Compare medicine benefits, by cost of plan


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

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2. Acute (presrcibed) medication:
3. Over-the-counter:
4. On Discharge:
5. Birth Control:
6. Notes:

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

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2. Acute (presrcibed) medication:
3. Over-the-counter:
4. On Discharge:
5. Birth Control:
6. Notes:

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Compcare Networx ED Plus A 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R283 R279 R154
Children: Pay for all children
Income limit: R0-R500 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Acute (presrcibed) medication:
  • Paid by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply and R 280 per discharge
5. Birth Control:
  • R95 per month
6. Notes:
  • Meds must be prescribed by a Universal Network provider and dispensed by network pharmacy
  • Only formulary is covered, unless otherwise authorised
  • Reference pricing

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Topmed Network A 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R319 R319 R319
Children: Pay for all children
Income limit: R0-R1,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: scopes, medicine, dentistry, optometry, supplementary services, radiology, pathology. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Covered if dispensed by Network GP or pharmacy, according to formulary
3. Over-the-counter:
  • R216 per family per year, with a maximum of R72 per script
4. On Discharge:
  • No benefit
5. Birth Control:
6. Notes:
  • For PMBs chronic medication, there is a 30% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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Compcare Networx ED A 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R330 R330 R330
Children: Pay for all children
Income limit: R0-R500 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Acute (presrcibed) medication:
  • Paid by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply and R 280 per discharge
5. Birth Control:
  • R95 per month
6. Notes:
  • Meds must be prescribed by a Universal Network provider and dispensed by network pharmacy
  • Only formulary is covered, unless otherwise authorised
  • Reference pricing

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Momentum Ingwe A 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe Active Primary Care Network
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R335 R335 R210
Children: Pay for all children
Income limit: R0-R650 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Momentum Ingwe Network A 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe primary Primary Care Network
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R335 R335 R210
Children: Pay for all children
Income limit: R0-R650 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Momentum Ingwe State A 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe primary Primary Care Network
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R335 R335 R210
Children: Pay for all children
Income limit: R0-R650 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Sizwe Primary Care A 2017: Medicine Benefits
In brief:
1. Chronic:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R407 R407 R407
Children: Pay for all children
Income limit: R0-R530 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Day-to-day limit: M =R5,390 M1 =R7,980 M2 =R9,330 M3 =R10,670 M4 =R12,020 M5 =R13,370 M6+ =R14,720
2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit, with following sub limits:
M =R1,680 M1 =R3,030 M2 =R3,370 M3 =R3,820 M4 =R3,930 M5 =R4,150 M6+ =R4,490
3. Over-the-counter:
4. On Discharge:
5. Birth Control:
  • Paid from R2,490 per family
6. Notes:

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Compcare Networx ED Plus B 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R413 R405 R204
Children: Pay for all children
Income limit: R501-R4,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Acute (presrcibed) medication:
  • Paid by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply and R 280 per discharge
5. Birth Control:
  • R95 per month
6. Notes:
  • Meds must be prescribed by a Universal Network provider and dispensed by network pharmacy
  • Only formulary is covered, unless otherwise authorised
  • Reference pricing

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Medihelp Necesse A 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from network pharmacy and according to formulary
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R438 R438 R438
Children: Pay for all children
Income limit: R0-R400 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • If dispensed by GP: 100% of scheme rate
  • Paid from pharmacy: 100% of MMAP
3. Over-the-counter:
  • R100 per event, R260 per person per year
4. On Discharge:
  • R320 per admission
5. Birth Control:
6. Notes:

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Compcare Networx ED Plus D 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R529 R502 R251
Children: Pay for all children
Income limit: R5,001-R6,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Acute (presrcibed) medication:
  • Paid by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply and R 280 per discharge
5. Birth Control:
  • R95 per month
6. Notes:
  • Meds must be prescribed by a Universal Network provider and dispensed by network pharmacy
  • Only formulary is covered, unless otherwise authorised
  • Reference pricing

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Makoti Primary C 2017: Medicine Benefits
In brief:
1. Chronic:
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. Acute (presrcibed) medication:
3. Over-the-counter:
4. On Discharge:
5. Birth Control:
6. Notes:

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Momentum Ingwe State B 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe primary Primary Care Network
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-

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2. Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Makoti Primary D 2017: Medicine Benefits
In brief:
1. Chronic:
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. Acute (presrcibed) medication:
3. Over-the-counter:
4. On Discharge:
5. Birth Control:
6. Notes:

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Makoti Primary E 2017: Medicine Benefits
In brief:
1. Chronic:
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-

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2. Acute (presrcibed) medication:
3. Over-the-counter:
4. On Discharge:
5. Birth Control:
6. Notes:

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Compcare Networx ED Plus F 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R631 R599 R300
Children: Pay for all children
Income limit: R8,001-R9,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Acute (presrcibed) medication:
  • Paid by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply and R 280 per discharge
5. Birth Control:
  • R95 per month
6. Notes:
  • Meds must be prescribed by a Universal Network provider and dispensed by network pharmacy
  • Only formulary is covered, unless otherwise authorised
  • Reference pricing

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Momentum Ingwe State C 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe primary Primary Care Network
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-

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2. Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Discovery KeyCare Access A 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R644 R644 R281
Children: Pay for maximum 3 children
Income limit: R0-R5,050 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Full coverage for medicines on the medicine list, if prescribed by KeyCare network GP
  • From Overall Annual Limit (OAL)
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • Medicines on medicine list, if prescribed by KeyCare network GP: Covered
5. Birth Control:
  • No benefit
6. Notes:

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Makoti Primary F 2017: Medicine Benefits
In brief:
1. Chronic:
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. Acute (presrcibed) medication:
3. Over-the-counter:
4. On Discharge:
5. Birth Control:
6. Notes:

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Compcare Networx ED B 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R665 R632 R233
Children: Pay for all children
Income limit: R501-R4,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Acute (presrcibed) medication:
  • Paid by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply and R 280 per discharge
5. Birth Control:
  • R95 per month
6. Notes:
  • Meds must be prescribed by a Universal Network provider and dispensed by network pharmacy
  • Only formulary is covered, unless otherwise authorised
  • Reference pricing

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Compcare Networx ED Plus G 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
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. Acute (presrcibed) medication:
  • Paid by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply and R 280 per discharge
5. Birth Control:
  • R95 per month
6. Notes:
  • Meds must be prescribed by a Universal Network provider and dispensed by network pharmacy
  • Only formulary is covered, unless otherwise authorised
  • Reference pricing

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Compcare Networx ED C 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
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. Acute (presrcibed) medication:
  • Paid by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply and R 280 per discharge
5. Birth Control:
  • R95 per month
6. Notes:
  • Meds must be prescribed by a Universal Network provider and dispensed by network pharmacy
  • Only formulary is covered, unless otherwise authorised
  • Reference pricing

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Momentum Ingwe Network B 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe primary Primary Care Network
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. Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Discovery KeyCare Core A 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • No benefit
5. Birth Control:
  • No benefit
6. Notes:

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Momentum Ingwe State D 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe primary Primary Care Network
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-

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2. Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Fedhealth Blue Door A: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
  • Unlimited if dispensed by network GP
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
6. Notes:
  • Chronic meds: if not on the formulary, 40% co-payment

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Compcare Networx ED D 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
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

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2. Acute (presrcibed) medication:
  • Paid by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply and R 280 per discharge
5. Birth Control:
  • R95 per month
6. Notes:
  • Meds must be prescribed by a Universal Network provider and dispensed by network pharmacy
  • Only formulary is covered, unless otherwise authorised
  • Reference pricing

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Commed Roots A 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Paid at formulary reference price
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. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
5. Birth Control:
6. Notes:
  • PMBs: Single exit price t plus dispensing fee
  • Otherwise, subject to formulary reference price

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Selfmed Selfnet Essential 2017: Medicine Benefits
In brief:
1. Chronic:
  • PMB chronic: paid by scheme
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. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:
  • Chronic meds: Must be obtained from DSP. Formularies apply. Otherwise, 40% co-payment

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Compcare Networx ED E 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
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

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2. Acute (presrcibed) medication:
  • Paid by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply and R 280 per discharge
5. Birth Control:
  • R95 per month
6. Notes:
  • Meds must be prescribed by a Universal Network provider and dispensed by network pharmacy
  • Only formulary is covered, unless otherwise authorised
  • Reference pricing

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Discovery KeyCare Access B 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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-

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2. Acute (presrcibed) medication:
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • Medicines on medicine list, if prescribed by KeyCare network GP: Covered
5. Birth Control:
  • No benefit
6. Notes:

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Suremed Explorer A 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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-

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2. Acute (presrcibed) medication:
  • Unlimited if prescribed by nominated provider, limited to R70 per event
3. Over-the-counter:
  • R230 per person and R265 per family
4. On Discharge:
  • R300 per event
5. Birth Control:
6. Notes:

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Momentum Ingwe Network C 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe primary Primary Care Network
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-

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2. Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Resolution Fundation A 2017: Medicine Benefits
In brief:
1. Chronic:
  • PMB chronic: paid by scheme
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. Acute (presrcibed) medication:
  • Limited to network providers and formularies
3. Over-the-counter:
  • Limited to network providers and formularies
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:
  • Chronic meds: Must be obtained from DSP. Formularies apply. Reference and GRP pricing apply

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Momentum Ingwe B 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe Active Primary Care Network
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-

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2. Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Discovery KeyCare Core B 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • No benefit
5. Birth Control:
  • No benefit
6. Notes:

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Discovery KeyCare Plus A 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
  • Medicines on medicine list, if prescribed by KeyCare network GP: Covered
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • Medicines on medicine list, if prescribed by KeyCare network GP: Covered
5. Birth Control:
  • No benefit
6. Notes:

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Topmed Network B 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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-

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2. Acute (presrcibed) medication:
  • Covered if dispensed by Network GP or pharmacy, according to formulary
3. Over-the-counter:
  • R216 per family per year, with a maximum of R72 per script
4. On Discharge:
  • No benefit
5. Birth Control:
6. Notes:
  • For PMBs chronic medication, there is a 30% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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Commed Roots B 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Paid at formulary reference price
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. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
5. Birth Control:
6. Notes:
  • PMBs: Single exit price t plus dispensing fee
  • Otherwise, subject to formulary reference price

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Compcare Networx ED F 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
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. Acute (presrcibed) medication:
  • Paid by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply and R 280 per discharge
5. Birth Control:
  • R95 per month
6. Notes:
  • Meds must be prescribed by a Universal Network provider and dispensed by network pharmacy
  • Only formulary is covered, unless otherwise authorised
  • Reference pricing

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Fedhealth Blue Door B: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
  • Unlimited if dispensed by network GP
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
6. Notes:
  • Chronic meds: if not on the formulary, 40% co-payment

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Genesis Private Choice 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: No benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,000 R1,000 R325
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: dentistry. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • No benefit
5. Birth Control:
  • No benefit
6. Notes:
  • Scheme pays 100% of cost for medicines on the formulary

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Medimed Alpha 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme on authorisation
  • Extended chronic conditions: R3,000 per person and R6,000 per family, paid at 75% scheme 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-

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2. Acute (presrcibed) medication:
  • R3,300 per person, R7,900 per family
  • 60% scheme rate, member pays balance
3. Over-the-counter:
  • R120 per prescription and R1,200 per family, subject to acute medicine limit (see above) and a 40% co-payment
4. On Discharge:
5. Birth Control:
6. Notes:

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Compcare Networx ED G 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R1,037 R987 R364
Children: Pay for all children
Income limit: R9,001-R10,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Acute (presrcibed) medication:
  • Paid by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply and R 280 per discharge
5. Birth Control:
  • R95 per month
6. Notes:
  • Meds must be prescribed by a Universal Network provider and dispensed by network pharmacy
  • Only formulary is covered, unless otherwise authorised
  • Reference pricing

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Medshield MediPhila 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
R500,000 per person, R1 million per family for non-PMB
Contributions:
Main: Adult: Child:
Total Cost: R1,041 R1.041 R261
Children: Pay for three children only
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, optometry, preventative benefits. Limits apply. All else paid from extended fund or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,500 per family R R

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2. Acute (presrcibed) medication:
  • R1,135 per family, from day-to-day benefit
3. Over-the-counter:
  • Shared with Acute medicine benefit, and limited to M= R285 and M1+= R395 with R60 limit per script
4. On Discharge:
  • R150 per admission
5. Birth Control:
  • R96 per monthly script
6. Notes:
  • PMB: Basic formulary
  • Out of formulary PMB or obtained from non-network provider: 40% co-payment
  • PMB: reimbursed at Maximum Generic Price

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Resolution Fundation B 2017: Medicine Benefits
In brief:
1. Chronic:
  • PMB chronic: paid by scheme
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. Acute (presrcibed) medication:
  • Limited to network providers and formularies
3. Over-the-counter:
  • Limited to network providers and formularies
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:
  • Chronic meds: Must be obtained from DSP. Formularies apply. Reference and GRP pricing apply

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Suremed Explorer B 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,080 R960 R480
Children: Pay for all children
Income limit: R7,501-R11,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, optometry, pathology, radiology, specialised radiology, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Unlimited if prescribed by nominated provider, limited to R70 per event
3. Over-the-counter:
  • R230 per person and R265 per family
4. On Discharge:
  • R300 per event
5. Birth Control:
6. Notes:

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Discovery Essential Smart 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,100 R1,100 R1,100
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GP consults, eye and dental check up. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Cover for a defined list of medicine, with a R10 co-payment for each medicine item
  • Limited to 12 prescriptions per year per person from network pharmacies
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • No benefit
5. Birth Control:
  • No benefit
6. Notes:
  • Discovery pays for medicine up to the scheme rate, which includes the dispensing fee
  • Use MedExpress to have medicines delivered for free

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Medimed Essential A 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme on authorisation
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,110 R1,110 R380
Children: Pay for all children
Income limit: R0-R7,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, GPs, specialists, medication, dentistry, optometry, radiology and pathology. Limits apply. All else paid from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R1,332 R1,332 R456

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2. Acute (presrcibed) medication:
  • Unlimited if prescribed by GP according to formulary
  • Paid by scheme
3. Over-the-counter:
  • R100 per prescription, and R400 per family
  • Paid from day-to-day benefit
4. On Discharge:
  • See "Acute Medicine" benefit
5. Birth Control:
6. Notes:
  • For acute medicine not on the formulary: if there is a generic equivalent on the formulary, scheme will pay maximum of formulary generic alternative. If there is no generic equivalent, the member pays full amount out-of-pocket.

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Bestmed Beat 1 Network 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Co-payment if out of formulary: 40% co-payment
  • Overall limit: unlimited
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-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days
5. Birth Control:
  • R1,800 per family per year, paid by scheme
6. Notes:

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Bestmed Pulse 1 A 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Co-payment if out of formulary: 40% co-payment
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,131 R1,075 R679
Children: Pay for maximum 4 children
Income limit: R0-R6,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GP and specialist consults, dentistry, optometry, maternity, radiology and pathology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
3. Over-the-counter:
  • R300 per family
4. On Discharge:
  • 7 days
5. Birth Control:
  • R1,800 per family per year, paid by scheme
6. Notes:

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Selfmed Selfnet 2017: Medicine Benefits
In brief:
1. Chronic:
  • PMB chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,185 R1,185 R418
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Covered if prescribed by Network GP and part of formulary
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:
  • Chronic meds: Must be obtained from DSP. Formularies apply. Otherwise, 40% co-payment

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Hosmed Essential A 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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-

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2. Acute (presrcibed) medication:
  • Unlimited if dispensed by network GP
  • R950 per person, and R2,650 per family if obtained from pharmacy
3. Over-the-counter:
  • R210 per family, with a maximum of R80 per script
4. On Discharge:
  • 5 days
5. Birth Control:
  • R55 per person, limited to R660 per family per year
6. Notes: Medicines paid at reference price, subject to formulary

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Medimed Essential B 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme on authorisation
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,200 R1,200 R390
Children: Pay for all children
Income limit: R7,001-R8,500 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, GPs, specialists, medication, dentistry, optometry, radiology and pathology. Limits apply. All else paid from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R1,440 R1,440 R468

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2. Acute (presrcibed) medication:
  • Unlimited if prescribed by GP according to formulary
  • Paid by scheme
3. Over-the-counter:
  • R100 per prescription, and R400 per family
  • Paid from day-to-day benefit
4. On Discharge:
  • See "Acute Medicine" benefit
5. Birth Control:
6. Notes:
  • For acute medicine not on the formulary: if there is a generic equivalent on the formulary, scheme will pay maximum of formulary generic alternative. If there is no generic equivalent, the member pays full amount out-of-pocket.

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Spectramed Aqua 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
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. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 5 days supply
5. Birth Control:
  • No benefit
6. Notes:
  • All medication must be on formulary, otherwise no benefit
  • All medication must be obtained from DSP, otherwise 40% co-payment

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Momentum Ingwe Network D 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe primary Primary Care Network
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R1,241 R1,241 R365
Children: Pay for all children
Income limit: R8,201-R11,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Discovery KeyCare Access C 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • Medicines on medicine list, if prescribed by KeyCare network GP: Covered
5. Birth Control:
  • No benefit
6. Notes:

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Bestmed Beat 1 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Co-payment if out of formulary: 40% co-payment
  • Overall limit: unlimited
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. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days
5. Birth Control:
  • R1,800 per family per year, paid by scheme
6. Notes:

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Medihelp Dimension Prime 1 Network 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,260 R1,026 R378
Children: Pay for maximum 2 children under 18yrs.
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment), GP, specialists, physio, medication, maternity, infant paediatrics, medical appliances. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Acute (presrcibed) medication:
  • M =R1,050 and M+ =R2,100
  • Shared with GPs, specialists, physio, acute medicine and over the counter medication
3. Over-the-counter:
  • M= R1,000 and M+= R2,000
  • Shared with GP and Acute medicine benefit
  • paid by scheme
4. On Discharge:
  • R320 per admission
5. Birth Control:
  • See "Acute Medicine" benefit, above
6. Notes:
  • PMBs chronic: only 40% of the reference price is paid if medicine is outside the formulary and/or obtained from non-network provider
  • For acute and non-PMBs chronic medicines:
    • 80% of scheme rate where no generic is available
    • 70% of MMAP (maximum medical aid price) for voluntary use of original medicine where generic is available

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Compcare Axis ED 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Netcare hospitals. Some exclusions apply. Most out-of-hospital benefits covered only if PMBs.
1. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
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. Acute (presrcibed) medication:
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • R120 per month
6. Notes:

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Momentum Custom Associate (and State provider for chronic) 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from State provider
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. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Momentum Ingwe C 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe Active Primary Care Network
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. Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Keyhealth Essence 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • R450
5. Birth Control:
  • No benefit
6. Notes:
  • Chronic medicine: 30% co-payment where non-DSP pharmacy is used
  • Reference pricing

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Discovery KeyCare Plus B 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
  • Medicines on medicine list, if prescribed by KeyCare network GP: Covered
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • Medicines on medicine list, if prescribed by KeyCare network GP: Covered
5. Birth Control:
  • No benefit
6. Notes:

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Topmed Network C 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
  • Covered if dispensed by Network GP or pharmacy, according to formulary
3. Over-the-counter:
  • R216 per family per year, with a maximum of R72 per script
4. On Discharge:
  • No benefit
5. Birth Control:
6. Notes:
  • For PMBs chronic medication, there is a 30% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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Momentum Ingwe State E 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe primary Primary Care Network
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. Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Discovery Essential Delta Core 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Network hospitals. Most day-to-day claims paid from out of pocket, unless PMB.
1. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • No benefit
5. Birth Control:
  • No benefit
6. Notes:
  • Discovery pays for medicine up to the scheme rate, which includes the dispensing fee
  • Use MedExpress to have medicines delivered for free

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Compcare Networx ED Plus H 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R1,318 R1,186 R585
Children: Pay for all children
Income limit: R10,001+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Acute (presrcibed) medication:
  • Paid by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply and R 280 per discharge
5. Birth Control:
  • R95 per month
6. Notes:
  • Meds must be prescribed by a Universal Network provider and dispensed by network pharmacy
  • Only formulary is covered, unless otherwise authorised
  • Reference pricing

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Suremed Shuttle 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • No benefit
5. Birth Control:
  • No benefit
6. Notes:

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Medshield MediValue 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,521 R1,323 R414
Children: Pay for three children only
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, alternative to hospitalisation, optometry, some non-surgical procedures including scopes,preventative benefits. Limits apply. All else paid from extended fund or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: RM= R4,815
M1= R5,240
M2= R5,900
M3= R6,660
M4+ =R7,600
R R

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • R185 per script. Limited to R400 per person and R600 per family. Paid from day-to-day benefit
4. On Discharge:
  • R400 per admission
5. Birth Control:
  • R140 per monthly script
  • Mirena: one per female every four years. Includes consultation, insertion if done in rooms.
6. Notes:
  • PMB: Restrictive formulary
  • Out of formulary PMB or obtained from non-network provider: 40% co-payment
  • PMB: reimbursed at Maximum Generic Price

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Fedhealth Maxima EntryZone 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Devices and medicine: paid by scheme, including IUDs
  • Consultations: from day-to-day benefit
6. Notes:
  • Chronic meds: if not on the formulary, 40% co-payment

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Resolution Fundation C 2017: Medicine Benefits
In brief:
1. Chronic:
  • PMB chronic: paid by scheme
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-

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2. Acute (presrcibed) medication:
  • Limited to network providers and formularies
3. Over-the-counter:
  • Limited to network providers and formularies
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:
  • Chronic meds: Must be obtained from DSP. Formularies apply. Reference and GRP pricing apply

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Bestmed Pulse 1 B 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Co-payment if out of formulary: 40% co-payment
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-

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2. Acute (presrcibed) medication:
3. Over-the-counter:
  • R300 per family
4. On Discharge:
  • 7 days
5. Birth Control:
  • R1,800 per family per year, paid by scheme
6. Notes:

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Fedhealth Blue Door C: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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-

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2. Acute (presrcibed) medication:
  • Unlimited if dispensed by network GP
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
6. Notes:
  • Chronic meds: if not on the formulary, 40% co-payment

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Medimed Essential C 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme on authorisation
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

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2. Acute (presrcibed) medication:
  • Unlimited if prescribed by GP according to formulary
  • Paid by scheme
3. Over-the-counter:
  • R100 per prescription, and R400 per family
  • Paid from day-to-day benefit
4. On Discharge:
  • See "Acute Medicine" benefit
5. Birth Control:
6. Notes:
  • For acute medicine not on the formulary: if there is a generic equivalent on the formulary, scheme will pay maximum of formulary generic alternative. If there is no generic equivalent, the member pays full amount out-of-pocket.

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Bestmed Beat 2 Network 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Co-payment if out of formulary: 40% co-payment
  • Overall limit: unlimited
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

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days
5. Birth Control:
  • R1,800 per family per year, paid by scheme
6. Notes:

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Medihelp Necesse B 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from network pharmacy and according to formulary
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,404 R1,110 R600
Children: Pay for all children
Income limit: R401-R5,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • If dispensed by GP: 100% of scheme rate
  • Paid from pharmacy: 100% of MMAP
3. Over-the-counter:
  • R100 per event, R260 per person per year
4. On Discharge:
  • R320 per admission
5. Birth Control:
6. Notes:

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Discovery KeyCare Core C 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • No benefit
5. Birth Control:
  • No benefit
6. Notes:

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Commed Roots C 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Paid at formulary reference price
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-

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
5. Birth Control:
6. Notes:
  • PMBs: Single exit price t plus dispensing fee
  • Otherwise, subject to formulary reference price

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Topmed Essential 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:
  • For PMBs chronic medication, there is a 30% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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Hosmed Essential B 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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-

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2. Acute (presrcibed) medication:
  • Unlimited if dispensed by network GP
  • R950 per person, and R2,650 per family if obtained from pharmacy
3. Over-the-counter:
  • R210 per family, with a maximum of R80 per script
4. On Discharge:
  • 5 days
5. Birth Control:
  • R55 per person, limited to R660 per family per year
6. Notes: Medicines paid at reference price, subject to formulary

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Medihelp Necesse C 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from network pharmacy and according to formulary
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-

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2. Acute (presrcibed) medication:
  • If dispensed by GP: 100% of scheme rate
  • Paid from pharmacy: 100% of MMAP
3. Over-the-counter:
  • R100 per event, R260 per person per year
4. On Discharge:
  • R320 per admission
5. Birth Control:
6. Notes:

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

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2. Acute (presrcibed) medication:
3. Over-the-counter:
4. On Discharge:
5. Birth Control:
6. Notes:

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Bonitas Essential 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Co-payment if out of formulary: 40% co-payment
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,473 R1,127 R432
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • R340 per person per admission
5. Birth Control:
  • No benefit
6. Notes:
  • For PMBs chronic medication, there is a 40% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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Discovery Coastal Core 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Network hospitals. Most day-to-day claims paid from out of pocket, unless PMB.
1. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • No benefit
5. Birth Control:
  • No benefit
6. Notes:
  • Discovery pays for medicine up to the scheme rate, which includes the dispensing fee
  • Use MedExpress to have medicines delivered for free

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Commed Shina A 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Paid at formulary reference price
Overall Annual Limit (OAL):
R600k per person, R1,200,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R1,498 R1,274 R300
Children: Pay for all children
Income limit: R0-R6,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R1,798 R1,529 R360

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
5. Birth Control:
6. Notes:
  • PMBs: Single exit price t plus dispensing fee
  • Otherwise, subject to formulary reference price

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Genesis Private 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • No benefit
5. Birth Control:
  • No benefit
6. Notes:
  • Scheme pays 100% of cost for medicines on the formulary

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Topmed Active Saver 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Paid by scheme
6. Notes:
  • For PMBs chronic medication, there is a 30% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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Discovery Classic Smart 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,535 R1,209 R612
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GP consults, acute meds, eye and dental check up and sport related injuries, specialised radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Cover for a defined list of medicine, with a R10 co-payment for each medicine item
  • Limited to 12 prescriptions per year per person from network pharmacies
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • No benefit
5. Birth Control:
  • No benefit
6. Notes:
  • Discovery pays for medicine up to the scheme rate, which includes the dispensing fee
  • Use MedExpress to have medicines delivered for free

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Discovery Classic Delta Core 2017: Medicine Benefits
In brief: 200% scheme rate for specialists. Network hospitals. Most day-to-day claims paid from out of pocket, unless PMB.
1. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,535 R1,209 R612
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Most claims paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • No benefit
5. Birth Control:
  • No benefit
6. Notes:
  • Discovery pays for medicine up to the scheme rate, which includes the dispensing fee
  • Use MedExpress to have medicines delivered for free

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Cape Medical Premium 2017: Medicine Benefits
In brief:
1. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,548 R1,548 R271
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • No benefit
5. Birth Control:
  • No benefit
6. Notes:
  • Medicines are paid at cost to a maximum of Single Exit price plus dispensing fee

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Bestmed Beat 2 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Co-payment if out of formulary: 40% co-payment
  • Overall limit: unlimited
Overall Annual Limit (OAL):
Unlimited overall, but sub-limits can apply
Contributions:
Main: Adult: Child:
Total Cost: R1,554 R1,208 R655
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Preventative dentistry, wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,168 R2,460 R1,332

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days
5. Birth Control:
  • R1,800 per family per year, paid by scheme
6. Notes:

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Resolution Hospital 2017: Medicine Benefits
In brief:
1. Chronic:
  • PMB chronic: paid by scheme
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-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:
  • Chronic meds: Must be obtained from DSP. Formularies apply. Reference and GRP pricing apply

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Momentum Custom Associate (and Network provider for chronic) 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from Network provider
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,573 R1,219 R556
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Selfmed MexXXI 2017: Medicine Benefits
In brief:
1. Chronic:
  • PMB chronic: paid by scheme
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-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • R1,500 per family
6. Notes:
  • Chronic meds: Must be obtained from DSP. Formularies apply. Otherwise, 40% co-payment

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Medihelp Dimension Prime 1 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,608 R1,320 R486
Children: Pay for maximum 2 children under 18yrs.
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment), GP, specialists, physio, medication, maternity, infant paediatrics, medical appliances. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • M =R1,050 and M+ =R2,100
  • Shared with GPs, specialists, physio, acute medicine and over the counter medication
3. Over-the-counter:
  • M= R1,000 and M+= R2,000
  • Shared with GP benefit
4. On Discharge:
  • R320 per admission
5. Birth Control:
  • See "Acute Medicine" benefit, above
6. Notes:
  • PMBs chronic: only 40% of the reference price is paid if medicine is outside the formulary and/or obtained from non-network provider
  • For acute and non-PMBs chronic medicines:
    • 80% of scheme rate where no generic is available
    • 70% of MMAP (maximum medical aid price) for voluntary use of original medicine where generic is available

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Momentum Custom (State for chronic) 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from State provider
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,610 R1,215 R590
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Bestmed Pulse 1 C 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Co-payment if out of formulary: 40% co-payment
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,630 R1,466 R814
Children: Pay for maximum 4 children
Income limit: R10,001+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GP and specialist consults, dentistry, optometry, maternity, radiology and pathology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
3. Over-the-counter:
  • R300 per family
4. On Discharge:
  • 7 days
5. Birth Control:
  • R1,800 per family per year, paid by scheme
6. Notes:

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Discovery Essential Delta Saver 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,634 R1,230 R655
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GP consults if savings run out. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R2,940 R2,208 R1,176

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • Paid from day-to-day benefit
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • Discovery pays for medicine up to the scheme rate, which includes the dispensing fee
  • Use MedExpress to have medicines delivered for free

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Fedhealth Maxima EntrySaver 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,640 R1,181 R524
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: post hospitalisation treatment (30 days), casualty visits, GP visits, specialised radiology, contraceptives, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,168 R2,280 R1,008

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Devices and medicine: paid by scheme, including IUDs
  • Consultations: from day-to-day benefit
6. Notes:
  • Chronic meds: if not on the formulary, 40% co-payment

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Discovery Essential Core 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Most day-to-day claims paid from out of pocket, unless PMB.
1. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,648 R1,234 R661
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Most claims paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • No benefit
5. Birth Control:
  • No benefit
6. Notes:
  • Discovery pays for medicine up to the scheme rate, which includes the dispensing fee
  • Use MedExpress to have medicines delivered for free

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Medihelp Necesse D 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from network pharmacy and according to formulary
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,656 R1,290 R726
Children: Pay for all children
Income limit: R7,001-R11,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • If dispensed by GP: 100% of scheme rate
  • Paid from pharmacy: 100% of MMAP
3. Over-the-counter:
  • R100 per event, R260 per person per year
4. On Discharge:
  • R320 per admission
5. Birth Control:
6. Notes:

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Medimed Essential D 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme on authorisation
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,660 R1,660 R420
Children: Pay for all children
Income limit: R13,001-R17,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, GPs, specialists, medication, dentistry, optometry, radiology and pathology. Limits apply. All else paid from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R1,992 R1,992 R504

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2. Acute (presrcibed) medication:
  • Unlimited if prescribed by GP according to formulary
  • Paid by scheme
3. Over-the-counter:
  • R100 per prescription, and R400 per family
  • Paid from day-to-day benefit
4. On Discharge:
  • See "Acute Medicine" benefit
5. Birth Control:
6. Notes:
  • For acute medicine not on the formulary: if there is a generic equivalent on the formulary, scheme will pay maximum of formulary generic alternative. If there is no generic equivalent, the member pays full amount out-of-pocket.

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Medimed Standard A 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Extended chronic conditions: R1,600 per person and R3,200 per family paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,660 R1,660 R390
Children: Pay for all children
Income limit: R0-R8,500 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R9,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R9,480 R9,480 R1,170
Extended Fund: R4,500 pp R9,000 pf R

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • R150 per prescription, R1,500 per family
  • Paid from day-to-day benefit
4. On Discharge:
5. Birth Control:
6. Notes:

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Sizwe Gomomo A 2017: Medicine 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. Chronic:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,666 R1,546 R410
Children: Pay for all children
Income limit: R0-R10,112 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some:maternity. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • R280 per family
4. On Discharge:
5. Birth Control:
  • No benefit
6. Notes:

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Medihelp Dimension Prime 2 Network 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • non-PMBs: paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,668 R1,368 R498
Children: Pay for maximum 2 children under 18yrs.
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment), GPs, optometry, dentistry, maternity, infant paediatrics, medical appliances. Limits apply. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R2,448 R2,016 R720

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2. Acute (presrcibed) medication:
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • Paid from day-to-day benefit
5. Birth Control:
  • See "Acute Medicine" benefit, above
6. Notes:
  • PMBs chronic: only 40% of the reference price is paid if medicine is outside the formulary and/or obtained from non-network provider
  • For acute and non-PMBs chronic medicines:
    • 80% of scheme rate where no generic is available
    • 70% of MMAP (maximum medical aid price) for voluntary use of original medicine where generic is available

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

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2. Acute (presrcibed) medication:
3. Over-the-counter:
4. On Discharge:
5. Birth Control:
6. Notes:

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Momentum Incentive Network hospital (and State provider for chronic) 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from State provider
  • non-PMBs chronic: additional 6 conditions covered, R8,800 per family
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,700 R1,333 R883
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R2,040 R2,040 R1,600

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:

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Cape Medical Silver 2017: Medicine Benefits
In brief:
1. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,704 R1,704 R258
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R3,000 R3,000 R456

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2. Acute (presrcibed) medication:
  • R440 per family. Thereafter from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • Paid from acute medicine benefit
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • Medicines are paid at cost to a maximum of Single Exit price plus dispensing fee

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Fedhealth Maxima Core Grid 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,716 R1,454 R600
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some:post hospitalisation treatment (30 days), casualty visits, GP visit, specialised radiology, contraceptives, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Devices and medicine: paid by scheme, including IUDs
  • Consultations: from day-to-day benefit
6. Notes:
  • Chronic meds: if not on the formulary, 40% co-payment

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Suremed Explorer C 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,720 R1,720 R500
Children: Pay for all children
Income limit: R11,001-R15,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, optometry, pathology, radiology, specialised radiology, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Unlimited if prescribed by nominated provider, limited to R70 per event
3. Over-the-counter:
  • R230 per person and R265 per family
4. On Discharge:
  • R300 per event
5. Birth Control:
6. Notes:

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Spectramed Cyan A 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • non-PMB: 2 more conditions, paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,730 R1,669 R692
Children: Pay for maximum 3 children
Income limit: R0-R8,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R2,904 R2,808 R1,164

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 5 days supply
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • All medication must be on formulary, otherwise no benefit
  • All medication must be obtained from DSP, otherwise 40% co-payment

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Momentum Ingwe D 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe Active Primary Care Network
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R1,734 R1,734 R406
Children: Pay for all children
Income limit: R8,201-R11,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Compcare Axis 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Some exclusions apply. Most out-of-hospital benefits covered only if PMBs.
1. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,734 R1,734 R534
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: preventative benefits. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • R120 per month
6. Notes:

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Topmed Network D 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,734 R1,734 R464
Children: Pay for all children
Income limit: R11,001+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: scopes, medicine, dentistry, optometry, supplementary services, radiology, pathology. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Covered if dispensed by Network GP or pharmacy, according to formulary
3. Over-the-counter:
  • R216 per family per year, with a maximum of R72 per script
4. On Discharge:
  • No benefit
5. Birth Control:
6. Notes:
  • For PMBs chronic medication, there is a 30% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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Momentum Custom Associate (and any provider for chronic) 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from any provider
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,742 R1,374 R614
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Fedhealth Blue Door D: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
  • Unlimited if dispensed by network GP
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
6. Notes:
  • Chronic meds: if not on the formulary, 40% co-payment

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Momentum Ingwe Network E 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe primary Primary Care Network
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R1,758 R1,758 R518
Children: Pay for all children
Income limit: R11,001+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Medimed Standard B 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Extended chronic conditions: R1,600 per person and R3,200 per family paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,760 R1,760 R410
Children: Pay for all children
Income limit: R8,501-R13,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R9,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R9,780 R9,780 R1,230
Extended Fund: R4,500 pp R9,000 pf R

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • R150 per prescription, R1,500 per family
  • Paid from day-to-day benefit
4. On Discharge:
5. Birth Control:
6. Notes:

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Bonitas BonFit 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Co-payment if out of formulary: 40% co-payment
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,789 R1,385 R535
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,228 R2,496 R960

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • R340 per person per admission
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • For PMBs chronic medication, there is a 40% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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Commed Shina B 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Paid at formulary reference price
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. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
5. Birth Control:
6. Notes:
  • PMBs: Single exit price t plus dispensing fee
  • Otherwise, subject to formulary reference price

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Keyhealth Equilibrium 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 3 conditions for children under 21 (Acne, ADD/ADHD, Rhinitis), 10% co-payment
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,817 R1,096 R556
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, medical appliances, preventative benefits. Limits apply. All else paid from savings, from fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R1,584 R960 R480
Extended Fund: R2,070 R1,150 R625

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • R450
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • Chronic medicine: 30% co-payment where non-DSP pharmacy is used
  • Reference pricing

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Hosmed Essential C 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
PMBs only
Contributions:
Main: Adult: Child:
Total Cost: R1,826 R1,666 R707
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialists, medicine, pathology, radiology, specialised radiology, optometry, dentistry, appliances, maternity benefits, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Unlimited if dispensed by network GP
  • R950 per person, and R2,650 per family if obtained from pharmacy
3. Over-the-counter:
  • R210 per family, with a maximum of R80 per script
4. On Discharge:
  • 5 days
5. Birth Control:
  • R55 per person, limited to R660 per family per year
6. Notes: Medicines paid at reference price, subject to formulary

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Makoti Comprehensive C 2017: Medicine Benefits
In brief:
1. Chronic:
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. Acute (presrcibed) medication:
3. Over-the-counter:
4. On Discharge:
5. Birth Control:
6. Notes:

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Momentum Access 2017: Medicine 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. Chronic:
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. Acute (presrcibed) medication:
  • Some medication covered
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Discovery KeyCare Access D 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • Medicines on medicine list, if prescribed by KeyCare network GP: Covered
5. Birth Control:
  • No benefit
6. Notes:

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Fedhealth Maxima Saver Grid 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Devices and medicine: paid by scheme, including IUDs
  • Consultations: from day-to-day benefit
6. Notes:
  • Chronic meds: if not on the formulary, 40% co-payment

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Momentum Custom (Network for chronic) 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from Network provider
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. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Genesis Private Plus 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,900 R1,900 R365
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: dentistry. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R4,140 R4,140 R

Compare with these plans:

2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • Paid from day-to-day benefit
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • Scheme pays 100% of cost for medicines on the formulary

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Discovery KeyCare Plus C 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,906 R1,906 R510
Children: Pay for maximum 3 children
Income limit: R11,551+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Medicines on medicine list, if prescribed by KeyCare network GP: Covered
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • Medicines on medicine list, if prescribed by KeyCare network GP: Covered
5. Birth Control:
  • No benefit
6. Notes:

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Sizwe Primary Care B 2017: Medicine Benefits
In brief:
1. Chronic:
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:

Day-to-day limit: M =R5,390 M1 =R7,980 M2 =R9,330 M3 =R10,670 M4 =R12,020 M5 =R13,370 M6+ =R14,720
2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit, with following sub limits:
M =R1,680 M1 =R3,030 M2 =R3,370 M3 =R3,820 M4 =R3,930 M5 =R4,150 M6+ =R4,490
3. Over-the-counter:
4. On Discharge:
5. Birth Control:
  • Paid from R2,490 per family
6. Notes:

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Fedhealth Maxima Core 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Devices and medicine: paid by scheme, including IUDs
  • Consultations: from day-to-day benefit
6. Notes:
  • Chronic meds: if not on the formulary, 40% co-payment

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Compcare Networx ED H 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered
Overall Annual Limit (OAL):
R1,100,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R1,908 R1,718 R669
Children: Pay for all children
Income limit: R10,001+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, medicine, radiology, pathology, maternity and preventative benefits. All else paid from out of fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R2,800 (main) R4,170 (family) R

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2. Acute (presrcibed) medication:
  • Paid by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply and R 280 per discharge
5. Birth Control:
  • R95 per month
6. Notes:
  • Meds must be prescribed by a Universal Network provider and dispensed by network pharmacy
  • Only formulary is covered, unless otherwise authorised
  • Reference pricing

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Discovery Classic Core 2017: Medicine Benefits
In brief: 200% scheme rate for specialists. Most day-to-day claims paid from out of pocket, unless PMB.
1. Chronic:
  • PMBs chronic: paid by scheme
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. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • No benefit
5. Birth Control:
  • No benefit
6. Notes:
  • Discovery pays for medicine up to the scheme rate, which includes the dispensing fee
  • Use MedExpress to have medicines delivered for free

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Suremed Explorer D 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,920 R1,920 R600
Children: Pay for all children
Income limit: R15,000+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, optometry, pathology, radiology, specialised radiology, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Unlimited if prescribed by nominated provider, limited to R70 per event
3. Over-the-counter:
  • R230 per person and R265 per family
4. On Discharge:
  • R300 per event
5. Birth Control:
6. Notes:

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Bonitas Primary 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Co-payment if out of formulary: 40% co-payment
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:

Fund:
Main M+1 M+2 M+3 M4+
R1,900 R3,400 R4,000 R4,300 R4,650
Specialists, medicine, radiology, pathology, etc
2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit, limited to R440 per person and R1,290 per family
4. On Discharge:
  • R340 per person per admission
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • For PMBs chronic medication, there is a 40% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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Medshield MediCore 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,926 R1,623 R438
Children: Pay for three children only
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, optometry, some non-surgical procedures including scopes, preventative benefits. Limits apply. All else paid from extended fund or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • R300 per admission
5. Birth Control:
  • R140 per monthly script
6. Notes:
  • PMB: Basic formulary
  • Out of formulary PMB or obtained from non-network provider: 40% co-payment
  • PMB: reimbursed at Maximum Generic Price

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Medihelp Necesse E 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from network pharmacy and according to formulary
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,932 R1,506 R834
Children: Pay for all children
Income limit: R11,001+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • If dispensed by GP: 100% of scheme rate
  • Paid from pharmacy: 100% of MMAP
3. Over-the-counter:
  • R100 per event, R260 per person per year
4. On Discharge:
  • R320 per admission
5. Birth Control:
6. Notes:

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Medihelp Unify 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,944 R1,602 R588
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment). Limits apply. All else paid from savings or from out-of-pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R5,832 R4,824 R1,800

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • Paid from day-to-day benefit
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:

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Compcare Unisave 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 1 condition covered from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,974 R1,680 R594
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, appliances, preventative benefits. Limits apply. . Limits apply. All else paid out of savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R5,904 R5,040 R1,800

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • One script per day, and R150 per event>
  • R500 per person and R900 per family
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • R120 per month
6. Notes:

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Medimed Essential E 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme on authorisation
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,990 R1,990 R440
Children: Pay for all children
Income limit: R17,001+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, GPs, specialists, medication, dentistry, optometry, radiology and pathology. Limits apply. All else paid from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R2,388 R2,388 R528

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2. Acute (presrcibed) medication:
  • Unlimited if prescribed by GP according to formulary
  • Paid by scheme
3. Over-the-counter:
  • R100 per prescription, and R400 per family
  • Paid from day-to-day benefit
4. On Discharge:
  • See "Acute Medicine" benefit
5. Birth Control:
6. Notes:
  • For acute medicine not on the formulary: if there is a generic equivalent on the formulary, scheme will pay maximum of formulary generic alternative. If there is no generic equivalent, the member pays full amount out-of-pocket.

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Spectramed Capri 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,003 R1,609 R909
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R2,400 R1,932 R1,092

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 5 days supply
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • All medication must be on formulary, otherwise no benefit
  • All medication must be obtained from DSP, otherwise 40% co-payment

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Discovery Coastal Saver 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,007 R1,506 R808
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GP consults if savings run out. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R4,812 R3,612 R1,932

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • Paid from day-to-day benefit
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • Discovery pays for medicine up to the scheme rate, which includes the dispensing fee
  • Use MedExpress to have medicines delivered for free

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

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2. Acute (presrcibed) medication:
3. Over-the-counter:
4. On Discharge:
5. Birth Control:
6. Notes:

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Sizwe Savings Care A 2017: Medicine 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. Chronic:
  • non-PMB: 11 additional conditions covered
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,015 R1,742 R490
Children: Pay for all children
Income limit: R0-R15,052 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialists, medication, radiology, physio, pathology, standard dentistry, optometry, maternity. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,627 R3,136 R882

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:

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Resolution Fundation D 2017: Medicine Benefits
In brief:
1. Chronic:
  • PMB chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,022 R2,022 R694
Children: Pay for all children
Income limit: R9,701+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Limited to network providers and formularies
3. Over-the-counter:
  • Limited to network providers and formularies
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:
  • Chronic meds: Must be obtained from DSP. Formularies apply. Reference and GRP pricing apply

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Discovery Essential Saver 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,047 R1,536 R819
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GP consults if savings run out. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,684 R2,760 R1,464

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • Paid from day-to-day benefit
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • Discovery pays for medicine up to the scheme rate, which includes the dispensing fee
  • Use MedExpress to have medicines delivered for free

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Medimed Standard C 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Extended chronic conditions: R1,600 per person and R3,200 per family paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,050 R2,050 R440
Children: Pay for all children
Income limit: R13,001-R17,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R9,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R10,650 R10,650 R1,320
Extended Fund: R4,500 pp R9,000 pf R

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • R150 per prescription, R1,500 per family
  • Paid from day-to-day benefit
4. On Discharge:
5. Birth Control:
6. Notes:

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Compcare Mumed ED 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 10 conditions covered from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,054 R1,600 R572
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R5,376 R3,372 R1,338

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • One script per day, and R160 per event>
  • R530 per person and R950 per family
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • R120 per month
6. Notes:

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Discovery Classic Delta Saver 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,058 R1,623 R826
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GP consults, maternity, kids' casualty if savings run out. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R6,168 R4,860 R2,472

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • Paid from day-to-day benefit
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • Discovery pays for medicine up to the scheme rate, which includes the dispensing fee
  • Use MedExpress to have medicines delivered for free

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Momentum Custom (Any provider for chronic) 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,059 R1,653 R735
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Sizwe Gomomo B 2017: Medicine 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. Chronic:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,060 R1,623 R420
Children: Pay for all children
Income limit: R10,113+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialists, medication, radiology, physio, pathology, standard dentistry, optometry, maternity. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • No benefit
3. Over-the-counter:
  • R280 per family
4. On Discharge:
5. Birth Control:
  • No benefit
6. Notes:

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Fedhealth Maxima Saver 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,079 R1,693 R600
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: post hospitalisation treatment (30 days), casualty visits, GP visits, specialised radiology, contraceptives, some dentistry, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,744 R3,048 R1,080

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Devices and medicine: paid by scheme, including IUDs
  • Consultations: from day-to-day benefit
6. Notes:
  • Chronic meds: if not on the formulary, 40% co-payment

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Momentum Incentive (State provider for chronic) 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from State provider
  • non-PMBs chronic: additional 6 conditions covered, R8,800 per family
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,088 R1,646 R984
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R2,506 R2,506 R1,975

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:

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Bestmed Beat 3 Network 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs plus 5 conditions covered at 75% scheme rate
  • Co-payment if out of formulary: 40% co-payment
  • Overall limit: R2,700 per person and R5,450 per family. Once depleted, only CDL and PMBs will continue to be covered by scheme
Overall Annual Limit (OAL):
Unlimited overall, but sub-limits can apply
Contributions:
Main: Adult: Child:
Total Cost: R2,123 R1,509 R820
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Preventative dentistry, optometry, maternity, wound care, specialised radiology, contraceptives, some medicine and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R4,332 R3,084 R1,668

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days
5. Birth Control:
  • R1,800 per family per year, paid by scheme
6. Notes:

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Hosmed Access 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
R1,250,000
Contributions:
Main: Adult: Child:
Total Cost: R2,124 R1,829 R413
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialists, medicine, pathology, radiology, specialised radiology, optometry, dentistry, appliances, supplementary services, maternity benefits, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Unlimited if dispensed by network GP
  • R1,700 per person, and R4,200 per family if obtained from pharmacy
3. Over-the-counter:
  • R475 per family, with a maximum of R85 per script
4. On Discharge:
  • 5 days
5. Birth Control:
  • R70 per person, limited to R840 per family per year
6. Notes: Medicines paid at reference price, subject to formulary

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Bonitas BonSave 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered by scheme: 27 CDLs and PMBs
  • Co-payment if out of formulary: 40% co-payment
  • Other chronic meds: paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,135 R1,654 R640
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, mental health, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R4,104 R3,180 R1,236

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • R340 per person per admission
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • For PMBs chronic medication, there is a 40% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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Medihelp Dimension Prime 2 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • non-PMBs: paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,136 R1,746 R642
Children: Pay for maximum 2 children under 18yrs.
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment), GPs, optometry, dentistry, maternity, infant paediatrics, medical appliances. Limits apply. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,096 R2,520 R936

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2. Acute (presrcibed) medication:
3. Over-the-counter:
  • M= R1,000 and M+= R2,000
  • Shared with GP and Acute medicine benefit
  • paid by scheme
4. On Discharge:
  • Paid from day-to-day benefit
5. Birth Control:
  • See "Acute Medicine" benefit, above
6. Notes:
  • PMBs chronic: only 40% of the reference price is paid if medicine is outside the formulary and/or obtained from non-network provider
  • For acute and non-PMBs chronic medicines:
    • 80% of scheme rate where no generic is available
    • 70% of MMAP (maximum medical aid price) for voluntary use of original medicine where generic is available

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Resolution Progressive Flex 2017: Medicine Benefits
In brief:
1. Chronic:
  • PMB chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,154 R2,017 R666
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • From limit below
  • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1+
R2,268R2,878
3. Over-the-counter:
  • From limit below, with following sub limits: M =R623 and M+ =R873
  • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1+
R2,268R2,878
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • R1,496 per female, from preventative benefit limit
6. Notes:
  • Chronic meds: Must be obtained from DSP. Formularies apply. Reference and GRP pricing apply

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Medihelp Dimension Prime 3 Network 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
>
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,184 R1,848 R636
Children: Pay for maximum 2 children under 18yrs.
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Shared with the GP, specialists, mental health, supplementary services
Main M1 M2 M3+
R5,700 R9,550 R11,700 R12,600
3. Over-the-counter:
  • See "Acute medicine" benefit
4. On Discharge:
  • R320 per admission
5. Birth Control:
  • See "Acute Medicine" benefit, above
6. Notes:
  • PMBs chronic: only 40% of the reference price is paid if medicine is outside the formulary and/or obtained from non-network provider
  • For acute and non-PMBs chronic medicines:
    • 80% of scheme rate where no generic is available
    • 70% of MMAP (maximum medical aid price) for voluntary use of original medicine where generic is available

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Genesis Private Comprehensive 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,200 R2,200 R365
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: dentistry, consults and medicine. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R1,740 R1,740 R

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2. Acute (presrcibed) medication:
  • R3,900 per adult
  • Balance from day-to-day benefit
3. Over-the-counter: See Acute Medicine benefit, above
4. On Discharge: See Acute Medicine benefit, above
5. Birth Control: See Acute Medicine benefit, above
6. Notes:
  • Scheme pays 100% of cost for medicines on the formulary

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Momentum Ingwe E 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe Active Primary Care Network
Overall Annual Limit (OAL):
R1,190,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R2,225 R2,225 R646
Children: Pay for all children
Income limit: R11,001+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: std dentistry, GPs, specialists, optometry, pathology, std radiology, medicine, maternity, alternatives to hospitalistion, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • No benefit
6. Notes:

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Medimed Standard D 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • Extended chronic conditions: R1,600 per person and R3,200 per family paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,230 R2,230 R470
Children: Pay for all children
Income limit: R17,001+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R9,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R11,190 R11,190 R1,410
Extended Fund: R4,500 pp R9,000 pf R

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • R150 per prescription, R1,500 per family
  • Paid from day-to-day benefit
4. On Discharge:
5. Birth Control:
6. Notes:

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Topmed Limited 2017: Medicine 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. Chronic:
  • PMBs and non-PMBs: R10,884 per family. Thereafter, only PMBs are covered
  • 20% co-payment for non-PMBs
Overall Annual Limit (OAL):
R1,000,000 per person
Contributions:
Main: Adult: Child:
Total Cost: R2,245 R600 R260
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: most out-of-hospital claims, with 20% co-payment. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • R7,440 per family
  • 20% co-payment
3. Over-the-counter:
4. On Discharge:
  • 7 days supply
5. Birth Control:
6. Notes:
  • For PMBs chronic medication, there is a 30% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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Fedhealth Maxima Basis Grid 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,251 R1,916 R679
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: post hospitalisation treatment (30 days), casualty visits, GP visits, specialised radiology, contraceptives, some dentistry and maternity, optometry, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R4,056 R3,444 R1,224

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Devices and medicine: paid by scheme, including IUDs
  • Consultations: from day-to-day benefit
6. Notes:
  • Chronic meds: if not on the formulary, 40% co-payment

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Fedhealth Maxima Standard Elect 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs: Additional 14 conditions covered
  • R5,120 per person, and R10,200 per family. Thereafter only PMBs are covered
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,316 R1,974 R694
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive plan with extended fund and threshold benefits (with 20% co-payment) that can be used for most out-of-hospital claims.
Main: Adult: Child:
(S) Savings: R5,004 R4,260 R1,500
(SP) Self Payment: R6,196 R4,340 R1,380
Threshold (S+SP): R11,200 R8,600 R2,880
Above Threshold: No limit, with 20% co-payment No limit, with 20% co-payment No limit, with 20% co-payment

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2. Acute (presrcibed) medication:
  • R5,120 per person and R10,200 per family, from day-to-day benefit
3. Over-the-counter:
  • Paid from savings benefit only and does not add up to threshold
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Devices and medicine: paid by scheme, including IUDs
  • Consultations: from day-to-day benefit
6. Notes:
  • Chronic meds: if not on the formulary, 40% co-payment

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Topmed Savings 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,317 R1,850 R698
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (with co-payment), maternity, scopes, alternatives to hospitalisation, extended rehab benefits, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R4,452 R3,552 R1,344

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • For PMBs chronic medication, there is a 30% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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Momentum Incentive Network hospital (and Network provider for chronic) 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from Network provider
  • non-PMBs chronic: additional 6 conditions covered, R8,800 per family
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,323 R1,848 R949
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R2,788 R2,788 R2,218

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:

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Sizwe Primary Care C 2017: Medicine Benefits
In brief:
1. Chronic:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,326 R1,519 R480
Children: Pay for all children
Income limit: R8,767+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Day-to-day limit: M =R5,390 M1 =R7,980 M2 =R9,330 M3 =R10,670 M4 =R12,020 M5 =R13,370 M6+ =R14,720
2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit, with following sub limits:
M =R1,680 M1 =R3,030 M2 =R3,370 M3 =R3,820 M4 =R3,930 M5 =R4,150 M6+ =R4,490
3. Over-the-counter:
4. On Discharge:
5. Birth Control:
  • Paid from R2,490 per family
6. Notes:

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Bestmed Beat 3 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs plus 5 conditions covered at 75% scheme rate
  • Co-payment if out of formulary: 40% co-payment
  • Overall limit: R2,700 per person and R5,450 per family. Once depleted, only CDL and PMBs will continue to be covered by scheme
Overall Annual Limit (OAL):
Unlimited overall, but sub-limits can apply
Contributions:
Main: Adult: Child:
Total Cost: R2,359 R1,676 R911
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Preventative dentistry, optometry, maternity, wound care, specialised radiology, contraceptives, some medicine and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R4,812 R3,420 R1,860

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days
5. Birth Control:
  • R1,800 per family per year, paid by scheme
6. Notes:

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Resolution Progressive Flex Plus 2017: Medicine Benefits
In brief:
1. Chronic:
  • PMB chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,369 R2,219 R733
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • From limit below
  • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1+
R2,268R2,878
3. Over-the-counter:
  • From limit below, with following sub limits: M =R623 and M+ =R873
  • Limit shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
MM1+
R2,268R2,878
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • R1,496 per female, from preventative benefit limit
6. Notes:
  • Chronic meds: Must be obtained from DSP. Formularies apply. Reference and GRP pricing apply

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Fedhealth Blue Door E: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,378 R2,061 R895
Children: Pay for all children
Income limit: R12,001+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: prescribed medication, GP consults, dentistry, optometry. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Unlimited if dispensed by network GP
3. Over-the-counter:
  • No benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
6. Notes:
  • Chronic meds: if not on the formulary, 40% co-payment

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Spectramed Cyan B 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • non-PMB: 2 more conditions, paid by scheme
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

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 5 days supply
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • All medication must be on formulary, otherwise no benefit
  • All medication must be obtained from DSP, otherwise 40% co-payment

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

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2. Acute (presrcibed) medication:
  • Paid from savings first. Thereafter R2,640 per person from overall day-to-day benefit
3. Over-the-counter:
  • R140 per prescription per month, limited to R1,250 per family per year
  • Included in acute medicine benefit
4. On Discharge:
  • R500 per person per admission
5. Birth Control:
6. Notes:

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Commed Shina C 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Paid at formulary reference price
Overall Annual Limit (OAL):
R600k per person, R1,200,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R2,441 R2,075 R488
Children: Pay for all children
Income limit: R18,001+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R2,929 R2,490 R586

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
5. Birth Control:
6. Notes:
  • PMBs: Single exit price t plus dispensing fee
  • Otherwise, subject to formulary reference price

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Selfmed Selfsure 2017: Medicine Benefits
In brief:
1. Chronic:
  • PMB chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,456 R2,451 R836
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • R1,500 per family
6. Notes:
  • Chronic meds: Must be obtained from DSP. Formularies apply. Otherwise, 40% co-payment

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Fedhealth Maxima Basis 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,501 R2,129 R754
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: post hospitalisation treatment (30 days), casualty visits, GP visits, specialised radiology, contraceptives, some dentistry and maternity, optometry, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R4,500 R3,828 R1,356

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Devices and medicine: paid by scheme, including IUDs
  • Consultations: from day-to-day benefit
6. Notes:
  • Chronic meds: if not on the formulary, 40% co-payment

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Momentum Incentive (Network provider for chronic) 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from Network provider
  • non-PMBs chronic: additional 6 conditions covered, R8,800 per family
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,506 R2,010 R1,089
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,007 R3,007 R2,412

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:

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Momentum Incentive Network hospital (and any provider for chronic) 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • non-PMBs chronic: additional 6 conditions covered, R8,800 per family
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,529 R2,034 R826
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,035 R3,035 R2,441

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:

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Compcare Mumed 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 10 conditions covered from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,532 R1,974 R714
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers fund for out-of-hospital claims, incl unlimited GP visits, Scheme also pays for specialised radiology, medical appliances and preventative benefits.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R5,376 R3,372 R1,338

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • One script per day, and R160 per event>
  • R530 per person and R950 per family
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • R120 per month
6. Notes:

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Medshield MediPlus 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs: Additional 14 conditions covered
  • R5,385 per person and R10,775 per family, thereafter unlimited for PMBs
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,544 R1,797 R558
Children: Pay for three children only
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, alternative to hospitalisation, optometry, some non-surgical procedures including scopes,preventative benefits. Limits apply. All else paid from extended fund or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: RM=R6,750
M1 =R9,420
M2 =R10,600
M3 = R11,910
M4+ +R13,050
R R

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • R535 per person and R985 per family limited to R185 per script. From day-to-day benefit
4. On Discharge:
  • R500 per admission
5. Birth Control:
  • R140 per monthly script
  • Mirena: one per female every four years. Includes consultation, insertion if done in rooms.
6. Notes:
  • PMB: Restrictive formulary
  • Out of formulary PMB or obtained from non-network provider: 40% co-payment
  • PMB: reimbursed at Maximum Generic Price

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Discovery Essential Priority 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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

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2. Acute (presrcibed) medication:
  • Schedule 3 and above, from day-to-day benefit, up to the limits below
Main M1 M2 M3
R12,250 R14,500 R17,150 R20,850
3. Over-the-counter:
  • Paid from day-to-day benefit
  • These do not add up to the annual threshold, and are not paid for from it
4. On Discharge:
  • See "Acute Medicine" benefit
5. Birth Control:
6. Notes:
  • Discovery pays for medicine up to the scheme rate, which includes the dispensing fee
  • Use MedExpress to have medicines delivered for free

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Medshield MediSaver 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • R185 per script from day-to-day benefit
4. On Discharge:
  • R600 per admission
5. Birth Control:
  • R140 per monthly script
  • Mirena: one per female every four years. Includes consultation, insertion if done in rooms.
6. Notes:
  • PMB: Restrictive formulary
  • Out of formulary PMB or obtained from non-network provider: 40% co-payment
  • PMB: reimbursed at Maximum Generic Price

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Discovery Classic Saver 2017: Medicine 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. Chronic:
  • PMBs chronic: paid by scheme
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

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • Paid from day-to-day benefit
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • Discovery pays for medicine up to the scheme rate, which includes the dispensing fee
  • Use MedExpress to have medicines delivered for free

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Bonitas Standard Select 2017: Medicine 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. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs plus 17 conditions
  • Co-payment if out of formulary: 40% co-payment
  • Overall limit:R8,650 per person and R17,350 per family. Once depleted, only CDL and PMBs will continue to be covered by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,597 R2,247 R760
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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day-to-day funds
Main M+1 M+2 M+3 M4+
R5,232 R7,970 R9,214 R10,062 R10,966
Specialists, medicine, radiology, pathology, etc
2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit, limited to R700 per person and R2,121 per family
4. On Discharge:
  • R420 per person per admission
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • For PMBs chronic medication, there is a 40% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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Compcare Symmetry ED 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Netcare hospitals. Some co-payments. Scheme offers extended fund once savings are depleted, and also pays for: specialised radiology, GPs (unlimited), medical appliances and preventative benefits. Limits apply.
1. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 20 conditions covered
  • non-PMBs limited to R4,100 per person and R6,160 per family from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,598 R2,022 R732
Children: Pay for all children
Day-to-Day Benefit:
Scheme offers extended fund for claims once savings are depleted, and also pays for: specialised radiology, GPs, medical appliances and preventative benefits. Limits apply. All else paid from savings, fund or out of pocket.
Main: Adult: Child:
(S) Savings: R3,118 R2,426 R878
Extended Fund: R3,118 R2,426 R878

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • One script per day, and R170 per event>
  • R650 per person and R1,050 per family
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • R120 per month
6. Notes:

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Medihelp Dimension Prime 3 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Some co-payments. Scheme pays out-of-hospital claims for: radiology (co-payment), pathology, GPs, specialists, supplementary services, medicine, optometry, dentistry, maternity, infant paediatrics, medical appliances. Limits apply. All else paid from out of pocket, unless PMB.
1. Chronic:
  • PMB chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,730 R2,316 R798
Children: Pay for maximum 2 children under 18yrs.
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Acute (presrcibed) medication:
  • Shared with the GP, specialists, mental health, supplementary services
Main M1 M2 M3+
R5,700 R9,550 R11,700 R12,600
3. Over-the-counter:
  • See "Acute medicine" benefit
4. On Discharge:
  • R320 per admission
5. Birth Control:
  • See "Acute Medicine" benefit, above
6. Notes:
  • PMBs chronic: only 40% of the reference price is paid if medicine is outside the formulary and/or obtained from non-network provider
  • For acute and non-PMBs chronic medicines:
    • 80% of scheme rate where no generic is available
    • 70% of MMAP (maximum medical aid price) for voluntary use of original medicine where generic is available

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Sizwe Affordable Care A 2017: Medicine Benefits
In brief:
1. Chronic:
  • non-PMB: 13 additional conditions covered
  • R4,940 per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,733 R2,511 R630
Children: Pay for all children
Income limit: R0-R15,052 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Day-to-day limit: M =R9,330 M1 =R13,370 M2 =R15,390 M3 =R16,740 M4 =R18,760 M5 =R20,790 M6+ =R22,690
2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit, with following sub limits:
M =R3,250 M1 =R4,940 M2 =R5,840 M3 =R6,290 M4 =R7,190 M5 =R7,420 M6+ =R7,640
3. Over-the-counter:
4. On Discharge:
5. Birth Control:
  • Paid from R2,490 per family
6. Notes:

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Momentum Incentive (Any provider for chronic) 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Chronic benefits at any provider. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
1. Chronic:
  • PMB chronic: paid by scheme
  • non-PMBs chronic: additional 6 conditions covered, R8,800 per family
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,794 R2,270 R389
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,288 R3,288 R2,724

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:

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Sizwe Savings Care B 2017: Medicine Benefits
In brief:
1. Chronic:
  • non-PMB: 11 additional conditions covered
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,800 R2,243 R555
Children: Pay for all children
Income limit: R15,053+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R5,040 R4,037 R999

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:

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Medimed Max A 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Income based plan. Over and above the savings and extended fund, scheme pays out-of-hospital claims for: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
1. Chronic:
  • PMB chronic: paid by scheme
  • Extended chronic conditions: R3,200 per person and R6,400 per family paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,810 R2,810 R500
Children: Pay for all children
Income limit: R0-R10,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R13,430 R13,430 R1,500
Extended Fund: R5,000 pp R10,000 pf R

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • R150 per prescription, R1,500 per family
  • Paid from day-to-day benefit
4. On Discharge:
5. Birth Control:
6. Notes:

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Sizwe Affordable Care B 2017: Medicine Benefits
In brief:
1. Chronic:
  • non-PMB: 13 additional conditions covered
  • R4,940 per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,843 R2,610 R660
Children: Pay for all children
Income limit: R15,053-R18,444 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Day-to-day limit: M =R9,330 M1 =R13,370 M2 =R15,390 M3 =R16,740 M4 =R18,760 M5 =R20,790 M6+ =R22,690
2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit, with following sub limits:
M =R3,250 M1 =R4,940 M2 =R5,840 M3 =R6,290 M4 =R7,190 M5 =R7,420 M6+ =R7,640
3. Over-the-counter:
4. On Discharge:
5. Birth Control:
  • Paid from R2,490 per family
6. Notes:

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Bonitas BonComplete 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Over and above the savings/threshold fund, scheme pays out-of-hospital claims for: specialised radiology, mental health, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings, or from above threshold benefit or from out of pocket, unless PMB.
1. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Co-payment if out of formulary: 40% co-payment
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,923 R2,340 R794
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, mental health, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings, or from above threshold benefit or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R5,256 R4,200 R1,428
(SP) Self Payment: R1,568 R1,326 R336
Threshold (S+SP): R6,824 R5,526 R1,764
Above Threshold: R4,150 R2,450 R1,060

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • R370 per person per admission
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • For PMBs chronic medication, there is a 40% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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Commed Standard A 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Some-co-payments. Network hospitals. Annual limit of R760,000 per person and R1,460,000 per family. Scheme pays out-of-hospital claims for: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
1. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Paid at formulary reference price
Overall Annual Limit (OAL):
R730k per person, R1,460,000 per family
Contributions:
Main: Adult: Child:
Total Cost: R2,946 R2,413 R591
Children: Pay for all children
Income limit: R0-R6,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Alternative to hopitalisation, mammogram and external appliances. Limits apply. All else paid from out of savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R4,419 R3,620 R887

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
5. Birth Control:
6. Notes:
  • PMBs: Single exit price t plus dispensing fee
  • Otherwise, subject to formulary reference price

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Hosmed Value 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: GPs, specialists, medicine, pathology, radiology, specialised radiology, optometry, dentistry, appliances, mental health, supplementary services, maternity benefits, preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
1. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: R5,936 per person, and R11,980 per family
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,964 R2,144 R482
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialists, medicine, pathology, radiology, specialised radiology, optometry, dentistry, appliances, mental health, supplementary services, maternity benefits, preventative benefits. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Overall out-of-hospital annual limit for : Acute medicine, advanced dentistry, alternative services, biokinetics, physio, remedial and other therapies and mental health:
Main M+1 M+2 M+3
R8,500 R17,950 R19,525 R21,625
2. Acute (presrcibed) medication:
  • R3,040 per person, and R6,170 per family
3. Over-the-counter:
  • R600 per family, with a maximum of R135 per script
4. On Discharge:
  • 7 days
5. Birth Control:
  • R100 per person, limited to R1,200 per family per year
6. Notes: Medicines paid at reference price, subject to formulary

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Discovery Classic Priority 2017: Medicine Benefits
In brief: 200% scheme rate for specialists. Comprehensive cover with savings, extended fund, and limited above threshold benefits that cover most out-of-hospital benefits (with sub limits). Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
1. Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,968 R2,337 R1,187
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Comprehensive cover that covers most out-of-hospital benefits (with sub limits) with limited above threshold benefit. Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R8,904 R7,008 R3,552
(SP) Self Payment: R4,246 R2,842 R748
Threshold (S+SP): R13,150 R9,850 R4,300
Above Threshold: 11,150 7,950 3,850

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2. Acute (presrcibed) medication:
  • Schedule 3 and above, from day-to-day benefit, up to the limits below
Main M1 M2 M3
R17,200 R20,850 R25,150 R27,450
3. Over-the-counter:
  • Paid from day-to-day benefit
  • These do not add up to the annual threshold, and are not paid for from it
4. On Discharge:
  • See "Acute Medicine" benefit
5. Birth Control:
6. Notes:
  • Discovery pays for medicine up to the scheme rate, which includes the dispensing fee
  • Use MedExpress to have medicines delivered for free

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Keyhealth Silver 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Network hospitals. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), dentistry, medicine, optometry, maternity, medical appliances, preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
1. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 3 conditions for children under 21 (Acne, ADD/ADHD, Rhinitis), 10% co-payment
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,977 R1,601 R620
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment), dentistry, medicine, optometry, maternity, medical appliances, preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-
Extended Fund: R6,485 R4,710 R1,305

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Limited to R1,400 per family
  • Paid from day-to-day benefit
4. On Discharge:
  • R450
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • Chronic medicine: 30% co-payment where non-DSP pharmacy is used
  • Reference pricing

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Bonitas Standard 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Over and above the fund, scheme pays out-of-hospital claims for: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
1. Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs plus 17 conditions
  • Co-payment if out of formulary: 40% co-payment
  • Overall limit:R8,650 per person and R17,350 per family. Once depleted, only CDL and PMBs will continue to be covered by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,998 R2,600 R880
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Fund:
Main M+1 M+2 M+3 M4+
R5,232 R7,970 R9,214 R10,062 R10,966
Specialists, medicine, radiology, pathology, etc
2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit, limited to R700 per person and R2,121 per family
4. On Discharge:
  • R420 per person per admission
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:
  • For PMBs chronic medication, there is a 40% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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Fedhealth Maxima Standard 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Comprehensive plan with extended fund and threshold benefits (with 20% co-payment) that can be used for most out-of-hospital claims.
1. Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs: Additional 14 conditions covered
  • R5,120 per person, and R10,200 per family. Thereafter only PMBs are covered
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R3,032 R2,583 R907
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive plan with extended fund and threshold benefits (with 20% co-payment) that can be used for most out-of-hospital claims.
Main: Adult: Child:
(S) Savings: R6,552 R5,580 R1,956
(SP) Self Payment: R4,648 R3,020 R924
Threshold (S+SP): R11,200 R8,600 R2,880
Above Threshold: No limit, with 20% co-payment No limit, with 20% co-payment No limit, with 20% co-payment

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2. Acute (presrcibed) medication:
  • R5,120 per person and R10,200 per family, from day-to-day benefit
3. Over-the-counter:
  • Paid from savings benefit only and does not add up to threshold
4. On Discharge:
  • 7 days supply
5. Birth Control:
  • Devices and medicine: paid by scheme, including IUDs
  • Consultations: from day-to-day benefit
6. Notes:
  • Chronic meds: if not on the formulary, 40% co-payment

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Medimed Max B 2017: Medicine Benefits
In brief: 100% scheme rate for specialists. Income based plan. Over and above the savings and extended fund, scheme pays out-of-hospital claims for: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
1. Chronic:
  • PMB chronic: paid by scheme
  • Extended chronic conditions: R3,200 per person and R6,400 per family paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R3,050 R3,050 R530
Children: Pay for all children
Income limit: R10,001-R17,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, preventative benefits, some medication. Limits apply. All else paid from savings, extended fund (max R10,000 per family) or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R14,150 R14,150 R1,590
Extended Fund: R5,000 pp R10,000 pf R

Compare with these plans:

2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • R150 per prescription, R1,500 per family
  • Paid from day-to-day benefit
4. On Discharge:
5. Birth Control:
6. Notes:

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Bestmed Pace 1 2017: Medicine Benefits
In brief: 100%