  • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
  • End of life care: R37,350 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home

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Makoti Primary F 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • State hospitals
3. Specialised Radiology:
  • PMBs only, in state hospitals
4. Supplementary Services: (Physio, etc)
  • PMBs only, in state hospitals
5. Transplants:
  • PMBs only, in state hospitals
6. Co-payments: None
7. Alternatives to hospitals:

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Compcare Networx ED B 2017: In-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. Payout Rate:
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

Compare with these plans:
2. Hospital Choice:
  • Network (Private and State)
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
7. Alternatives to hospitals:
  • Step down nursing facilities, hospice and rehabilitation: subject to OAL
  • Private nursing at home: PMBs only

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Compcare Networx ED Plus G 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network (Private)
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
7. Alternatives to hospitals:
  • Step down nursing facilities, hospice and rehabilitation: subject to OAL
  • Private nursing at home: PMBs only

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Compcare Networx ED C 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network (Private and State)
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
7. Alternatives to hospitals:
  • Step down nursing facilities, hospice and rehabilitation: subject to OAL
  • Private nursing at home: PMBs only

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Momentum Ingwe Network B 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Ingwe Network
3. Specialised Radiology:
  • PMBs only, at state facilities
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMBs only, at state facilities
6. Co-payments: n/a
7. Alternatives to hospitals:
  • Medical rehabilitation and step-down facilities: R11,260 per family
  • Private nursing and hospice: no benefit

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Discovery KeyCare Core A 2017: In-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. Payout Rate:
  • Covered in full at network hospitals
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. Hospital Choice:
  • KeyCare Hospital Network or KeyCare day surgery network
3. Specialised Radiology:
  • If related to approved hospital admission, covered in full
  • If not, Discovery will pay up to R3,250 per person
  • No cover for conservative back or neck treatments
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • Covered
6. Co-payments:
  • Endoscopic procedures: Covered if performed in Day Surgery network
7. Alternatives to hospitals:
  • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
  • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
  • End of life care: R37,350 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home

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Momentum Ingwe State D 2017: In-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. Payout Rate:
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. Hospital Choice:
  • State Hospitals
3. Specialised Radiology:
  • PMBs only, at state facilities
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMBs only, at state facilities
6. Co-payments: n/a
7. Alternatives to hospitals:
  • Medical rehabilitation and step-down facilities: R11,260 per family
  • Private nursing and hospice: no benefit

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Fedhealth Blue Door A: In-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. Payout Rate:
  • Covered in full for specialists and GPs in Fedhealth network
  • Otherwise, 100% scheme rate, limited to R2,000 per person
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. Hospital Choice:
  • Network, or R10,000 co-payment
3. Specialised Radiology:
  • R12,100 per person and R24,400 per family
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMBs only, in state facilities
6. Co-payments:
7. Alternatives to hospitals:
  • PMBs only, excludes hospice

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Compcare Networx ED D 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network (Private and State)
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
7. Alternatives to hospitals:
  • Step down nursing facilities, hospice and rehabilitation: subject to OAL
  • Private nursing at home: PMBs only

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Commed Roots A 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Arthroscopy: R3,000 co-payment
  • Circumcision (elective): R2,000 co-payment
  • Colonoscopy, sigmoidoscopy, proctoscopy: R2,500 co-payment
  • Cystoscopy: R2,000 co-payment
  • Dental admissions: R2,000 co-payment
  • Excision nail bed: R2,000 co-payment
  • Gastroscopy: R2,500 co-payment
  • Hernia repair: R2,500 co-payment
  • Hysterectomy: R3,500 co-payment
  • Hysteroscopy: R3,500 co-payment
  • Joint Replacements: R6,000 co-payment
  • Laparoscopic procedures: R3,500 co-payment
  • Myringotomy: R2,000 co-payment
  • Nasal Surgery: R2,500 co-payment
  • Reflux surgery: R3,500 co-payment
  • Skin lesions: R2,000 co-payment
  • Spinal surgery: R6,000 co-payment
  • Urinary incontinence repair: R4,000 co-payment
  • Varicose veins: R4,000 co-payment
7. Alternatives to hospitals:
  • Physical rehabilitation, sub-acute facilities, nursing services, hospice: 14 days per person

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Selfmed Selfnet Essential 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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. Hospital Choice:
  • Network
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • Heart, lung, bone-marrow, kidney and liver transplants only. Donor costs covered up to limits only if recipient is part of the scheme
6. Co-payments:
7. Alternatives to hospitals:

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Compcare Networx ED E 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network (Private and State)
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
7. Alternatives to hospitals:
  • Step down nursing facilities, hospice and rehabilitation: subject to OAL
  • Private nursing at home: PMBs only

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Discovery KeyCare Access B 2017: In-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. Payout Rate:
  • Covered in full at network hospitals
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. Hospital Choice:
  • Emergencies, trauma, childbirth and care for newborn in KeyCare Access Network
  • Traumas covered: injuries at work, burns, injuries from a crime, sexual assault, injuries from a car accident, injuries from a fall, loss of arm, leg or foot, near drowning, head injuries, poisoning or serious allergic reaction that may cause death
  • Other conditions in contracted state facilities
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • Covered
6. Co-payments:
7. Alternatives to hospitals:
  • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
  • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
  • End of life care: R37,350 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home

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Suremed Explorer A 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network
3. Specialised Radiology:
  • 2 scans per family,in and out of hospital
4. Supplementary Services: (Physio, etc)
  • Physiotherapy: R3,300 per family
5. Transplants:
6. Co-payments: none
7. Alternatives to hospitals:
  • Private nursing and step down facilities: R12,500 per family
  • Hospice: R20,000 per family

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Momentum Ingwe Network C 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Ingwe Network
3. Specialised Radiology:
  • PMBs only, at state facilities
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMBs only, at state facilities
6. Co-payments: n/a
7. Alternatives to hospitals:
  • Medical rehabilitation and step-down facilities: R11,260 per family
  • Private nursing and hospice: no benefit

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Resolution Fundation A 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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. Hospital Choice:
  • Network or R3,896 co-payment
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
    Co-payments might apply, depending on scheme protocols and alternative available treatment
7. Alternatives to hospitals:
  • Home nursing: no benefit, unless in lieu of hospitalisation
  • Hospice, rehab and step down facility: no benefit

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Momentum Ingwe B 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Unlimited
3. Specialised Radiology:
  • PMBs only, at state facilities
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMBs only, at state facilities
6. Co-payments: n/a
7. Alternatives to hospitals:
  • Medical rehabilitation and step-down facilities: R11,260 per family
  • Private nursing and hospice: no benefit

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Discovery KeyCare Core B 2017: In-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. Payout Rate:
  • Covered in full at network hospitals
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. Hospital Choice:
  • KeyCare Hospital Network or KeyCare day surgery network
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • Covered
6. Co-payments:
7. Alternatives to hospitals:
  • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
  • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
  • End of life care: R37,350 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home

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Discovery KeyCare Plus A 2017: In-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. Payout Rate:
  • Covered in full at network hospitals
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. Hospital Choice:
  • KeyCare Hospital Network or KeyCare day surgery network
3. Specialised Radiology:
  • If related to approved hospital admission, covered in full
  • If not, Discovery will pay up to R3,250 per person
  • No cover for conservative back or neck treatments
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • Covered
6. Co-payments:
  • Endoscopic procedures: Covered if performed in Day Surgery network
7. Alternatives to hospitals:
  • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
  • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
  • End of life care: R37,350 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home

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Topmed Network B 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network
3. Specialised Radiology:
  • R2,500 co-payment per scan
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Hysterectomy: R3,500
  • Cholecystectomy: R2,500
  • Tonsils, adenoids, grommets: R500
  • Specialised radiology: R2,500 per scan
7. Alternatives to hospitals:

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Commed Roots B 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Arthroscopy: R3,000 co-payment
  • Circumcision (elective): R2,000 co-payment
  • Colonoscopy, sigmoidoscopy, proctoscopy: R2,500 co-payment
  • Cystoscopy: R2,000 co-payment
  • Dental admissions: R2,000 co-payment
  • Excision nail bed: R2,000 co-payment
  • Gastroscopy: R2,500 co-payment
  • Hernia repair: R2,500 co-payment
  • Hysterectomy: R3,500 co-payment
  • Hysteroscopy: R3,500 co-payment
  • Joint Replacements: R6,000 co-payment
  • Laparoscopic procedures: R3,500 co-payment
  • Myringotomy: R2,000 co-payment
  • Nasal Surgery: R2,500 co-payment
  • Reflux surgery: R3,500 co-payment
  • Skin lesions: R2,000 co-payment
  • Spinal surgery: R6,000 co-payment
  • Urinary incontinence repair: R4,000 co-payment
  • Varicose veins: R4,000 co-payment
7. Alternatives to hospitals:
  • Physical rehabilitation, sub-acute facilities, nursing services, hospice: 14 days per person

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Compcare Networx ED F 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network (Private and State)
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
7. Alternatives to hospitals:
  • Step down nursing facilities, hospice and rehabilitation: subject to OAL
  • Private nursing at home: PMBs only

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Fedhealth Blue Door B: In-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. Payout Rate:
  • Covered in full for specialists and GPs in Fedhealth network
  • Otherwise, 100% scheme rate, limited to R2,000 per person
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. Hospital Choice:
  • Network, or R10,000 co-payment
3. Specialised Radiology:
  • R12,100 per person and R24,400 per family
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMBs only, in state facilities
6. Co-payments:
7. Alternatives to hospitals:
  • PMBs only, excludes hospice

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Genesis Private Choice 2017: In-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. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Unlimited
3. Specialised Radiology:
  • R2,750 co-payment per scan
  • Limited to R6,250 per scan, and 2 scans per family
  • Excludes dentoalveolar procedures and conservative treatment of back and neck
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • Limited to R50,000 per person for admissions related to cancer, stroke, motor-neuron disease and organ transplant
6. Co-payments:
  • Specialised Radiology: R2,750 co-payment per scan
  • Internal medical appliances or prosthetics: 50% of cost co-payment
  • External medical appliances 25% of cost co-payment
7. Alternatives to hospitals:
  • No benefit

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Medimed Alpha 2017: In-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. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Unlimited
3. Specialised Radiology:
  • 25% co-payment for non-PMBs
  • , in and out of hospital
4. Supplementary Services: (Physio, etc)
  • 40% co-payment for non-PMBs
  • R4,500 per family, for in and out-of-hospital
5. Transplants:
  • R100,000 per family
  • Benefit is shared with Dialysis Benefit
6. Co-payments:
  • Member pays 25% or 40% co-payment to providers for in-hospital treatment of non-PMBs conditions. No co-payment for PMBs.
7. Alternatives to hospitals:
  • R5,000 per family

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Compcare Networx ED G 2017: In-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. Payout Rate:
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

Compare with these plans:
2. Hospital Choice:
  • Network (Private and State)
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
7. Alternatives to hospitals:
  • Step down nursing facilities, hospice and rehabilitation: subject to OAL
  • Private nursing at home: PMBs only

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Medshield MediPhila 2017: In-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. Payout Rate:
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

Compare with these plans:
2. Hospital Choice:
  • Network
3. Specialised Radiology:
  • 1 scan per family, with 10% co-payment and subject to overall hospital limit
4. Supplementary Services: (Physio, etc)
  • Subject to Overall Annual Limit (see above)
5. Transplants:
6. Co-payments:
  • Endoscopic procedures: R1,500 co-payment if done in hospital
7. Alternatives to hospitals:

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Resolution Fundation B 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Network or R3,896 co-payment
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
    Co-payments might apply, depending on scheme protocols and alternative available treatment
7. Alternatives to hospitals:
  • Home nursing: no benefit, unless in lieu of hospitalisation

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Suremed Explorer B 2017: In-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. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Network
3. Specialised Radiology:
  • 2 scans per family,in and out of hospital
4. Supplementary Services: (Physio, etc)
  • Physiotherapy: R3,300 per family
5. Transplants:
6. Co-payments: none
7. Alternatives to hospitals:
  • Private nursing and step down facilities: R12,500 per family
  • Hospice: R20,000 per family

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Discovery Essential Smart 2017: In-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. Payout Rate:
  • Covered in full for specialists with payment arrangement with Discovery
  • Otherwise, 100% scheme rate
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-

Compare with these plans:
2. Hospital Choice:
  • Hospitals in Smart Network
  • Otherwise, R8,200 co-payment
3. Specialised Radiology:
  • If not related to admission or for conservative back or neck treatment: no benefit
4. Supplementary Services: (Physio, etc)
  • Covered in full for professionals with payment arrangement with Discovery
  • Otherwise, 100% scheme rate
5. Transplants:
  • Covered
6. Co-payments:
  • Scopes: R3,900 co-payment from day-to-day benefit. No co-payment if done in doctor's rooms.
7. Alternatives to hospitals:
  • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
  • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
  • End of life care: R52,750 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home

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Medimed Essential A 2017: In-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. Payout Rate:
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

Compare with these plans:
2. Hospital Choice:
  • Network, or a 20% co-payment applies
3. Specialised Radiology:
  • 3 scans per family, up to R10,000 per family, in and out of hospital
4. Supplementary Services: (Physio, etc)
  • R2,000 per person
5. Transplants:
  • R50,000 per family
  • Benefit is shared with Dialysis and Oncology Benefit
6. Co-payments:
7. Alternatives to hospitals:
  • R6,000 per person

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Bestmed Beat 1 Network 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Netcare Hospitals, or up to R10,000 co-payment if you voluntarily choose another hospital
3. Specialised Radiology:
  • Private hospital: R3,000 co-payment
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Scopes: R3,000 co-payment if in private hospital
  • Specialised radiology: R3,000 co-payment if in private hospital
7. Alternatives to hospitals:

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Bestmed Pulse 1 A 2017: In-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. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Network or R10,000 co-payment
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Private hospital endoscopic procedures: R2,950 co-payment
  • Laparoscopic procedures: R2,950 co-payment
  • Prostate Procedures: R2,950 co-payment
  • Procedures for prolapse/incontinence: R2,950 co-payment
  • Arthroscopy, other than acute trauma: R2,950 co-payment
7. Alternatives to hospitals:

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Selfmed Selfnet 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Network
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • Heart, lung, bone-marrow, kidney and liver transplants only. Donor costs covered up to limits only if recipient is part of the scheme
6. Co-payments:
7. Alternatives to hospitals:

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Hosmed Essential A 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Netcare
3. Specialised Radiology:
  • 2 scans per person, in and out of hospital
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • paid by scheme
6. Co-payments:
7. Alternatives to hospitals:
  • No benefit

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Medimed Essential B 2017: In-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. Payout Rate:
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

Compare with these plans:
2. Hospital Choice:
  • Network, or a 20% co-payment applies
3. Specialised Radiology:
  • 3 scans per family, up to R10,000 per family, in and out of hospital
4. Supplementary Services: (Physio, etc)
  • R2,000 per person
5. Transplants:
  • R50,000 per family
  • Benefit is shared with Dialysis and Oncology Benefit
6. Co-payments:
7. Alternatives to hospitals:
  • R6,000 per person

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Spectramed Aqua 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Unlimited, but a Designated Service Provider must be used for many benefits
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
  • Physio: R2,250 per family
5. Transplants:
6. Co-payments:
  • Dental in-hospital: R2,500 co-payment
  • Gastroscopy, Colonoscopy: R1,500 co-payment if in hospital
  • Sigmoidoscopy: R1,500 co-payment
  • Hysterectomy and reflux surgery: R3,000 co-payment
  • Laparoscopy, hysteroscopy, endometrial ablation: R2,500 co-payment
  • Procedural arthroscopy: R2,000 co-payment
  • Non-surgical admissions: R1,000 co-payment
7. Alternatives to hospitals:
  • No benefit

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Momentum Ingwe Network D 2017: In-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. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Ingwe Network
3. Specialised Radiology:
  • PMBs only, at state facilities
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMBs only, at state facilities
6. Co-payments: n/a
7. Alternatives to hospitals:
  • Medical rehabilitation and step-down facilities: R11,260 per family
  • Private nursing and hospice: no benefit

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Discovery KeyCare Access C 2017: In-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. Payout Rate:
  • Covered in full at network hospitals
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. Hospital Choice:
  • Emergencies, trauma, childbirth and care for newborn in KeyCare Access Network
  • Traumas covered: injuries at work, burns, injuries from a crime, sexual assault, injuries from a car accident, injuries from a fall, loss of arm, leg or foot, near drowning, head injuries, poisoning or serious allergic reaction that may cause death
  • Other conditions in contracted state facilities
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • Covered
6. Co-payments:
7. Alternatives to hospitals:
  • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
  • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
  • End of life care: R37,350 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home

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Bestmed Beat 1 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Unlimited
3. Specialised Radiology:
  • Private hospital: R3,000 co-payment
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Scopes: R3,000 co-payment if in private hospital
  • Specialised radiology: R3,000 co-payment if in private hospital
7. Alternatives to hospitals:

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Medihelp Dimension Prime 1 Network 2017: In-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. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Network (106 facilities)
3. Specialised Radiology:
  • Co-payment of R1,500, in or out of hospital
4. Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • In addition, scheme covers professional services for up to 30 days after discharge following hospital admission, including speech therapy, occupational therapy and physiotherapy. M =R1,650 and M+ =R2,200
5. Transplants:
  • Cornea implants: R24,750 per implant
  • Otherwise, unlimited
6. Co-payments:
  • Back and neck fusion: R10,100 co-payment
  • In-hospital dentistry for children younger than 5yrs: R2,760 co-payment, with dentist's account paid out of pocket
  • Gastroscopy and Colonoscopy in doctor's rooms: R900 co-payment
  • Gastroscopy, Colonoscopy, Arthroscopy, Sigmoidoscopy in-hospital: R2,800 co-payment
  • Specialised radiology: R1,500 co-payment
7. Alternatives to hospitals:
  • Hospice and sub-acute facilities: paid by scheme, subject to authorisation
  • Private nursing: paid by scheme, subject to authorisation

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Compcare Axis ED 2017: In-hospital Benefits
In brief: 100% scheme rate for specialists. Netcare hospitals. Some exclusions apply. Most out-of-hospital benefits covered only if PMBs.
1. Payout Rate:
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. Hospital Choice:
  • Netcare Network
3. Specialised Radiology:
  • R20,000 per family
  • No benefit for screening purposes
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Excision lesion:R1,000
  • Gastroscopy, colonoscopy, cystoscopy, proctoscopy, nasal/sinus endoscopy, hysteroscopy, flexible sigmoidoscopy, diagnostic laparoscopy, dental: R3,300
  • Adenoidectomy, myringotomy, grommets, tonsillectomy: R2,550
  • Laparoscopic hemicolectomy, laparoscopic inguinal hernia repair, laparoscopic appendicectomy : R4,000
  • Laminectomy and spinal fusion, : R8,000
  • Hysterectomy (except for cancer), laparoscopy, hysteroscopy, endometrial ablation, arthroscopy, functional nasal surgry and septoplasty: R6,150
7. Alternatives to hospitals:

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Momentum Custom Associate (and State provider for chronic) 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network hospitals
3. Specialised Radiology:
  • Unlimited with a R2,030 co-payment
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • Recipient: Unlimited
  • Donor R17,600 cadaver costs and R35,700 for live donor costs. Only covered if recipient is a member of the scheme
6. Co-payments:
  • Gastroscopies, nail surgery, cystoscopies, colonoscopies, sigmoidoscopies, removing of extensive skin lesions: R500 co-payment if done in day-clinic
  • Otherwise, R1,200 co-payment for most admissions other than for maternity, motor accident and emergency treatment
  • Specialised radiology: R2,030 co-payment
7. Alternatives to hospitals:
  • Medical rehabilitation, private nursing, hospice and step-down facilities: R44,400 per family. paid by scheme.

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Momentum Ingwe C 2017: In-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. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Unlimited
3. Specialised Radiology:
  • PMBs only, at state facilities
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMBs only, at state facilities
6. Co-payments: n/a
7. Alternatives to hospitals:
  • Medical rehabilitation and step-down facilities: R11,260 per family
  • Private nursing and hospice: no benefit

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Keyhealth Essence 2017: In-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. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Netcare or Life or State
3. Specialised Radiology:
  • MRI and CT scans: R13,900 per family with R1,400 co-payment, in and out of hospital
  • PET scans: No benefit
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • Unlimited, subject to use of DSP
6. Co-payments:
  • Sigmoidoscopy and Cystoscopy: R2,000 co-payment in hospital
  • Hysteroscopy: R2,800 co-payment
  • Arthroscopy and Laparoscopy: R3,500 co-payment
  • Specialised radiology: R1,400 co-payment
7. Alternatives to hospitals:
  • Hospice, private nursing, rehab, step-down and wound care: PMB only

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Discovery KeyCare Plus B 2017: In-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. Payout Rate:
  • Covered in full at network hospitals
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. Hospital Choice:
  • KeyCare Hospital Network or KeyCare day surgery network
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • Covered
6. Co-payments:
7. Alternatives to hospitals:
  • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
  • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
  • End of life care: R37,350 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home

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Topmed Network C 2017: In-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. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Network
3. Specialised Radiology:
  • R2,500 co-payment per scan
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Hysterectomy: R3,500
  • Cholecystectomy: R2,500
  • Tonsils, adenoids, grommets: R500
  • Specialised radiology: R2,500 per scan
7. Alternatives to hospitals:

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Momentum Ingwe State E 2017: In-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. Payout Rate:
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. Hospital Choice:
  • State Hospitals
3. Specialised Radiology:
  • PMBs only, at state facilities
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMBs only, at state facilities
6. Co-payments: n/a
7. Alternatives to hospitals:
  • Medical rehabilitation and step-down facilities: R11,260 per family
  • Private nursing and hospice: no benefit

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Discovery Essential Delta Core 2017: In-hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals. Most day-to-day claims paid from out of pocket, unless PMB.
1. Payout Rate:
  • Covered in full for specialists with payment arrangement with Discovery
  • Otherwise, 100% scheme rate
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. Hospital Choice:
  • Hospitals in Delta Network
  • Otherwise, R7,100 co-payment
3. Specialised Radiology:
  • If not related to admission or for conservative back or neck treatment: no benefit
4. Supplementary Services: (Physio, etc)
  • Covered in full for professionals with payment arrangement with Discovery
  • Otherwise, 100% scheme rate
5. Transplants:
  • Covered
6. Co-payments:
  • Scopes: R3,900 co-payment from day-to-day benefit. No co-payment if done in doctor's rooms.
7. Alternatives to hospitals:
  • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
  • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
  • End of life care: R52,750 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home

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Compcare Networx ED Plus H 2017: In-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. Payout Rate:
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

Compare with these plans:
2. Hospital Choice:
  • Network (Private)
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
7. Alternatives to hospitals:
  • Step down nursing facilities, hospice and rehabilitation: subject to OAL
  • Private nursing at home: PMBs only

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Suremed Shuttle 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Unlimited
3. Specialised Radiology:
  • 3 scans per family,in and out of hospital
4. Supplementary Services: (Physio, etc)
  • Physiotherapy: R5,000 per person
5. Transplants:
6. Co-payments: none
7. Alternatives to hospitals:
  • Private nursing and step down facilities: R14,000 per family
  • Hospice: R20,000 per family

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Medshield MediValue 2017: In-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. Payout Rate:
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

Compare with these plans:
2. Hospital Choice:
  • Network
3. Specialised Radiology:
  • R5,560 per family, with 8% co-payment in and out of hospital
4. Supplementary Services: (Physio, etc)
  • Physiotherapy: Unlimited
5. Transplants:
6. Co-payments:
7. Alternatives to hospitals:
  • Physical rehabilitation, sub-acute facilities, nursing services, hospice: R23,000 per family

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Fedhealth Maxima EntryZone 2017: In-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. Payout Rate:
  • Covered in full for specialists and GPs in Fedhealth network
  • Otherwise, 100% scheme rate
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. Hospital Choice:
  • Network, or a R5,600 co-payment
3. Specialised Radiology:
  • R2,500 co-payment
4. Supplementary Services: (Physio, etc)
  • Physio and biokinetics: 100% scheme rate
  • Dietetics, occupational therapy, speech therapy: PMBs only
5. Transplants:
  • PMBs only, in state facilities
6. Co-payments:
  • Colonoscopy, upper GI endoscopy, open hiatus hernia surgery, spinal surgery, back and neck procedures, bunion procedures, cataract surgery, gastritis, dyspepsia, heartburn, hysterectomy, nasal procedures, skin biopsy/excision, tonsil/adenoid procedures, varicose vein procedures, cystoscopy: R5,300 co-payment
  • Arthroscopic procedures: R6,900 co-payment. Hip or wrist, PMBs only with no co-payment
  • Laparoscopic procedures: R5,800 co-payment
  • Elective caesarean: R10,000 co-payment
7. Alternatives to hospitals:
  • Terminal care: R27,900 per family
  • Physical rehabilitation, sub-acute facilities, nursing services: PMBs only

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Resolution Fundation C 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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. Hospital Choice:
  • Network or R3,896 co-payment
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
    Co-payments might apply, depending on scheme protocols and alternative available treatment
7. Alternatives to hospitals:
  • Home nursing: no benefit, unless in lieu of hospitalisation

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Bestmed Pulse 1 B 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network or R10,000 co-payment
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Private hospital endoscopic procedures: R2,950 co-payment
  • Laparoscopic procedures: R2,950 co-payment
  • Prostate Procedures: R2,950 co-payment
  • Procedures for prolapse/incontinence: R2,950 co-payment
  • Arthroscopy, other than acute trauma: R2,950 co-payment
7. Alternatives to hospitals:

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Fedhealth Blue Door C: In-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. Payout Rate:
  • Covered in full for specialists and GPs in Fedhealth network
  • Otherwise, 100% scheme rate, limited to R2,000 per person
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. Hospital Choice:
  • Network, or R10,000 co-payment
3. Specialised Radiology:
  • R12,100 per person and R24,400 per family
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMBs only, in state facilities
6. Co-payments:
7. Alternatives to hospitals:
  • PMBs only, excludes hospice

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Medimed Essential C 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network, or a 20% co-payment applies
3. Specialised Radiology:
  • 3 scans per family, up to R10,000 per family, in and out of hospital
4. Supplementary Services: (Physio, etc)
  • R2,000 per person
5. Transplants:
  • R50,000 per family
  • Benefit is shared with Dialysis and Oncology Benefit
6. Co-payments:
7. Alternatives to hospitals:
  • R6,000 per person

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Bestmed Beat 2 Network 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Netcare Hospitals, or up to R10,000 co-payment if you voluntarily choose another hospital
3. Specialised Radiology:
  • Private hospital: R3,000 co-payment
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Scopes: R3,000 co-payment if in private hospital
  • Specialised radiology: R3,000 co-payment if in private hospital
7. Alternatives to hospitals:

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Medihelp Necesse B 2017: In-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. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Network
3. Specialised Radiology:
  • R14,200 per family, in and out of hospital
4. Supplementary Services: (Physio, etc)
  • Physiotherapy and occupational therapy: R8,500 per family
5. Transplants:
  • Cornea implants: R24,750 per implant
  • Otherwise, PMBs only
6. Co-payments:
7. Alternatives to hospitals:
  • Private nursing and sub-acute care: R19,200 per family, subject to authorisation.

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Discovery KeyCare Core C 2017: In-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. Payout Rate:
  • Covered in full at network hospitals
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. Hospital Choice:
  • KeyCare Hospital Network or KeyCare day surgery network
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • Covered
6. Co-payments:
7. Alternatives to hospitals:
  • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
  • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
  • End of life care: R37,350 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home

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Commed Roots C 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Arthroscopy: R3,000 co-payment
  • Circumcision (elective): R2,000 co-payment
  • Colonoscopy, sigmoidoscopy, proctoscopy: R2,500 co-payment
  • Cystoscopy: R2,000 co-payment
  • Dental admissions: R2,000 co-payment
  • Excision nail bed: R2,000 co-payment
  • Gastroscopy: R2,500 co-payment
  • Hernia repair: R2,500 co-payment
  • Hysterectomy: R3,500 co-payment
  • Hysteroscopy: R3,500 co-payment
  • Joint Replacements: R6,000 co-payment
  • Laparoscopic procedures: R3,500 co-payment
  • Myringotomy: R2,000 co-payment
  • Nasal Surgery: R2,500 co-payment
  • Reflux surgery: R3,500 co-payment
  • Skin lesions: R2,000 co-payment
  • Spinal surgery: R6,000 co-payment
  • Urinary incontinence repair: R4,000 co-payment
  • Varicose veins: R4,000 co-payment
7. Alternatives to hospitals:
  • Physical rehabilitation, sub-acute facilities, nursing services, hospice: 14 days per person

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Topmed Essential 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Unlimited
3. Specialised Radiology:
  • R2,500 co-payment per scan
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • In-hospital scopes: R2,500 co-payment
  • Specialised radiology: R2,500 co-payment per scan
7. Alternatives to hospitals:
  • Private nursing and step down facilities and hospice: R131,676 per person

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Hosmed Essential B 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Netcare
3. Specialised Radiology:
  • 2 scans per person, in and out of hospital
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • paid by scheme
6. Co-payments:
7. Alternatives to hospitals:
  • No benefit

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Medihelp Necesse C 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network
3. Specialised Radiology:
  • R14,200 per family, in and out of hospital
4. Supplementary Services: (Physio, etc)
  • Physiotherapy and occupational therapy: R8,500 per family
5. Transplants:
  • Cornea implants: R24,750 per implant
  • Otherwise, PMBs only
6. Co-payments:
7. Alternatives to hospitals:
  • Private nursing and sub-acute care: R19,200 per family, subject to authorisation.

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Makoti Comprehensive A 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Private hospitals
3. Specialised Radiology:
  • PMBs only, in private hospitals
4. Supplementary Services: (Physio, etc)
  • PMBs only, in private hospitals
5. Transplants:
  • PMBs only, in private hospitals
6. Co-payments: None
7. Alternatives to hospitals:

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Bonitas Essential 2017: In-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. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Unlimited, but a co-payment may apply for admission to certain hospitals. Speak to scheme.
3. Specialised Radiology:
4. Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Physical rehabilitation: R44,650 per family
5. Transplants:
  • Unlimited
6. Co-payments:
  • Colonoscopy,
  • Conservative back treatment
  • Cystoscopy,
  • Facet joint injections,
  • Flexible sigmoidoscopy,
  • Functional nasal surgery,
  • Gastroscopy,
  • Hysteroscopy,
  • Myringotomy,
  • Tonsillectomy and adenoidectomy
  • Umbilical hernia repair
  • Varicose vein surgery:
  • R1,300 co-payment
  • Arthroscopy,
  • Diagnostic laparoscopy,
  • Laparoscopic hysterectomy (except cancer and PMBs),
  • Laparoscopic appendectomy,
  • Percutaneous rhizotomies,
  • R3,300 co-payment
  • Back surgery including spinal fusion,
  • Joint replacements,
  • Laparoscopic pyeloplasty,
  • Laparoscopic radical prostatectomy,
  • Nissen fundoplication (reflux surgery),
  • R6,500 co-payment
7. Alternatives to hospitals:
  • R14,900 per family

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Discovery Coastal Core 2017: In-hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals. Most day-to-day claims paid from out of pocket, unless PMB.
1. Payout Rate:
  • Covered in full for specialists with payment arrangement with Discovery
  • Otherwise, 100% scheme rate
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-

Compare with these plans:
2. Hospital Choice:
  • Selected private hospitals in coastal provinces
  • Otherwise, no payment if a non-selected hospital is used in coastal province, or a 70% payment if a hospital is used outside the coastal provinces.
3. Specialised Radiology:
  • If not related to admission or for conservative back or neck treatment: no benefit
4. Supplementary Services: (Physio, etc)
  • Covered in full for professionals with payment arrangement with Discovery
  • Otherwise, 100% scheme rate
5. Transplants:
  • Covered
6. Co-payments:
  • Scopes: R3,900 co-payment from day-to-day benefit. No co-payment if done in doctor's rooms.
7. Alternatives to hospitals:
  • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
  • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
  • End of life care: R52,750 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home

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Commed Shina A 2017: In-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. Payout Rate:
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

Compare with these plans:
2. Hospital Choice:
  • Network
3. Specialised Radiology:
  • R6,000 per person with a R2,000 co-payment
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Arthroscopy: R3,000 co-payment
  • Circumcision (elective): R2,000 co-payment
  • Colonoscopy, sigmoidoscopy, proctoscopy: R2,500 co-payment
  • Cystoscopy: R2,000 co-payment
  • Dental admissions: R2,000 co-payment
  • Excision nail bed: R2,000 co-payment
  • Gastroscopy: R2,500 co-payment
  • Hernia repair: R2,500 co-payment
  • Hysterectomy: R3,500 co-payment
  • Hysteroscopy: R3,500 co-payment
  • Joint Replacements: R6,000 co-payment
  • Laparoscopic procedures: R3,500 co-payment
  • Myringotomy: R2,000 co-payment
  • Nasal Surgery: R2,500 co-payment
  • Reflux surgery: R3,500 co-payment
  • Skin lesions: R2,000 co-payment
  • Spinal surgery: R6,000 co-payment
  • Urinary incontinence repair: R4,000 co-payment
  • Varicose veins: R4,000 co-payment
7. Alternatives to hospitals:
  • Physical rehabilitation, sub-acute facilities, nursing services, hospice: 14 days per person

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Genesis Private 2017: In-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. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Unlimited
3. Specialised Radiology:
  • Scans related to conservative treatment of back and neck covered up to 50% scheme rate, and limited to R6,000 per person
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • Limited to R550,000 per person for admissions related to cancer, stroke, motor-neuron disease and organ transplant
  • Cost of immunosuppressants: R84,000
6. Co-payments:
  • External medical appliances: 25% of cost copayment
7. Alternatives to hospitals:
  • Hospice: 100% of cost
  • Home care visits: R200 per day
  • Home visits by medical practitioner: 100% scheme rate

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Topmed Active Saver 2017: In-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. Payout Rate:
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

Compare with these plans:
2. Hospital Choice:
  • Unlimited
3. Specialised Radiology:
  • R2,500 co-payment per scan
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Hysterectomy: R3,500
  • Cholecystectomy, specialised radiology, scopes (in-hospital): R2,500
  • Tonsils, adenoids, grommets: R500
7. Alternatives to hospitals:

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Discovery Classic Smart 2017: In-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. Payout Rate:
  • Covered in full for specialists with payment arrangement with Discovery
  • Otherwise, 200% scheme rate
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-

Compare with these plans:
2. Hospital Choice:
  • Hospitals in Smart Network
  • Otherwise, R8,200 co-payment
3. Specialised Radiology:
  • If not related to admission or for conservative back or neck treatment: R2,750 co-payment
4. Supplementary Services: (Physio, etc)
  • Covered in full for professionals with payment arrangement with Discovery
  • Otherwise, 200% scheme rate
5. Transplants:
  • Covered
6. Co-payments:
  • Scopes: R3,900 co-payment from day-to-day benefit. No co-payment if done in doctor's rooms.
7. Alternatives to hospitals:
  • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
  • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
  • End of life care: R52,750 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home

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Discovery Classic Delta Core 2017: In-hospital Benefits
In brief: 200% scheme rate for specialists. Network hospitals. Most day-to-day claims paid from out of pocket, unless PMB.
1. Payout Rate:
  • Covered in full for specialists with payment arrangement with Discovery
  • Otherwise, 200% scheme rate
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-

Compare with these plans:
2. Hospital Choice:
  • Hospitals in Delta Network
  • Otherwise, R7,100 co-payment
3. Specialised Radiology:
  • If not related to admission or for conservative back or neck treatment: no benefit
4. Supplementary Services: (Physio, etc)
  • Covered in full for professionals with payment arrangement with Discovery
  • Otherwise, 200% scheme rate
5. Transplants:
  • Covered
6. Co-payments:
  • Scopes: R3,900 co-payment from day-to-day benefit. No co-payment if done in doctor's rooms.
7. Alternatives to hospitals:
  • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
  • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
  • End of life care: R52,750 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home

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Cape Medical Premium 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Unlimited for non PMBs
  • PMBs: State or simialar facility, nominated by scheme
3. Specialised Radiology:
  • R10,220 per person with a R1,500 co-payment, in and out of hospital
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • PMB level of care
6. Co-payments:
  • Arthroscopy, appendectomy, inguinal hernia repair, gynaecological procedures, urology procedures, umbilical hernia repair, incisional hernia repair, ventral hernia repair, colectomy, colonoscopy, gastroscopy, hysteroscopy, sympathectomy, vaginal hysterectomy, cystoscopy: R1,000 co-payment
7. Alternatives to hospitals:

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Bestmed Beat 2 2017: In-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. Payout Rate:
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

Compare with these plans:
2. Hospital Choice:
  • Unlimited
3. Specialised Radiology:
  • Private hospital: R3,000 co-payment
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Scopes: R3,000 co-payment if in private hospital
  • Specialised radiology: R3,000 co-payment if in private hospital
7. Alternatives to hospitals:

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Resolution Hospital 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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. Hospital Choice:
  • Network or R3,896 co-payment
3. Specialised Radiology:
  • R7,502 per family with R1,892 co-payment. In and out of hospital
4. Supplementary Services: (Physio, etc)
5. Transplants:
6. Co-payments:
  • Excision nail bed, skin lesions, tympanoplasty:R1,881 co-payment
  • Myringotomy, tonsillectomy, adenoidectomy: R2,193 co-payment
  • Dental admissions, circumcision, colonoscopy, sigmoidoscopy, proctoscopy, cystoscopy, gastroscopy: R2,504 co-payment
  • Hysteroscopy: R2,816 co-payment
  • Arthroscopy, endometrial ablation, laparoscopic procedures, urinary incontinence repair, varicose veins, conservative back, spinal treatment, hernia repair, hysterectomy: R3,751 co-payment
  • Nasal surgery: R5,632 co-payment
  • Joint replacements, rotator cuff surgery: R7,157 co-payment
  • Spinal surgery: R7,824 co-payment
  • Reflux surgery: R10,752 co-payment
7. Alternatives to hospitals:
  • Home nursing: no benefit, unless in lieu of hospitalisation
  • Hospice, rehab and step down facility: 10 days per family

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Momentum Custom Associate (and Network provider for chronic) 2017: In-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. Payout Rate:
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-

Compare with these plans:
2. Hospital Choice:
  • Network hospitals
3. Specialised Radiology:
  • Unlimited with a R2,030 co-payment
4. Supplementary Services: (Physio, etc)
5. Transplants:
  • Recipient: Unlimited
  • Donor R17,600 cadaver costs and R35,700 for live donor costs. Only covered if recipient is a member of the scheme
6. Co-payments:
  • Gastroscopies, nail surgery, cystoscopies, colonoscopies, sigmoidoscopies, removing of extensive skin lesions: R500 co-payment if done in day-clinic
  • Otherwise, R1,200 co-payment for most admissions other than for maternity, motor accident and emergency treatment
  • Specialised radiology: R2,030 co-payment
7. Alternatives to hospitals:
  • Medical rehabilitation, private nursing, hospice and step-down facilities: R44,400 per family. paid by scheme.

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Selfmed MexXXI 2017: In-hospital Benefits
In brief:
1. Payout Rate:
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. Hospital Choice:
  • Network
3. Specialised Radiology:
  • R1,600 co-payment. In and out of hospital
4. Supplementary Services: (Physio, etc)
  • 100% scheme tariff
    5. Transplants:
    • Donor costs covered up to limits only if recipient is part of the scheme
    6. Co-payments:
    7. Alternatives to hospitals:

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    Medihelp Dimension Prime 1 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • Co-payment of R1,500, in or out of hospital
    4. Supplementary Services: (Physio, etc)
    • 100% scheme rate
    • Professional services for up to 30 days after discharge following hospital admission: speech therapy, occupational therapy and physiotherapy. M=R1,650yr and M+=R2,200yr
    5. Transplants:
    • Cornea implants: R24,750 per implant
    • Otherwise, unlimited
    6. Co-payments:
    • Back and neck fusion: R10,100 co-payment
    • In-hospital dentistry for children younger than 5yrs: R2,760 co-payment, with dentist's account paid out of pocket
    • Gastroscopy and Colonoscopy in doctor's rooms: R900 co-payment
    • Gastroscopy, Colonoscopy, Arthroscopy, Sigmoidoscopy in-hospital: R2,800 co-payment
    • Specialised radiology: R1,500 co-payment
    7. Alternatives to hospitals:
    • Hospice and sub-acute facilities: paid by scheme, subject to authorisation
    • Private nursing: paid by scheme, subject to authorisation

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    Momentum Custom (State for chronic) 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • Unlimited with a R2,030 co-payment
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • Recipient: Unlimited
    • Donor R17,600 cadaver costs and R35,700 for live donor costs. Only covered if recipient is a member of the scheme
    6. Co-payments:
    • Gastroscopies, nail surgery, cystoscopies, colonoscopies, sigmoidoscopies, removing of extensive skin lesions: R500 co-payment if done in day-clinic
    • Otherwise, R1,200 co-payment for most admissions other than for maternity, motor accident and emergency treatment
    • Specialised radiology: R2,030 co-payment
    7. Alternatives to hospitals:
    • Medical rehabilitation, private nursing, hospice and step-down facilities: R44,400 per family. paid by scheme.

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    Bestmed Pulse 1 C 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network or R10,000 co-payment
    3. Specialised Radiology:
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    6. Co-payments:
    • Private hospital endoscopic procedures: R2,950 co-payment
    • Laparoscopic procedures: R2,950 co-payment
    • Prostate Procedures: R2,950 co-payment
    • Procedures for prolapse/incontinence: R2,950 co-payment
    • Arthroscopy, other than acute trauma: R2,950 co-payment
    7. Alternatives to hospitals:

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    Discovery Essential Delta Saver 2017: In-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. Payout Rate:
    • Covered in full for specialists with payment arrangement with Discovery
    • Otherwise, 100% scheme rate
    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

    Compare with these plans:
    2. Hospital Choice:
    • Hospitals in Delta Network
    • Otherwise, R7,100 co-payment
    3. Specialised Radiology:
    • If not related to admission or for conservative back or neck treatment: the first R2,750 paid from day-to-day benefit
    4. Supplementary Services: (Physio, etc)
    • Covered in full for professionals with payment arrangement with Discovery
    • Otherwise, 100% scheme rate
    5. Transplants:
    • Covered
    6. Co-payments:
    • Scopes: R3,900 co-payment from day-to-day benefit. No co-payment if done in doctor's rooms.
    7. Alternatives to hospitals:
    • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
    • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
    • End of life care: R52,750 per person, per lifetime
    • Cancer: Unlimited palliative care cover for approved care at home

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    Fedhealth Maxima EntrySaver 2017: In-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. Payout Rate:
    • Covered in full for specialists and GPs in Fedhealth network
    • Otherwise, 100% scheme rate
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • R2,500 co-payment
    4. Supplementary Services: (Physio, etc)
    • Physio and biokinetics: 100% scheme rate
    • Dietetics, occupational therapy, speech therapy: from day-to-day benefit
    5. Transplants:
    • PMBs only, in state facilities
    6. Co-payments:
    • Colonoscopy, upper GI endoscopy, open hiatus hernia surgery, spinal surgery, back and neck procedures, bunion procedures, cataract surgery, gastritis, dyspepsia, heartburn, hysterectomy, nasal procedures, skin biopsy/excision, tonsil/adenoid procedures, varicose vein procedures, cystoscopy: R5,300 co-payment
    • Arthroscopic procedures: R6,900 co-payment
    • Laparoscopic procedures: R5,800 co-payment
    • Elective caesarean: R10,000 co-payment
    7. Alternatives to hospitals:
    • Terminal care: R27,900 per family
    • Physical rehabilitation, sub-acute facilities, nursing services: PMBs only

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    Discovery Essential Core 2017: In-hospital Benefits
    In brief: 100% scheme rate for specialists. Most day-to-day claims paid from out of pocket, unless PMB.
    1. Payout Rate:
    • Covered in full for specialists with payment arrangement with Discovery
    • Otherwise, 100% scheme rate
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • If not related to admission or for conservative back or neck treatment: no benefit
    4. Supplementary Services: (Physio, etc)
    • Covered in full for professionals with payment arrangement with Discovery
    • Otherwise, 100% scheme rate
    5. Transplants:
    • Covered
    6. Co-payments:
    • Scopes: R3,900 co-payment from day-to-day benefit. No co-payment if done in doctor's rooms.
    7. Alternatives to hospitals:
    • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
    • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
    • End of life care: R52,750 per person, per lifetime
    • Cancer: Unlimited palliative care cover for approved care at home

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    Medihelp Necesse D 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network
    3. Specialised Radiology:
    • R14,200 per family, in and out of hospital
    4. Supplementary Services: (Physio, etc)
    • Physiotherapy and occupational therapy: R8,500 per family
    5. Transplants:
    • Cornea implants: R24,750 per implant
    • Otherwise, PMBs only
    6. Co-payments:
    7. Alternatives to hospitals:
    • Private nursing and sub-acute care: R19,200 per family, subject to authorisation.

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    Medimed Essential D 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Network, or a 20% co-payment applies
    3. Specialised Radiology:
    • 3 scans per family, up to R10,000 per family, in and out of hospital
    4. Supplementary Services: (Physio, etc)
    • R2,000 per person
    5. Transplants:
    • R50,000 per family
    • Benefit is shared with Dialysis and Oncology Benefit
    6. Co-payments:
    7. Alternatives to hospitals:
    • R6,000 per person

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    Medimed Standard A 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • 3 scans per family, up to R15,000 per family, in and out of hospital
    4. Supplementary Services: (Physio, etc)
    • R3,000 per family
    5. Transplants:
    • R100,000 per family
    • Benefit is shared with Dialysis Benefit
    6. Co-payments:
    7. Alternatives to hospitals:
    • R10,000 per person

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    Sizwe Gomomo A 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network
    3. Specialised Radiology:
    4. Supplementary Services: (Physio, etc)
    • 100% scheme rate
    • Dietician, speech therapy, occupational therapy: subject to protocols
    5. Transplants:
    • Unlimited, at PMB level of care
    6. Co-payments:
    7. Alternatives to hospitals:

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    Medihelp Dimension Prime 2 Network 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Network (106 facilities)
    3. Specialised Radiology:
    • Co-payment of R1,500, in or out of hospital
    4. Supplementary Services: (Physio, etc)
    • 100% scheme rate
    • In addition, scheme covers professional services for up to 30 days after discharge following hospital admission, including speech therapy, occupational therapy and physiotherapy. M =R1,650 and M+ =R2,200
    5. Transplants:
    • Cornea implants: R24,750 per implant
    • Otherwise, unlimited
    6. Co-payments:
    • Back and neck fusion: R9,000 co-payment
    • In-hospital dentistry for children younger than 5yrs: R1,810 co-payment, with dentist's account paid out of savings account
    • Gastroscopy and Colonoscopy in doctor's rooms: no co-payment
    • Gastroscopy, Colonoscopy, Arthroscopy, Sigmoidoscopy in-hospital: R3,400 co-payment
    • Specialised radiology: R1,500 co-payment
    7. Alternatives to hospitals:
    • Hospice and sub-acute facilities: paid by scheme, subject to authorisation
    • Private nursing: paid by scheme, subject to authorisation

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    Makoti Comprehensive B 2017: In-hospital Benefits
    In brief:
    1. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Private hospitals
    3. Specialised Radiology:
    • PMBs only, in private hospitals
    4. Supplementary Services: (Physio, etc)
    • PMBs only, in private hospitals
    5. Transplants:
    • PMBs only, in private hospitals
    6. Co-payments: None
    7. Alternatives to hospitals:

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    Momentum Incentive Network hospital (and State provider for chronic) 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Network hospitals
    3. Specialised Radiology:
    • Unlimited with a R2,030 co-payment
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • Recipient: Unlimited
    • Donor R17,600 cadaver costs and R35,700 for live donor costs. Only covered if recipient is a member of the scheme
    6. Co-payments:
    • Some in-hospital procedures: R1,200 co-payment applies
    • Specialised radiology: R2,030 co-payment
    7. Alternatives to hospitals:
    • Medical rehabilitation, private nursing, hospice and step-down facilities: R44,400 per family. paid by scheme.

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    Cape Medical Silver 2017: In-hospital Benefits
    In brief:
    1. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited for non PMBs
    • PMBs: State or simialar facility, nominated by scheme
    3. Specialised Radiology:
    • R10,220 per person with a R1,500 co-payment in and out of hospital
    • Thereafter, from day-to-day benefit
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • PMB level of care
    6. Co-payments:
    • Arthroscopy, appendectomy, inguinal hernia repair, gynaecological procedures, urology procedures, umbilical hernia repair, incisional hernia repair, ventral hernia repair, colectomy, colonoscopy, gastroscopy, hysteroscopy, sympathectomy, vaginal hysterectomy, cystoscopy: R1,000 co-payment
    7. Alternatives to hospitals:
    • Hospice and registered nurses: up to 15 days per person

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    Fedhealth Maxima Core Grid 2017: In-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. Payout Rate:
    • Covered in full for specialists and GPs in Fedhealth network
    • Otherwise, 100% scheme rate
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network, or a R5,600 co-payment
    3. Specialised Radiology:
    • R1,900 co-payment
    4. Supplementary Services: (Physio, etc)
    • Physio and biokinetics: 100% scheme rate
    • Dietetics, occupational therapy, speech therapy: PMBs only
    5. Transplants:
    • R250,000 per family
    • Corneal graft: No benefit
    6. Co-payments:
    • Colonoscopy, upper GI endoscopy, hysterectomy, open hiatus hernia surgery, varicose vein procedures, wisdom teeth extraction: R3,700 co-payment
    • Spinal surgery, joint replacements: R5,300 co-payment
    • Arthroscopic procedures: R6,900 co-payment
    • Laparoscopic procedures: R5,800 co-payment
    7. Alternatives to hospitals:
    • Terminal care: R27,900 per family
    • Physical rehabilitation, sub-acute facilities, nursing services: PMBs only

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    Suremed Explorer C 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network
    3. Specialised Radiology:
    • 2 scans per family,in and out of hospital
    4. Supplementary Services: (Physio, etc)
    • Physiotherapy: R3,300 per family
    5. Transplants:
    6. Co-payments: none
    7. Alternatives to hospitals:
    • Private nursing and step down facilities: R12,500 per family
    • Hospice: R20,000 per family

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    Spectramed Cyan A 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited, but a Designated Service Provider must be used for many benefits
    3. Specialised Radiology:
    • R1,500 co-payment and limited to R4,500 per family
    4. Supplementary Services: (Physio, etc)
    • Physio: R2,780 per family
    5. Transplants:
    • R200,000 per family
    6. Co-payments:
    • Dental in-hospital: R2,500 co-payment
    • Gastroscopy, Colonoscopy: R1,500 co-payment if in hospital
    • Sigmoidoscopy: R1,500 co-payment
    • Hysterectomy and reflux surgery: R3,000 co-payment
    • Laparoscopy, hysteroscopy, endometrial ablation: R2,500 co-payment
    • Procedural arthroscopy: R2,000 co-payment
    • Non-surgical admissions: R1,000 co-payment
    7. Alternatives to hospitals:
    • No benefit

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    Momentum Ingwe D 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • PMBs only, at state facilities
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • PMBs only, at state facilities
    6. Co-payments: n/a
    7. Alternatives to hospitals:
    • Medical rehabilitation and step-down facilities: R11,260 per family
    • Private nursing and hospice: no benefit

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    Compcare Axis 2017: In-hospital Benefits
    In brief: 100% scheme rate for specialists. Some exclusions apply. Most out-of-hospital benefits covered only if PMBs.
    1. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • R20,000 per family
    • No benefit for screening purposes
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    6. Co-payments:
    • Excision lesion:R1,000
    • Gastroscopy, colonoscopy, cystoscopy, proctoscopy, nasal/sinus endoscopy, hysteroscopy, flexible sigmoidoscopy, diagnostic laparoscopy, dental: R3,300
    • Adenoidectomy, myringotomy, grommets, tonsillectomy: R2,550
    • Laparoscopic hemicolectomy, laparoscopic inguinal hernia repair, laparoscopic appendicectomy : R4,000
    • Laminectomy and spinal fusion, : R8,000
    • Hysterectomy (except for cancer), laparoscopy, hysteroscopy, endometrial ablation, arthroscopy, functional nasal surgry and septoplasty: R6,150
    7. Alternatives to hospitals:

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    Topmed Network D 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network
    3. Specialised Radiology:
    • R2,500 co-payment per scan
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    6. Co-payments:
    • Hysterectomy: R3,500
    • Cholecystectomy: R2,500
    • Tonsils, adenoids, grommets: R500
    • Specialised radiology: R2,500 per scan
    7. Alternatives to hospitals:

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    Momentum Custom Associate (and any provider for chronic) 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network hospitals
    3. Specialised Radiology:
    • Unlimited with a R2,030 co-payment
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • Recipient: Unlimited
    • Donor R17,600 cadaver costs and R35,700 for live donor costs. Only covered if recipient is a member of the scheme
    6. Co-payments:
    • Gastroscopies, nail surgery, cystoscopies, colonoscopies, sigmoidoscopies, removing of extensive skin lesions: R500 co-payment if done in day-clinic
    • Otherwise, R1,200 co-payment for most admissions other than for maternity, motor accident and emergency treatment
    • Specialised radiology: R2,030 co-payment
    7. Alternatives to hospitals:
    • Medical rehabilitation, private nursing, hospice and step-down facilities: R44,400 per family. paid by scheme.

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    Fedhealth Blue Door D: In-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. Payout Rate:
    • Covered in full for specialists and GPs in Fedhealth network
    • Otherwise, 100% scheme rate, limited to R2,000 per person
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network, or R10,000 co-payment
    3. Specialised Radiology:
    • R12,100 per person and R24,400 per family
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • PMBs only, in state facilities
    6. Co-payments:
    7. Alternatives to hospitals:
    • PMBs only, excludes hospice

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    Momentum Ingwe Network E 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Ingwe Network
    3. Specialised Radiology:
    • PMBs only, at state facilities
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • PMBs only, at state facilities
    6. Co-payments: n/a
    7. Alternatives to hospitals:
    • Medical rehabilitation and step-down facilities: R11,260 per family
    • Private nursing and hospice: no benefit

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    Medimed Standard B 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • 3 scans per family, up to R15,000 per family, in and out of hospital
    4. Supplementary Services: (Physio, etc)
    • R3,000 per family
    5. Transplants:
    • R100,000 per family
    • Benefit is shared with Dialysis Benefit
    6. Co-payments:
    7. Alternatives to hospitals:
    • R10,000 per person

    View this plan

    Bonitas BonFit 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited, but a co-payment may apply for admission to certain hospitals. Speak to scheme.
    3. Specialised Radiology:
    4. Supplementary Services: (Physio, etc)
    • 100% scheme rate
    • Physical rehabilitation: R44,650 per family
    5. Transplants:
    • Unlimited
    6. Co-payments:
    • Colonoscopy,
    • Conservative back treatment
    • Cystoscopy,
    • Facet joint injections,
    • Flexible sigmoidoscopy,
    • Functional nasal surgery,
    • Gastroscopy,
    • Hysteroscopy,
    • Myringotomy,
    • Tonsillectomy and adenoidectomy
    • Umbilical hernia repair
    • Varicose vein surgery:
    • R1,300 co-payment
    • Arthroscopy,
    • Diagnostic laparoscopy,
    • Laparoscopic hysterectomy (except cancer and PMBs),
    • Laparoscopic appendectomy,
    • Percutaneous rhizotomies,
    • R3,300 co-payment
    • Back surgery including spinal fusion,
    • Joint replacements,
    • Laparoscopic pyeloplasty,
    • Laparoscopic radical prostatectomy,
    • Nissen fundoplication (reflux surgery),
    • R6,500 co-payment
    7. Alternatives to hospitals:
    • R14,900 per family

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    Commed Shina B 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Network
    3. Specialised Radiology:
    • R6,000 per person with a R2,000 co-payment
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    6. Co-payments:
    • Arthroscopy: R3,000 co-payment
    • Circumcision (elective): R2,000 co-payment
    • Colonoscopy, sigmoidoscopy, proctoscopy: R2,500 co-payment
    • Cystoscopy: R2,000 co-payment
    • Dental admissions: R2,000 co-payment
    • Excision nail bed: R2,000 co-payment
    • Gastroscopy: R2,500 co-payment
    • Hernia repair: R2,500 co-payment
    • Hysterectomy: R3,500 co-payment
    • Hysteroscopy: R3,500 co-payment
    • Joint Replacements: R6,000 co-payment
    • Laparoscopic procedures: R3,500 co-payment
    • Myringotomy: R2,000 co-payment
    • Nasal Surgery: R2,500 co-payment
    • Reflux surgery: R3,500 co-payment
    • Skin lesions: R2,000 co-payment
    • Spinal surgery: R6,000 co-payment
    • Urinary incontinence repair: R4,000 co-payment
    • Varicose veins: R4,000 co-payment
    7. Alternatives to hospitals:
    • Physical rehabilitation, sub-acute facilities, nursing services, hospice: 14 days per person

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    Keyhealth Equilibrium 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Netcare or Life or State
    3. Specialised Radiology:
    • MRI and CT scans: R13,900 per family with R1,400 co-payment, in and out of hospital
    • PET scans: No benefit
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • Unlimited, subject to use of DSP
    6. Co-payments:
    • Sigmoidoscopy and Cystoscopy: R2,000 co-payment in hospital
    • Hysteroscopy: R2,800 co-payment
    • Arthroscopy and Laparoscopy: R3,500 co-payment
    • Specialised radiology: R1,400 co-payment
    7. Alternatives to hospitals:
    • Hospice, private nursing, rehab, step-down and wound care: PMB only

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    Hosmed Essential C 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Netcare
    3. Specialised Radiology:
    • 2 scans per person, in and out of hospital
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • paid by scheme
    6. Co-payments:
    7. Alternatives to hospitals:
    • No benefit

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    Makoti Comprehensive C 2017: In-hospital Benefits
    In brief:
    1. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Private hospitals
    3. Specialised Radiology:
    • PMBs only, in private hospitals
    4. Supplementary Services: (Physio, etc)
    • PMBs only, in private hospitals
    5. Transplants:
    • PMBs only, in private hospitals
    6. Co-payments: None
    7. Alternatives to hospitals:

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    Momentum Access 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network hospitals
    3. Specialised Radiology:
    • PMBs only, at state facilities
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • PMBs only, at state facilities
    6. Co-payments: n/a
    7. Alternatives to hospitals:
    • Medical rehabilitation, private nursing, hospice and step-down facilities: R43,500 per family. paid by scheme.

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    Discovery KeyCare Access D 2017: In-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. Payout Rate:
    • Covered in full at network hospitals
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Emergencies, trauma, childbirth and care for newborn in KeyCare Access Network
    • Traumas covered: injuries at work, burns, injuries from a crime, sexual assault, injuries from a car accident, injuries from a fall, loss of arm, leg or foot, near drowning, head injuries, poisoning or serious allergic reaction that may cause death
    • Other conditions in contracted state facilities
    3. Specialised Radiology:
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • Covered
    6. Co-payments:
    7. Alternatives to hospitals:
    • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
    • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
    • End of life care: R37,350 per person, per lifetime
    • Cancer: Unlimited palliative care cover for approved care at home

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    Fedhealth Maxima Saver Grid 2017: In-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. Payout Rate:
    • Covered in full for specialists and GPs in Fedhealth network
    • Otherwise, 100% scheme rate
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • R1,900 co-payment
    4. Supplementary Services: (Physio, etc)
    • Physio and biokinetics: 100% scheme rate
    • Dietetics, occupational therapy, speech therapy: from day-to-day benefit
    5. Transplants:
    • R250,000 per family
    • Corneal graft: No benefit
    6. Co-payments:
    • Colonoscopy, upper GI endoscopy, open hiatus hernia surgery, wisdom teeth extraction: R3,700 co-payment
    • Spinal surgery, back and neck procedures, bunion procedures, cataract surgery, elective caesarean, gastritis, dyspepsia, heartburn, hysterectomy, nasal procedures, skin biopsy/excision, tonsil/adenoid procedures, varicose vein procedures, cystoscopy, : R5,300 co-payment
    • Arthroscopic procedures: R6,900 co-payment
    • Dental admissions, laparoscopic procedures: R5,800 co-payment
    7. Alternatives to hospitals:
    • Terminal care: R27,900 per family
    • Physical rehabilitation, sub-acute facilities, nursing services: PMBs only

    View this plan

    Momentum Custom (Network for chronic) 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • Unlimited with a R2,030 co-payment
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • Recipient: Unlimited
    • Donor R17,600 cadaver costs and R35,700 for live donor costs. Only covered if recipient is a member of the scheme
    6. Co-payments:
    • Gastroscopies, nail surgery, cystoscopies, colonoscopies, sigmoidoscopies, removing of extensive skin lesions: R500 co-payment if done in day-clinic
    • Otherwise, R1,200 co-payment for most admissions other than for maternity, motor accident and emergency treatment
    • Specialised radiology: R2,030 co-payment
    7. Alternatives to hospitals:
    • Medical rehabilitation, private nursing, hospice and step-down facilities: R44,400 per family. paid by scheme.

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    Genesis Private Plus 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • Scans related to conservative treatment of back and neck covered up to 50% scheme rate, and limited to R6,000 per person
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • Limited to R550,000 per person for admissions related to cancer, stroke, motor-neuron disease and organ transplant
    • Cost of immunosuppressants: R84,000
    6. Co-payments:
    • External medical appliances: 25% of cost copayment
    7. Alternatives to hospitals:
    • Hospice: 100% of cost
    • Home care visits: R200 per day
    • Home visits by medical practitioner: 100% scheme rate

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    Discovery KeyCare Plus C 2017: In-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. Payout Rate:
    • Covered in full at network hospitals
    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-

    Compare with these plans:
    2. Hospital Choice:
    • KeyCare Hospital Network or KeyCare day surgery network
    3. Specialised Radiology:
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • Covered
    6. Co-payments:
    7. Alternatives to hospitals:
    • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
    • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
    • End of life care: R37,350 per person, per lifetime
    • Cancer: Unlimited palliative care cover for approved care at home

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    Sizwe Primary Care B 2017: In-hospital Benefits
    In brief:
    1. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • R17,710 per family
    4. Supplementary Services: (Physio, etc)
    • 100% scheme rate
    • Dietician, speech therapy, occupational therapy: subject to PMBs
    5. Transplants:
    6. Co-payments:
    7. Alternatives to hospitals:
    • R4,310 per family

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    Fedhealth Maxima Core 2017: In-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. Payout Rate:
    • Covered in full for specialists and GPs in Fedhealth network
    • Otherwise, 100% scheme rate
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • R1,900 co-payment
    4. Supplementary Services: (Physio, etc)
    • Physio and biokinetics: 100% scheme rate
    • Dietetics, occupational therapy, speech therapy: PMBs only
    5. Transplants:
    • R250,000 per family
    • Corneal graft: No benefit
    6. Co-payments:
    • Colonoscopy, upper GI endoscopy, hysterectomy, open hiatus hernia surgery, varicose vein procedures, wisdom teeth extraction: R3,700 co-payment
    • Spinal surgery, joint replacements: R5,300 co-payment
    • Arthroscopic procedures: R6,900 co-payment
    • Laparoscopic procedures: R5,800 co-payment
    7. Alternatives to hospitals:
    • Terminal care: R27,900 per family
    • Physical rehabilitation, sub-acute facilities, nursing services: PMBs only

    View this plan

    Compcare Networx ED H 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Network (Private and State)
    3. Specialised Radiology:
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    6. Co-payments:
    7. Alternatives to hospitals:
    • Step down nursing facilities, hospice and rehabilitation: subject to OAL
    • Private nursing at home: PMBs only

    View this plan

    Discovery Classic Core 2017: In-hospital Benefits
    In brief: 200% scheme rate for specialists. Most day-to-day claims paid from out of pocket, unless PMB.
    1. Payout Rate:
    • Covered in full for specialists with payment arrangement with Discovery
    • Otherwise, 200% scheme rate
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • If not related to admission or for conservative back or neck treatment: no benefit
    4. Supplementary Services: (Physio, etc)
    • Covered in full for professionals with payment arrangement with Discovery
    • Otherwise, 200% scheme rate
    5. Transplants:
    • Covered
    6. Co-payments:
    • Scopes: R3,900 co-payment from day-to-day benefit. No co-payment if done in doctor's rooms.
    7. Alternatives to hospitals:
    • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
    • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
    • End of life care: R52,750 per person, per lifetime
    • Cancer: Unlimited palliative care cover for approved care at home

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    Suremed Explorer D 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network
    3. Specialised Radiology:
    • 2 scans per family,in and out of hospital
    4. Supplementary Services: (Physio, etc)
    • Physiotherapy: R3,300 per family
    5. Transplants:
    6. Co-payments: none
    7. Alternatives to hospitals:
    • Private nursing and step down facilities: R12,500 per family
    • Hospice: R20,000 per family

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    Bonitas Primary 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited, but a co-payment may apply for admission to certain hospitals. Speak to scheme.
    3. Specialised Radiology:
    • R11,700 per family, in and out of hospital
    4. Supplementary Services: (Physio, etc)
    • 100% scheme rate
    • Physical rehabilitation: R44,650 per family
    5. Transplants:
    6. Co-payments:
    • Colonoscopy,
    • Conservative back treatment
    • Cystoscopy,
    • Facet joint injections,
    • Flexible sigmoidoscopy,
    • Functional nasal surgery,
    • Gastroscopy,
    • Hysteroscopy,
    • Myringotomy,
    • Tonsillectomy and adenoidectomy
    • Umbilical hernia repair
    • Varicose vein surgery:
    • R1,300 co-payment
    • Arthroscopy,
    • Diagnostic laparoscopy,
    • Laparoscopic hysterectomy (except cancer and PMBs),
    • Laparoscopic appendectomy,
    • Percutaneous rhizotomies,
    • R3,300 co-payment
    • Back surgery including spinal fusion,
    • Joint replacements,
    • Laparoscopic pyeloplasty,
    • Laparoscopic radical prostatectomy,
    • Nissen fundoplication (reflux surgery),
    • R6,500 co-payment
    7. Alternatives to hospitals:
    • R14,900 per family

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    Medshield MediCore 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network
    3. Specialised Radiology:
    • 1 scan per family, with 10% co-payment
    4. Supplementary Services: (Physio, etc)
    • Physiotherapy: Unlimited
    5. Transplants:
    6. Co-payments:
    • Hernia repair: R3,000
    • Diagnostic laparoscopy: R2,000
    • Reflux: R5,000
    • Hysterectomy: R5,000
    • Functional nasal surgery: R5,000
    • Back surgery: R5,000
    • Scopes: R1,500, in hospital
    7. Alternatives to hospitals:
    • Physical rehabilitation, sub-acute facilities, nursing services, hospice: R30,000 per family

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    Medihelp Necesse E 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network
    3. Specialised Radiology:
    • R14,200 per family, in and out of hospital
    4. Supplementary Services: (Physio, etc)
    • Physiotherapy and occupational therapy: R8,500 per family
    5. Transplants:
    • Cornea implants: R24,750 per implant
    • Otherwise, PMBs only
    6. Co-payments:
    7. Alternatives to hospitals:
    • Private nursing and sub-acute care: R19,200 per family, subject to authorisation.

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    Medihelp Unify 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • R1,500 co-payment, in or out of hospital
    4. Supplementary Services: (Physio, etc)
    • 100% scheme rate
    • In addition, scheme covers professional services for up to 30 days after discharge following hospital admission, including speech therapy, occupational therapy and physiotherapy. M =R1,650 and M+ =R2,200
    5. Transplants:
    6. Co-payments:
    • Back and neck fusion: R9,000 co-payment
    • Gastroscopy, Colonoscopy, Arthroscopy, Sigmoidoscopy in-hospital: R3,400 co-payment
    • Specialised radiology: R1,500 co-payment
    7. Alternatives to hospitals:
    • Hospice and sub-acute facilities: paid by scheme, subject to authorisation
    • Private nursing: paid by scheme, subject to authorisation

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    Compcare Unisave 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • R18,000 per family, with first R1,000 paid from available day-to-day benefits
    • No benefit for screening purposes
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    6. Co-payments:
    • All hospitalisation: R3,500
    • Excision lesion:R1,000
    • Gastroscopy, colonoscopy, cystoscopy, proctoscopy, nasal/sinus endoscopy, hysteroscopy, flexible sigmoidoscopy, diagnostic laparoscopy, dental: R3,300
    • Adenoidectomy, myringotomy, grommets, tonsillectomy: R2,550
    • Laparoscopic hemicolectomy, laparoscopic inguinal hernia repair, laparoscopic appendicectomy : R4,000
    • Laminectomy and spinal fusion, : R8,000
    • Hysterectomy (except for cancer), laparoscopy, hysteroscopy, endometrial ablation, arthroscopy, functional nasal surgry and septoplasty: R6,150
    • Joint replacements, conservative back and neck treatment - spinal cord injections, laminectomy and spinal fusion, nissen fundoplication (reflux surgery):R15,000
    7. Alternatives to hospitals:
    • Step down nursing facilities, hospice and rehabilitation: Unlimited
    • Private nursing at home from day-to-day benefit limited to 60 days per family

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    Medimed Essential E 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Network, or a 20% co-payment applies
    3. Specialised Radiology:
    • 3 scans per family, up to R10,000 per family, in and out of hospital
    4. Supplementary Services: (Physio, etc)
    • R2,000 per person
    5. Transplants:
    • R50,000 per family
    • Benefit is shared with Dialysis and Oncology Benefit
    6. Co-payments:
    7. Alternatives to hospitals:
    • R6,000 per person

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    Spectramed Capri 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited, but a Designated Service Provider must be used for many benefits
    3. Specialised Radiology:
    • R1,500 co-payment and limited to R8,900 per family
    4. Supplementary Services: (Physio, etc)
    • Physio: R3,900 per family
    5. Transplants:
    • R350,000 per family
    6. Co-payments:
    • Dental in-hospital: R2,500 co-payment
    • Gastroscopy, Colonoscopy: R1,500 co-payment if in hospital
    • Sigmoidoscopy: R1,500 co-payment
    • Hysterectomy: R2,500 co-payment
    • Laparoscopy, hysteroscopy, endometrial ablation: R2,500 co-payment
    • Arthroscopy: R1,000 co-payment
    • Reflux surgery: R3,000 co-payment
    • Non-surgical admissions: R1,000 co-payment
    7. Alternatives to hospitals:
    • No benefit

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    Discovery Coastal Saver 2017: In-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. Payout Rate:
    • Covered in full for specialists with payment arrangement with Discovery
    • Otherwise, 100% scheme rate
    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

    Compare with these plans:
    2. Hospital Choice:
    • Selected private hospitals in coastal provinces
    • Otherwise, no payment if a non-selected hospital is used in coastal province, or a 70% payment if a hospital is used outside the coastal provinces.
    3. Specialised Radiology:
    • If not related to admission or for conservative back or neck treatment: the first R2,750 paid from day-to-day benefit
    4. Supplementary Services: (Physio, etc)
    • Covered in full for professionals with payment arrangement with Discovery
    • Otherwise, 100% scheme rate
    5. Transplants:
    • Covered
    6. Co-payments:
    • Scopes: R3,900 co-payment from day-to-day benefit. No co-payment if done in doctor's rooms.
    7. Alternatives to hospitals:
    • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
    • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
    • End of life care: R52,750 per person, per lifetime
    • Cancer: Unlimited palliative care cover for approved care at home

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    Makoti Comprehensive D 2017: In-hospital Benefits
    In brief:
    1. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Private hospitals
    3. Specialised Radiology:
    • PMBs only, in private hospitals
    4. Supplementary Services: (Physio, etc)
    • PMBs only, in private hospitals
    5. Transplants:
    • PMBs only, in private hospitals
    6. Co-payments: None
    7. Alternatives to hospitals:

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    Sizwe Savings Care A 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • R23,960 per family, in and out of hospital
    4. Supplementary Services: (Physio, etc)
    • 100% scheme rate
    • Dietician, speech therapy, occupational therapy: subject to PMBs
    5. Transplants:
    • R190,420 per family
    6. Co-payments:
    7. Alternatives to hospitals:
    • R5,750 per family

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    Resolution Fundation D 2017: In-hospital Benefits
    In brief:
    1. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network or R3,896 co-payment
    3. Specialised Radiology:
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    6. Co-payments:
      Co-payments might apply, depending on scheme protocols and alternative available treatment
    7. Alternatives to hospitals:
    • Home nursing: no benefit, unless in lieu of hospitalisation

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    Discovery Essential Saver 2017: In-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. Payout Rate:
    • Covered in full for specialists with payment arrangement with Discovery
    • Otherwise, 100% scheme rate
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • If not related to admission or for conservative back or neck treatment: the first R2,750 paid from day-to-day benefit
    4. Supplementary Services: (Physio, etc)
    • Covered in full for professionals with payment arrangement with Discovery
    • Otherwise, 100% scheme rate
    5. Transplants:
    • Covered
    6. Co-payments:
    • Scopes: R3,900 co-payment from day-to-day benefit. No co-payment if done in doctor's rooms.
    7. Alternatives to hospitals:
    • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
    • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
    • End of life care: R52,750 per person, per lifetime
    • Cancer: Unlimited palliative care cover for approved care at home

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    Medimed Standard C 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • 3 scans per family, up to R15,000 per family, in and out of hospital
    4. Supplementary Services: (Physio, etc)
    • R3,000 per family
    5. Transplants:
    • R100,000 per family
    • Benefit is shared with Dialysis Benefit
    6. Co-payments:
    7. Alternatives to hospitals:
    • R10,000 per person

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    Compcare Mumed ED 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Netcare Network
    3. Specialised Radiology:
    • R22,000 per family
    • No benefit for screening purposes
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    6. Co-payments:
    • Excision lesion:R1,000
    • Gastroscopy, colonoscopy, cystoscopy, proctoscopy, nasal/sinus endoscopy, hysteroscopy, flexible sigmoidoscopy, diagnostic laparoscopy, dental: R3,300
    • Adenoidectomy, myringotomy, grommets, tonsillectomy: R2,550
    • Laparoscopic hemicolectomy, laparoscopic inguinal hernia repair, laparoscopic appendicectomy : R4,000
    • Laminectomy and spinal fusion, : R8,000
    • Hysterectomy (except for cancer), laparoscopy, hysteroscopy, endometrial ablation, arthroscopy, functional nasal surgry and septoplasty: R6,150
    • Joint replacements, conservative back and neck treatment - spinal cord injections, laminectomy and spinal fusion, nissen fundoplication (reflux surgery):R15,000
    7. Alternatives to hospitals:
    • Step down nursing facilities, hospice and rehabilitation: Unlimited
    • Private nursing at home from day-to-day benefit limited to 60 days per family

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    Discovery Classic Delta Saver 2017: In-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. Payout Rate:
    • Covered in full for specialists with payment arrangement with Discovery
    • Otherwise, 200% scheme rate
    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

    Compare with these plans:
    2. Hospital Choice:
    • Hospitals in Delta Network
    • Otherwise, R7,100 co-payment
    3. Specialised Radiology:
    • If not related to admission or for conservative back or neck treatment: the first R2,750 paid from day-to-day benefit
    4. Supplementary Services: (Physio, etc)
    • Covered in full for professionals with payment arrangement with Discovery
    • Otherwise, 200% scheme rate
    5. Transplants:
    • Covered
    6. Co-payments:
    • Scopes: R3,900 co-payment from day-to-day benefit. No co-payment if done in doctor's rooms.
    7. Alternatives to hospitals:
    • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
    • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
    • End of life care: R52,750 per person, per lifetime
    • Cancer: Unlimited palliative care cover for approved care at home

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    Momentum Custom (Any provider for chronic) 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • Unlimited with a R2,030 co-payment
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • Recipient: Unlimited
    • Donor R17,600 cadaver costs and R35,700 for live donor costs. Only covered if recipient is a member of the scheme
    6. Co-payments:
    • Gastroscopies, nail surgery, cystoscopies, colonoscopies, sigmoidoscopies, removing of extensive skin lesions: R500 co-payment if done in day-clinic
    • Otherwise, R1,200 co-payment for most admissions other than for maternity, motor accident and emergency treatment
    • Specialised radiology: R2,030 co-payment
    7. Alternatives to hospitals:
    • Medical rehabilitation, private nursing, hospice and step-down facilities: R44,400 per family. paid by scheme.

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    Sizwe Gomomo B 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network
    3. Specialised Radiology:
    4. Supplementary Services: (Physio, etc)
    • 100% scheme rate
    • Dietician, speech therapy, occupational therapy: subject to protocols
    5. Transplants:
    • Unlimited, at PMB level of care
    6. Co-payments:
    7. Alternatives to hospitals:

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    Fedhealth Maxima Saver 2017: In-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. Payout Rate:
    • Covered in full for specialists and GPs in Fedhealth network
    • Otherwise, 100% scheme rate
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • R1,900 co-payment
    4. Supplementary Services: (Physio, etc)
    • Physio and biokinetics: 100% scheme rate
    • Dietetics, occupational therapy, speech therapy: from day-to-day benefit
    5. Transplants:
    • R250,000 per family
    • Corneal graft: No benefit
    6. Co-payments:
    • Colonoscopy, upper GI endoscopy, open hiatus hernia surgery, wisdom teeth extraction: R3,700 co-payment
    • Spinal surgery, back and neck procedures, bunion procedures, cataract surgery, elective caesarean, gastritis, dyspepsia, heartburn, hysterectomy, nasal procedures, skin biopsy/excision, tonsil/adenoid procedures, varicose vein procedures, cystoscopy, : R5,300 co-payment
    • Arthroscopic procedures: R6,900 co-payment
    • Dental admissions, laparoscopic procedures: R5,800 co-payment
    7. Alternatives to hospitals:
    • Terminal care: R27,900 per family
    • Physical rehabilitation, sub-acute facilities, nursing services: PMBs only

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    Momentum Incentive (State provider for chronic) 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • Unlimited with a R2,030 co-payment
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • Recipient: Unlimited
    • Donor R17,600 cadaver costs and R35,700 for live donor costs. Only covered if recipient is a member of the scheme
    6. Co-payments:
    • Some in-hospital procedures: R1,200 co-payment applies
    • Specialised radiology: R2,030 co-payment
    7. Alternatives to hospitals:
    • Medical rehabilitation, private nursing, hospice and step-down facilities: R44,400 per family. paid by scheme.

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    Bestmed Beat 3 Network 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Netcare Hospitals, or up to R10,000 co-payment if you voluntarily choose another hospital
    3. Specialised Radiology:
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    6. Co-payments:
    • Scopes: R3,000 co-payment if in private hospital
    7. Alternatives to hospitals:

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    Hosmed Access 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Netcare
    3. Specialised Radiology:
    • 2 scans per person, in and out of hospital
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • paid by scheme
    6. Co-payments: Some co-payments apply
    7. Alternatives to hospitals:
    • No benefit

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    Bonitas BonSave 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited, but a co-payment may apply for admission to certain hospitals. Speak to scheme.
    3. Specialised Radiology:
    • R21,000 per family, in and out of hospital
    4. Supplementary Services: (Physio, etc)
    • 100% scheme rate
    • Physical rehabilitation: R44,650 per family
    5. Transplants:
    • Unlimited
    6. Co-payments:
    • Colonoscopy,
    • Conservative back treatment
    • Cystoscopy,
    • Facet joint injections,
    • Flexible sigmoidoscopy,
    • Functional nasal surgery,
    • Gastroscopy,
    • Hysteroscopy,
    • Myringotomy,
    • Tonsillectomy and adenoidectomy
    • Umbilical hernia repair
    • Varicose vein surgery:
    • R1,300 co-payment
    • Arthroscopy,
    • Diagnostic laparoscopy,
    • Laparoscopic hysterectomy (except cancer and PMBs),
    • Laparoscopic appendectomy,
    • Percutaneous rhizotomies,
    • R3,300 co-payment
    • Back surgery including spinal fusion,
    • Joint replacements,
    • Laparoscopic pyeloplasty,
    • Laparoscopic radical prostatectomy,
    • Nissen fundoplication (reflux surgery),
    • R6,500 co-payment
    7. Alternatives to hospitals:
    • R14,900 per family

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    Medihelp Dimension Prime 2 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • Co-payment of R1,500, in or out of hospital
    4. Supplementary Services: (Physio, etc)
    • 100% scheme rate
    • In addition, scheme covers professional services for up to 30 days after discharge following hospital admission, including speech therapy, occupational therapy and physiotherapy. M =R1,650 and M+ =R2,200
    5. Transplants:
    • Cornea implants: R24,750 per implant
    • Otherwise, unlimited
    6. Co-payments:
    • Back and neck fusion: R9,000 co-payment
    • In-hospital dentistry for children younger than 5yrs: R1,810 co-payment, with dentist's account paid out of savings account
    • Gastroscopy and Colonoscopy in doctor's rooms: no co-payment
    • Gastroscopy, Colonoscopy, Arthroscopy, Sigmoidoscopy in-hospital: R3,400 co-payment
    • Specialised radiology: R1,500 co-payment
    7. Alternatives to hospitals:
    • Hospice and sub-acute facilities: paid by scheme, subject to authorisation
    • Private nursing: paid by scheme, subject to authorisation

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    Resolution Progressive Flex 2017: In-hospital Benefits
    In brief:
    1. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network or R3,896 co-payment
    3. Specialised Radiology:
    • R9,438 per family with R1,892 co-payment. In and out of hospital
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • R112,524 per family
    6. Co-payments:
    • Excision nail bed, skin lesions, tympanoplasty:R1,881 co-payment
    • Myringotomy, tonsillectomy, adenoidectomy: R2,193 co-payment
    • Dental admissions, circumcision, colonoscopy, sigmoidoscopy, proctoscopy, cystoscopy, gastroscopy: R2,504 co-payment
    • Hysteroscopy: R2,816 co-payment
    • Arthroscopy, endometrial ablation, laparoscopic procedures, urinary incontinence repair, varicose veins, conservative back, spinal treatment, hernia repair, hysterectomy: R3,751 co-payment
    • Nasal surgery: R5,632 co-payment
    • Joint replacements, rotator cuff surgery: R7,157 co-payment
    • Spinal surgery: R7,824 co-payment
    • Reflux surgery: R10,752 co-payment
    7. Alternatives to hospitals:
    • Home nursing: 5 days per family
    • Hospice, rehab and step down facility: 12 days per family

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    Medihelp Dimension Prime 3 Network 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network (106 facilities)
    3. Specialised Radiology:
    • Co-payment of R1,500, in or out of hospital
    4. Supplementary Services: (Physio, etc)
    • 100% scheme rate
    • In addition, scheme covers professional services for up to 30 days after discharge following hospital admission, including speech therapy, occupational therapy and physiotherapy. M =R1,650 and M+ =R2,200
    5. Transplants:
    • Cornea implants: R24,750 per implant
    • Otherwise, unlimited
    6. Co-payments:
    • Back and neck fusion: R7,850 co-payment
    • In-hospital dentistry for children younger than 5yrs: R780 co-payment
    • Gastroscopy and Colonoscopy in doctor's rooms: no co-payment
    • Gastroscopy, Colonoscopy, Arthroscopy, Sigmoidoscopy in-hospital: R2,800 co-payment
    • Specialised radiology: R1,500 co-payment
    7. Alternatives to hospitals:
    • Hospice and sub-acute facilities: paid by scheme, subject to authorisation
    • Private nursing: paid by scheme, subject to authorisation

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    Genesis Private Comprehensive 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • Scans related to conservative treatment of back and neck covered up to 50% scheme rate, and limited to R6,000 per person
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • Limited to R550,000 per person for admissions related to cancer, stroke, motor-neuron disease and organ transplant
    • Cost of immunosuppressants: R84,000
    6. Co-payments:
    • External medical appliances: 25% of cost copayment
    7. Alternatives to hospitals:
    • Hospice: 100% of cost
    • Home care visits: R200 per day
    • Home visits by medical practitioner: 100% scheme rate

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    Momentum Ingwe E 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • PMBs only, at state facilities
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • PMBs only, at state facilities
    6. Co-payments: n/a
    7. Alternatives to hospitals:
    • Medical rehabilitation and step-down facilities: R11,260 per family
    • Private nursing and hospice: no benefit

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    Medimed Standard D 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • 3 scans per family, up to R15,000 per family, in and out of hospital
    4. Supplementary Services: (Physio, etc)
    • R3,000 per family
    5. Transplants:
    • R100,000 per family
    • Benefit is shared with Dialysis Benefit
    6. Co-payments:
    7. Alternatives to hospitals:
    • R10,000 per person

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    Topmed Limited 2017: In-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. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • Subject to Overall Annual Limit and 20% co-payment
    4. Supplementary Services: (Physio, etc)
    • Subject to Overall Annual Limit and 20% co-payment
    5. Transplants:
    • Subject to Overall Annual Limit and 20% co-payment
    6. Co-payments:
    • Hospital account at private hospital: 50% of the first R4,950, then 10% of remainder up to a maximum of R10,650
    • All other accounts: 20% co-payment
    7. Alternatives to hospitals:
    • Private nursing and step down facilities and hospice: 21 days per person

    View this plan

    Fedhealth Maxima Basis Grid 2017: In-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. Payout Rate:
    • Covered in full for specialists and GPs in Fedhealth network
    • Otherwise, 100% scheme rate
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • R1,900 co-payment
    4. Supplementary Services: (Physio, etc)
    • Physio and biokinetics: 100% scheme rate
    • Dietetics, occupational therapy, speech therapy: from day-to-day benefit
    5. Transplants:
    • R250,000 per family
    • Corneal graft: No benefit
    6. Co-payments:
    • Colonoscopy, upper GI endoscopy, wisdom teeth extraction, open hernia surgery: R3,700 co-payment
    • Spinal surgery, joint replacements, : R5,300 co-payment
    • Laparoscopic procedures: R5,800 co-payment
    • Arthroscopic procedure: R6,900 co-payment
    7. Alternatives to hospitals:
    • Terminal care: R27,900 per family
    • Physical rehabilitation, sub-acute facilities, nursing services: Unlimited and paid by scheme

    View this plan

    Fedhealth Maxima Standard Elect 2017: In-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. Payout Rate:
    • Covered in full for specialists and GPs in Fedhealth network
    • Otherwise, 100% scheme rate
    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

    Compare with these plans:
    2. Hospital Choice:
    • Network
    3. Specialised Radiology:
    • R1,900 co-payment
    4. Supplementary Services: (Physio, etc)
    • Physio and biokinetics: 100% scheme rate
    • Audiology, dietetics, genetic counselling, occupational therapy, orthoptics, podiatry, psychologists, speech therapy, social workers and chiropractics: R10,500 per family, from day-to-day benefit for in and out of hospital
    5. Transplants:
    • R400,000 per family
    • Corneal graft: R18,700 per family
    6. Co-payments:
    • Colonoscopy, upper GI endoscopy, Arthroscopic procedures: R2,100 co-payment
    • Wisdom teeth extraction, balloon sinuplasty, spinal surgery, joint replacements, all laparoscopic procedures, rhizotomies and facet pain block: R3,700 co-payment
    7. Alternatives to hospitals:
    • Terminal care: R27,900 per family
    • Physical rehabilitation, sub-acute facilities, nursing services: Unlimited and paid by scheme

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    Topmed Savings 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • R2,500 co-payment per scan
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    6. Co-payments:
    • In-hospital scopes: R2,500 co-payment
    • Specialised radiology: R2,500 co-payment per scan
    7. Alternatives to hospitals:
    • Private nursing and step down facilities and hospice: R131,676 per person

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    Momentum Incentive Network hospital (and Network provider for chronic) 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Network hospitals
    3. Specialised Radiology:
    • Unlimited with a R2,030 co-payment
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • Recipient: Unlimited
    • Donor R17,600 cadaver costs and R35,700 for live donor costs. Only covered if recipient is a member of the scheme
    6. Co-payments:
    • Some in-hospital procedures: R1,200 co-payment applies
    • Specialised radiology: R2,030 co-payment
    7. Alternatives to hospitals:
    • Medical rehabilitation, private nursing, hospice and step-down facilities: R44,400 per family. paid by scheme.

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    Sizwe Primary Care C 2017: In-hospital Benefits
    In brief:
    1. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • R17,710 per family
    4. Supplementary Services: (Physio, etc)
    • 100% scheme rate
    • Dietician, speech therapy, occupational therapy: subject to PMBs
    5. Transplants:
    6. Co-payments:
    7. Alternatives to hospitals:
    • R4,310 per family

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    Bestmed Beat 3 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    6. Co-payments:
    • Scopes: R3,000 co-payment if in private hospital
    7. Alternatives to hospitals:

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    Resolution Progressive Flex Plus 2017: In-hospital Benefits
    In brief:
    1. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • R9,438 per family with R1,892 co-payment. In and out of hospital
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • R112,524 per family
    6. Co-payments:
    • Excision nail bed, skin lesions, tympanoplasty:R1,881 co-payment
    • Myringotomy, tonsillectomy, adenoidectomy: R2,193 co-payment
    • Dental admissions, circumcision, colonoscopy, sigmoidoscopy, proctoscopy, cystoscopy, gastroscopy: R2,504 co-payment
    • Hysteroscopy: R2,816 co-payment
    • Arthroscopy, endometrial ablation, laparoscopic procedures, urinary incontinence repair, varicose veins, conservative back, spinal treatment, hernia repair, hysterectomy: R3,751 co-payment
    • Nasal surgery: R5,632 co-payment
    • Joint replacements, rotator cuff surgery: R7,157 co-payment
    • Spinal surgery: R7,824 co-payment
    • Reflux surgery: R10,752 co-payment
    7. Alternatives to hospitals:
    • Home nursing: 5 days per family
    • Hospice, rehab and step down facility: 12 days per family

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    Fedhealth Blue Door E: In-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. Payout Rate:
    • Covered in full for specialists and GPs in Fedhealth network
    • Otherwise, 100% scheme rate, limited to R2,000 per person
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network, or R10,000 co-payment
    3. Specialised Radiology:
    • R12,100 per person and R24,400 per family
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    • PMBs only, in state facilities
    6. Co-payments:
    7. Alternatives to hospitals:
    • PMBs only, excludes hospice

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    Spectramed Cyan B 2017: In-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. Payout Rate:
    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. Hospital Choice:
    • Unlimited, but a Designated Service Provider must be used for many benefits
    3. Specialised Radiology:
    • R1,500 co-payment and limited to R4,500 per family
    4. Supplementary Services: (Physio, etc)
    • Physio: R2,780 per family
    5. Transplants:
    • R200,000 per family
    6. Co-payments:
    • Dental in-hospital: R2,500 co-payment
    • Gastroscopy, Colonoscopy: R1,500 co-payment if in hospital
    • Sigmoidoscopy: R1,500 co-payment
    • Hysterectomy and reflux surgery: R3,000 co-payment
    • Laparoscopy, hysteroscopy, endometrial ablation: R2,500 co-payment
    • Procedural arthroscopy: R2,000 co-payment
    • Non-surgical admissions: R1,000 co-payment
    7. Alternatives to hospitals:
    • No benefit

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    Suremed Navigator 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Unlimited
    3. Specialised Radiology:
    • R14,800 per family,in and out of hospital
    4. Supplementary Services: (Physio, etc)
    • Physiotherapy: R5,000 per person
    5. Transplants:
    • In and out of hospital: R140,000 per family
    6. Co-payments: none
    7. Alternatives to hospitals:
    • Private nursing and step down facilities: R20,000 per family
    • Hospice: R20,000 per family

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    Commed Shina C 2017: In-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. Payout Rate:
    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

    Compare with these plans:
    2. Hospital Choice:
    • Network
    3. Specialised Radiology:
    • R6,000 per person with a R2,000 co-payment
    4. Supplementary Services: (Physio, etc)
    5. Transplants:
    6. Co-payments:
    • Arthroscopy: R3,000 co-payment
    • Circumcision (elective): R2,000 co-payment
    • Colonoscopy, sigmoidoscopy, proctoscopy: R2,500 co-payment
    • Cystoscopy: R2,000 co-payment
    • Dental admissions: R2,000 co-payment
    • Excision nail bed: R2,000 co-payment
    • Gastroscopy: R2,500 co-payment
    • Hernia repair: R2,500 co-payment
    • Hysterectomy: R3,500 co-payment
    • Hysteroscopy: R3,500 co-payment
    • Joint Replacements: R6,000 co-payment
    • Laparoscopic procedures: R3,500 co-payment
    • Myringotomy: R2,000 co-payment
    • Nasal Surgery: R2,500 co-payment
    • Reflux surgery: R3,500 co-payment
    • Skin lesions: R2,000 co-payment
    • Spinal surgery: R6,000 co-payment
    • Urinary incontinence repair: R4,000 co-payment
    • Varicose veins: R4,000 co-payment
    7. Alternatives to hospitals:
    • Physical rehabilitation, sub-acute facilities, nursing services, hospice: 14 days per person

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    Selfmed Selfsure 2017: In-hospital Benefits
    In brief:
    1. Payout Rate:
    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-

    Compare with these plans:
    2. Hospital Choice:
    • Network
    3. Specialised Radiology:
    • R1,600 co-payment. In and out of hospital
    4. Supplementary Services: (Physio, etc)
    • 100% scheme tariff
      5. Transplants:
      • Donor costs covered up to limits only if recipient is part of the scheme
      6. Co-payments:
      7. Alternatives to hospitals:

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      Fedhealth Maxima Basis 2017: In-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. Payout Rate:
      • Covered in full for specialists and GPs in Fedhealth network
      • Otherwise, 100% scheme rate
      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

      Compare with these plans:
      2. Hospital Choice:
      • Unlimited
      3. Specialised Radiology:
      • R1,900 co-payment
      4. Supplementary Services: (Physio, etc)
      • Physio and biokinetics: 100% scheme rate
      • Dietetics, occupational therapy, speech therapy: from day-to-day benefit
      5. Transplants:
      • R250,000 per family
      • Corneal graft: No benefit
      6. Co-payments:
      • Colonoscopy, upper GI endoscopy, wisdom teeth extraction, open hernia surgery: R3,700 co-payment
      • Spinal surgery, joint replacements, : R5,300 co-payment
      • Laparoscopic procedures: R5,800 co-payment
      • Arthroscopic procedure: R6,900 co-payment
      7. Alternatives to hospitals:
      • Terminal care: R27,900 per family
      • Physical rehabilitation, sub-acute facilities, nursing services: Unlimited and paid by scheme

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      Momentum Incentive (Network provider for chronic) 2017: In-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. Payout Rate:
      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

      Compare with these plans:
      2. Hospital Choice:
      • Unlimited
      3. Specialised Radiology:
      • Unlimited with a R2,030 co-payment
      4. Supplementary Services: (Physio, etc)
      5. Transplants:
      • Recipient: Unlimited
      • Donor R17,600 cadaver costs and R35,700 for live donor costs. Only covered if recipient is a member of the scheme
      6. Co-payments:
      • Some in-hospital procedures: R1,200 co-payment applies
      • Specialised radiology: R2,030 co-payment
      7. Alternatives to hospitals:
      • Medical rehabilitation, private nursing, hospice and step-down facilities: R44,400 per family. paid by scheme.

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      Momentum Incentive Network hospital (and any provider for chronic) 2017: In-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. Payout Rate:
      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

      Compare with these plans:
      2. Hospital Choice:
      • Network hospitals
      3. Specialised Radiology:
      • Unlimited with a R2,030 co-payment
      4. Supplementary Services: (Physio, etc)
      5. Transplants:
      • Recipient: Unlimited
      • Donor R17,600 cadaver costs and R35,700 for live donor costs. Only covered if recipient is a member of the scheme
      6. Co-payments:
      • Some in-hospital procedures: R1,200 co-payment applies
      • Specialised radiology: R2,030 co-payment
      7. Alternatives to hospitals:
      • Medical rehabilitation, private nursing, hospice and step-down facilities: R44,400 per family. paid by scheme.

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      Compcare Mumed 2017: In-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. Payout Rate:
      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

      Compare with these plans:
      2. Hospital Choice:
      • Unlimited
      3. Specialised Radiology:
      • R22,000 per family
      • No benefit for screening purposes
      4. Supplementary Services: (Physio, etc)
      5. Transplants:
      6. Co-payments:
      • Excision lesion:R1,000
      • Gastroscopy, colonoscopy, cystoscopy, proctoscopy, nasal/sinus endoscopy, hysteroscopy, flexible sigmoidoscopy, diagnostic laparoscopy, dental: R3,300
      • Adenoidectomy, myringotomy, grommets, tonsillectomy: R2,550
      • Laparoscopic hemicolectomy, laparoscopic inguinal hernia repair, laparoscopic appendicectomy : R4,000
      • Laminectomy and spinal fusion, : R8,000
      • Hysterectomy (except for cancer), laparoscopy, hysteroscopy, endometrial ablation, arthroscopy, functional nasal surgry and septoplasty: R6,150
      • Joint replacements, conservative back and neck treatment - spinal cord injections, laminectomy and spinal fusion, nissen fundoplication (reflux surgery):R15,000
      7. Alternatives to hospitals:
      • Step down nursing facilities, hospice and rehabilitation: Unlimited
      • Private nursing at home from day-to-day benefit limited to 60 days per family

      View this plan

      Medshield MediPlus 2017: In-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. Payout Rate:
      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

      Compare with these plans:
      2. Hospital Choice:
      • Network
      3. Specialised Radiology:
      • R10,200 per family, with 10% co-payment in and out of hospital
      4. Supplementary Services: (Physio, etc)
      • Physiotherapy: Unlimited
      5. Transplants:
      • R140,000 per family
      6. Co-payments:
      • non-PMBs internal prostheses and devices: 25% co-payment
      • non-PMBs PET and PET-CT scan: 10% co-payment
      7. Alternatives to hospitals:
      • Physical rehabilitation, sub-acute facilities, nursing services, hospice: R47,000 per family

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      Discovery Essential Priority 2017: In-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. Payout Rate:
      • Covered in full for specialists with payment arrangement with Discovery
      • Otherwise, 100% scheme rate
      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. Hospital Choice:
      • Unlimited
      3. Specialised Radiology:
      • If not related to admission or for conservative back or neck treatment: you pay the first R2,800 of the hospital account. Also, the first R2,750 of scan is paid from day-to-day benefit.
      4. Supplementary Services: (Physio, etc)
      • Covered in full for professionals with payment arrangement with Discovery
      • Otherwise, 100% scheme rate
      5. Transplants:
      • Covered
      6. Co-payments:
      • Scopes: First R3,150 co-payment paid from day-to-day benefit
      • Conservative back and neck treatment, adenoidectomy, myringotomy (grommets), tonsillectomy: R2,800 co-payment
      • Arthroscopy, functional nasal procedures, hysterectomy, laparoscopy, hysteroscopy, endometrial ablation: R6,750 co-payment
      • Reflux surgery, spinal surgery, joint replacements: R13,850 co-payment
      • No co-payment is procedure can and is done out-of-hospital
      7. Alternatives to hospitals:
      • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
      • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
      • End of life care: R52,750 per person, per lifetime
      • Cancer: Unlimited palliative care cover for approved care at home

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      Medshield MediSaver 2017: In-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. Payout Rate:
      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. Hospital Choice:
      • Network
      3. Specialised Radiology:
      • R15,880 per family, with 10% co-payment in and out of hospital
      4. Supplementary Services: (Physio, etc)
      • Physiotherapy: Unlimited
      5. Transplants:
      • R250,000 per family
      6. Co-payments:
      • non-PMBs internal prostheses and devices: 25% co-payment
      • non-PMBs PET and PET-CT scan: 10% co-payment
      • Nissen Fundoplication: R5,000 co-payment
      • Hernia repair: R3,000 co-payment
      • Diagnostic laparoscopy: R3,000 co-payment
      • Hysterectomy: R5,000 co-payment
      • Functional nasal surgery: R5,000 co-payment
      • Back surgery: R5,000 co-payment
      • Scopes: R1,500 co-payment, in hospital
      7. Alternatives to hospitals:
      • Physical rehabilitation, sub-acute facilities, nursing services, hospice: R50,000 per family

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      Discovery Classic Saver 2017: In-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. Payout Rate:
      • Covered in full for specialists with payment arrangement with Discovery
      • Otherwise, 200% scheme rate
      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. Hospital Choice:
      • Unlimited
      3. Specialised Radiology:
      • If not related to admission or for conservative back or neck treatment: the first R2,750 paid from day-to-day benefit
      4. Supplementary Services: (Physio, etc)
      • Covered in full for professionals with payment arrangement with Discovery
      • Otherwise, 200% scheme rate
      5. Transplants:
      • Covered
      6. Co-payments:
      • Scopes: R3,900 co-payment from day-to-day benefit. No co-payment if done in doctor's rooms.
      7. Alternatives to hospitals:
      • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
      • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
      • End of life care: R52,750 per person, per lifetime
      • Cancer: Unlimited palliative care cover for approved care at home

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      Bonitas Standard Select 2017: In-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. Payout Rate:
      • 100%