Topmed out-of-hospital benefits: 2017

By Staff Writer -

Click here to compare out-of-hospital benefits across all schemes, or use the menu bar above for more options. Topmed home page.

Non income-limited plans

Income limited plans

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

Compare with these plans:

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

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Compcare Pinnacle 2017: Out Of Hospital Benefits
In brief: 200% scheme rate for specialists. Some co-payments. Comprehensive cover with savings, extended fund, and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
1. GP consultations:
    Paid
  • Paid from day-to-day benefit
  • If day-to-day benefit is depleted: 2 additional consults and one ER visit (limited to R1,000) per child younger than 6yrs, paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R5,328 R4,146 R1,476
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive cover with savings, extended fund, and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
Main: Adult: Child:
(S) Savings: R12,816 R9,936 R3,528
Extended Fund: R3,197 R2,488 R886
(SP) Self Payment: R1,900 R1,416 R460
Threshold (S+SP): R17,913 R13,840 R4,874
Above Threshold: R8,700 pb
R17,400 pf		 17,400 pf

Compare with these plans:

2. Specialists consultations:
  • Paid from day-to-day benefit, up to 200% scheme rate
  • Above-threshold sub-limit of R4,180 per family applies
3. Pathology:
  • Paid from day-to-day benefit
  • Above-threshold sub-limit of R4,175 per family
  • Combined with radiology benefit
4. General radiology:
  • Paid from day-to-day benefit
  • Above-threshold sub-limit of R4,175 per family
  • Combined with pathology benefit
5. Specialised radiology:
  • First R2,500 paid from available day-to-day benefit, but not from above threshold benefit. Balance paid by scheme.
6. Supplementary Services: (Physio, etc)
  • R6,950 per family
  • Only physio, biokinetics and OT are payable from above-threshold, and only up to R2,750 per family subject to sub-limits

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

Compare with these plans:

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

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

Compare with these plans:

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

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

Compare with these plans:

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

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Compcare Pinnacle ED 2017: Out Of Hospital Benefits
In brief: 200% scheme rate for specialists. Netcare hospitals. Some co-payments. Comprehensive cover with savings, extended fund, and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
1. GP consultations:
    Paid
  • Paid from day-to-day benefit
  • If day-to-day benefit is depleted: 2 additional consults and one ER visit (limited to R1,000) per child younger than 6yrs, paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,452 R3,462 R1,242
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive cover with savings, extended fund, and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
Main: Adult: Child:
(S) Savings: R10,656 R8,280 R2,952
(SP) Self Payment: R1,900 R1,416 R460
Threshold (S+SP): R15,226 R11,774 R4,158
Above Threshold: R8,700 pb
R17,400 pf		 17,400 pf

Compare with these plans:

2. Specialists consultations:
  • Paid from day-to-day benefit, up to 200% scheme rate
  • Above-threshold sub-limit of R4,180 per family applies
3. Pathology:
  • Paid from day-to-day benefit
  • Above-threshold sub-limit of R4,175 per family
  • Combined with radiology benefit
4. General radiology:
  • Paid from day-to-day benefit
  • Above-threshold sub-limit of R4,175 per family
  • Combined with pathology benefit
5. Specialised radiology:
  • First R2,500 paid from available day-to-day benefit, but not from above threshold benefit. Balance paid by scheme.
6. Supplementary Services: (Physio, etc)
  • R6,950 per family
  • Only physio, biokinetics and OT are payable from above-threshold, and only up to R2,750 per family subject to sub-limits

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

Compare with these plans:

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

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

Compare with these plans:

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

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

Compare with these plans:

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

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

Compare with these plans:

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

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Compcare Dynamix 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some co-payments. Comprehensive cover with savings, extended fund, and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
1. GP consultations:
    Paid
  • Paid from day-to-day benefit
  • If day-to-day benefit is depleted: 2 additional consults and one ER visit (limited to R1,000) per child younger than 6yrs, paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,014 R3,138 R1,122
Children: Pay for all children
Day-to-Day Benefit:
Comprehensive cover with savings, extended fund, and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
Main: Adult: Child:
(S) Savings: R7,200 R5,688 R2,016
Extended Fund: R2,408 R1,883 R673
(SP) Self Payment: R5,000 R3,878 R1,402
Threshold (S+SP): R14,608 R11,449 R4,091
Above Threshold: R5,800 pb
R11,600 pf		 11,600 pf

Compare with these plans:

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

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

Compare with these plans:

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

View this plan

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

Compare with these plans:

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

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

Compare with these plans:

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

View this plan

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

Compare with these plans:

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

View this plan

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

Compare with these plans:

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

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

Compare with these plans:

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

View this plan

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

Compare with these plans:

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

View this plan

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

Compare with these plans:

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

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

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

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

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

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

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

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

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

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

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

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

Compare with these plans:

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

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

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

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

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

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

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

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

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

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

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

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

Compare with these plans:

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

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

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

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

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

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

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

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

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

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

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

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

Compare with these plans:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Compare with these plans:

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

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

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

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

Compare with these plans:

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

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

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

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

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

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Momentum Extender (Any provider for chronic) 2017: Out Of Hospital Benefits
In brief: 200% scheme rate for specialists. Chronic benefits from any provider. Comprehensive plan, with out of hospital benefits paid by scheme from threshold (with sub-limits), once savings run out and self payment gap has been paid.
1. GP consultations:
  • Paediatrician: 2 consults for infants up to 1yr
  • Otherwise, from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R5,308 R4,235 R1,665
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: comprehensive plan, with out of hospital benefits paid by scheme from threshold (with sub-limits), once savings run out and self payment gap has been paid.
Main: Adult: Child:
(S) Savings: R15,924 R12,705 R4,995
(SP) Self Payment: R1,176 R2,095 R105
Threshold (S+SP): R17,100 R14,800 R5,100
Above Threshold: No limit No limit No limit

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

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

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

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

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

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Discovery Executive 2017: Out Of Hospital Benefits
In brief: 300% scheme rate for specialists. Comprehensive cover with savings, extended fund, and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R5,544 R5,544 R1,055
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Comprehensive cover that covers most out-of-hospital benefits (with sub limits). Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R16,632 R16,632 R3,156
(SP) Self Payment: R28 R28 R
Threshold (S+SP): R16,660 R16,660 R3,150
Above Threshold: No limit No limit No limit

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2. Specialists consultations:
  • Paid from day-to-day benefit
3. Pathology:
  • Paid from day-to-day benefit
4. General radiology:
  • Paid from day-to-day benefit
5. Specialised radiology:
  • Paid from day-to-day benefit
6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
  • Limited to:
    M M1 M2 M3+
    R19,750 R23,750 R27,750 R33,350
  • For a defined list of conditions you get unlimited cover for biokineticists, acousticians, physiotherapists, occupational therapists, and speech and language therapists. Speak to Discovery directly

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Discovery Classic Comprehensive 2017: Out Of Hospital Benefits
In brief: 200% scheme rate for specialists. Comprehensive cover with savings, extended fund, and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Paid from day-to-day benefit
  • While in the Self Payment Gap, face-to-face and video call consultations with a GP in Premier Plus Network are paid by scheme
  • While in the Self Payment Gap, kids under 10 years have access to two casualty visits per year and video call consults with a pediatrician with whom Discovery has payment arrangement
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,506 R4,264 R898
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Comprehensive cover that covers most out-of-hospital benefits (with sub limits). Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R13,512 R12,792 R2,688
(SP) Self Payment: R1,988 R2,708 R262
Threshold (S+SP): R15,500 R15,500 R2,950
Above Threshold: No limit No limit No limit

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2. Specialists consultations:
  • Paid from day-to-day benefit
3. Pathology:
  • Paid from day-to-day benefit
  • While in the Self Payment Gap, scheme will still pay for blood tests at partner clinic pharmacies
4. General radiology:
  • Paid from day-to-day benefit
5. Specialised radiology:
  • The first R2,750 from day-to-day benefit, balance paid by scheme
6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefits. Includes allied, therapeutic and psychology services
    • Main M1 M2 M3+
    R15,560 R21,200 R25,900 R30,000
  • For a defined list of conditions you get unlimited cover for biokineticists, acousticians, physiotherapists, occupational therapists, and speech and language therapists. Speak to Discovery directly

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

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

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

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

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

Compare with these plans:

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

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

Compare with these plans:

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

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

Compare with these plans:

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

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

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

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

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

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

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

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

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

    View this plan

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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

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

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

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

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

    Compare with these plans:

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

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

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

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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

    Compare with these plans:

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

    View this plan

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

    Compare with these plans:

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

    View this plan

    Commed Deluxe 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Comprehensive cover with savings, self-payment gap and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
    1. GP consultations:
    • 14 consults per person and 28 consults per family
    • Paid from day-to-day benefit
    • Shared with Specialist benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R5,802 R4,742 R1,158
    Children: Pay for all children
    Day-to-Day Benefit:
    Comprehensive cover with savings, self-payment gap and limited above threshold benefits that cover most out-of-hospital benefits (with limits).
    Main: Adult: Child:
    (S) Savings: R10,440 R8,532 R2,088
    (SP) Self Payment: R7,830 R6,399 R1,566
    Threshold (S+SP): R18,270 R14,931 R3,654
    Above Threshold: 2,610 2,133 522

    Compare with these plans:

    2. Specialists consultations:
    • 14 consults per person and 28 consults per family. Paid from day-to-day benefit
    • Shared with GP benefit
    3. Pathology:
    • R2,860 per person and R8,480 per family
    • Paid from day-to-day benefit
    4. General radiology:
    • R2,900 per person and R8,500 per family
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid from day-to-day benefit
    6. Supplementary Services: (Physio, etc)
    • R4,000 per person and R8,000 per family
    • Paid from day-to-day benefit but not from threshold

    View this plan

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

    Compare with these plans:

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

    View this plan

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

    Compare with these plans:

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

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

    Compare with these plans:

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

    View this plan

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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

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

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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    Sizwe Affordable Care C 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • M =7 consults; M1 =14 consults; M2 =16 consults; M3 =18 consults etc
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,657 R3,251 R730
    Children: Pay for all children
    Income limit: R18,445+ (other limits)
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

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

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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

    Compare with these plans:

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

    View this plan

    Sizwe Full Benefit A 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • M =12 consults; M1 =20 consults; M2 =25 consults; M3 =29 consults etc
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,210 R3,825 R860
    Children: Pay for all children
    Income limit: R0-R18,879 (other limits)
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    Day-to-day limit: M =R15,390 M1 =R20,790 M2 =R23,370 M3 =R26,060 M4 =R28,770 M5 =R31,460 M6+ =R34,150
    2. Specialists consultations:
    • Must be referred. Limited consults to: M =7 consults; M1 =12; M2 =15; M3 =16; M4 =17; M5 =19; M6+ =20
    • Paid from day-to-day benefit
    3. Pathology:
    • M =R1,300 and M1+ =R2,750
    • Shared with radiology benefit
    • Paid from day-to-day benefit
    4. General radiology:
    • M =R1,300 and M1+ =R2,750
    • Shared with pathology benefit
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R35,420 per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Physio: from day-to-day benefit
    • Otherwise, R2,630 per person and R4,420 per family, paid by scheme

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    Fedhealth Maxima Exec 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Comprehensive plan with extended fund and threshold benefits that can be used for most out-of-hospital claims.
    1. GP consultations:
    • Depending on the GP, paid from day-to-day benefit, or paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,302 R3,666 R1,284
    Children: Pay for all children
    Day-to-Day Benefit:
    Comprehensive plan with extended fund and threshold benefits that can be used for most out-of-hospital plans.
    Main: Adult: Child:
    (S) Savings: R3,768 R3,216 R1,128
    Extended Fund: R5,390 R4,200 R700
    (SP) Self Payment: R2,042 R1,184 R1,052
    Threshold (S+SP): R11,200 R8,600 R2,880
    Above Threshold: No limit No limit No limit

    Compare with these plans:

    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Paid by scheme, with a R1,900 co-payment
    6. Supplementary Services: (Physio, etc)
    • Audiology, dietetics, genetic counselling, occupational therapy, orthoptics, podiatry, psychologists, speech therapy, social workers, physio, biokinetics and chiropractics: R15,700 per family, from day-to-day benefit
    • Alternative healthcare: paid from day-to-day benefit, but not from threshold

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

    Compare with these plans:

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

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    Sizwe Full Benefit B 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • M =12 consults; M1 =20 consults; M2 =25 consults; M3 =29 consults etc
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,885 R4,441 R960
    Children: Pay for all children
    Income limit: R18,880+ (other limits)
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

    Compare with these plans:

    Day-to-day limit: M =R15,390 M1 =R20,790 M2 =R23,370 M3 =R26,060 M4 =R28,770 M5 =R31,460 M6+ =R34,150
    2. Specialists consultations:
    • Must be referred. Limited consults to: M =7 consults; M1 =12; M2 =15; M3 =16; M4 =17; M5 =19; M6+ =20
    • Paid from day-to-day benefit
    3. Pathology:
    • M =R1,300 and M1+ =R2,750
    • Shared with radiology benefit
    • Paid from day-to-day benefit
    4. General radiology:
    • M =R1,300 and M1+ =R2,750
    • Shared with pathology benefit
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R35,420 per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Physio: from day-to-day benefit
    • Otherwise, R2,630 per person and R4,420 per family, paid by scheme

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    Fedhealth Maxima Plus 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Comprehensive plan with extended fund and threshold benefits that can be used for most out-of-hospital claims.
    1. GP consultations:
    • Depending on the GP, paid from day-to-day benefit, or paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R6,740 R5,733 R2,021
    Children: Pay for all children
    Day-to-Day Benefit:
    Comprehensive plan with extended fund and threshold benefits that can be used for most out-of-hospital plans.
    Main: Adult: Child:
    (S) Savings: R4,452 R3,780 R1,332
    Extended Fund: R7,850 R5,670 R1,740
    (SP) Self Payment: R736 R578 R405
    Threshold (S+SP): R13,038 R10,028 R3,477
    Above Threshold: No limit No limit No limit

    Compare with these plans:

    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Unlimited
    6. Supplementary Services: (Physio, etc)
    • Audiology, dietetics, genetic counselling, occupational therapy, orthoptics, podiatry, psychologists, speech therapy, social workers: R15,700 per family, from day-to-day benefit
    • Alternative healthcare: paid from day-to-day benefit, but not from threshold
    • Physio, biokinetics and chiropractics: paid from day-to-day benefit

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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    Fedhealth Ultimax 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Comprehensive plan with extended fund and threshold benefits that can be used for most out-of-hospital claims.
    1. GP consultations:
    • Depending on the GP, paid from day-to-day benefit, or paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R9,215 R7,829 R2,765
    Children: Pay for all children
    Day-to-Day Benefit:
    Comprehensive plan with extended fund and threshold benefits that can be used for most out-of-hospital plans.
    Main: Adult: Child:
    (S) Savings: R5,748 R4,884 R1,728
    Extended Fund: R2560 (main) R4,010 (family) R
    (SP) Self Payment: R4,942 R3,747 R
    Threshold (S+SP): R13,250 R10,081 R3,360
    Above Threshold: No limit No limit No limit

    Compare with these plans:

    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Unlimited
    6. Supplementary Services: (Physio, etc)
    • Audiology, dietetics, genetic counselling, occupational therapy, orthoptics, podiatry, psychologists, speech therapy, social workers: R15,700 per family, from day-to-day benefit
    • Alternative healthcare: paid from day-to-day benefit, but not from threshold
    • Physio, biokinetics and chiropractics: paid from day-to-day benefit

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

    Compare with these plans:

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

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

    Compare with these plans:

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

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

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

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

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

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

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

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    Medihelp Plus 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: radiology, pathology, GPs, specialists, supplementary services, psychologists, medicine, optometry, dentistry, maternity, infant paediatrics, medical appliances. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Consult: R3,100 per person. Shared with GPs, specialists, physiotherapy, supplementary services and ER
    • Treatment (medical and surgical services, anesthesia, material and medicine used during service:Unlimited
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R6,936 R6,936 R1,728
    Children: Pay for all children.
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, medical appliances, GPs, specialists, psychologists, supplementary health, medication, radiology and pathology, dentistry and optometry. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • See GP benefit, above
    3. Pathology:
    • Unlimited.
    4. General radiology:
    • Unlimited
    5. Specialised radiology:
    • Unlimited for MRI, CT and Angiography, in and out of hospital
    • PET scans: R19,100 per case (non-PMB)
    • Paid by scheme
    6. Supplementary Services: (Physio, etc)
    • See GP benefit, above
    • Also, speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge following hospital admission. Limited to R1,650 per person and R2,200 per family

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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    Momentum Extender Network hospital (and any provider for chronic) 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Network hospitals. Chronic benefits from any provider. Comprehensive plan, with out of hospital benefits paid by scheme from threshold (with sub-limits), once savings run out and self payment gap has been paid.
    1. GP consultations:
    • Paediatrician: 2 consults for infants up to 1yr
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,671 R3,728 R1,465
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: comprehensive plan, with out of hospital benefits paid by scheme from threshold (with sub-limits), once savings run out and self payment gap has been paid.
    Main: Adult: Child:
    (S) Savings: R14,013 R11,184 R4,395
    (SP) Self Payment: R3,087 R3,616 R705
    Threshold (S+SP): R17,100 R14,800 R5,100
    Above Threshold: No limit No limit No limit

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

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    Momentum Summit 2017: Out Of Hospital Benefits
    In brief: 300% scheme rate. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), maternity, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paediatrician: 2 consults for infants up to 1yr
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R7,637 R6,108 R1,754
    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: R22,300 R22,300 R22,300

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • Unlimited with a R2,030 co-payment
    6. Supplementary Services: (Physio, etc)
    • R6,380 per family, from day-to-day benefit

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

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

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    Discovery Classic Delta Comprehensive 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Network hospitals. Comprehensive cover with savings, extended fund, and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    • While in the Self Payment Gap, face-to-face and video call consultations with a GP in Premier Plus Network are paid by scheme
    • While in the Self Payment Gap, kids under 10 years have access to two casualty visits per year and video call consults with a pediatrician with whom Discovery has payment arrangement
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,059 R3,842 R807
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Comprehensive cover that covers most out-of-hospital benefits (with sub limits). Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R12,168 R11,520 R2,412
    (SP) Self Payment: R3,332 R3,980 R538
    Threshold (S+SP): R15,500 R15,500 R2,950
    Above Threshold: No limit No limit No limit

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    • While in the Self Payment Gap, scheme will still pay for blood tests at partner clinic pharmacies
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • The first R2,750 from day-to-day benefit, balance paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefits. Includes allied, therapeutic and psychology services
      • Main M1 M2 M3+
      R15,560 R21,200 R25,900 R30,000
    • For a defined list of conditions you get unlimited cover for biokineticists, acousticians, physiotherapists, occupational therapists, and speech and language therapists. Speak to Discovery directly

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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    Bestmed Pace 2 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: preventative dentistry, optometry, maternity, specialised radiology, contraceptives, some medicine, trauma rehab and preventative benefits. Limits apply. All else paid from savings, from extended fund or from out of pocket, unless PMB.
    1. GP consultations:
    • Limited to M =R3,450 and M1+ =R6,950
    • Paid from day-to-day benefit
    • Shared with specialist benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,315 R4,231 R951
    Children: Pay for maximum 4 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Preventative dentistry, optometry, maternity, specialised radiology, contraceptives, medicine, trauma rehab and preventative benefits. Limits apply. All else paid from savings, from extended fund or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R7,764 R7,620 R1,716
    Extended Fund: R12,000 (main) R24,000 (family) R

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    2. Specialists consultations:
    • Shared with GP benefits, see above
    3. Pathology:
    • Limited to M =R2,550 and M1+ =R5,200
    • Paid from day-to-day benefit
    • Shared with radiology benefit
    4. General radiology:
    • Limited to M =R2,550 and M1+ =R5,200
    • Paid from day-to-day benefit
    • Shared with pathology benefit
    5. Specialised radiology:
    • 3 MRI/CT scans and 1 PET scan per family, paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Limited to M =R4,300 and M1+ =R8,650
    • Paid from day-to-day benefit
    • Shared with radiology benefit

    View this plan

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

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

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

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

    View this plan

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

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

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

    Compare with these plans:

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

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

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

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

    Compare with these plans:

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

    View this plan

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

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

    View this plan

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

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

    View this plan

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

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

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

    Compare with these plans:

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

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

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

    View this plan

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Compare with these plans:

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

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

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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. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R23,500 per family
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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

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

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

    Compare with these plans:

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

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    Momentum Extender (Network provider for chronic) 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Chronic benefits from Network provider. Comprehensive plan, with out of hospital benefits paid by scheme from threshold (with sub-limits), once savings run out and self payment gap has been paid.
    1. GP consultations:
    • Paediatrician: 2 consults for infants up to 1yr
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,776 R3,813 R1,495
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: comprehensive plan, with out of hospital benefits paid by scheme from threshold (with sub-limits), once savings run out and self payment gap has been paid.
    Main: Adult: Child:
    (S) Savings: R14,328 R11,439 R4,485
    (SP) Self Payment: R2,772 R3,361 R615
    Threshold (S+SP): R17,100 R14,800 R5,100
    Above Threshold: No limit No limit No limit

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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    Bestmed Pace 3 A 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: preventative dentistry, optometry, maternity, specialised radiology, contraceptives, some medicine, trauma rehab and preventative benefits. Limits apply. All else paid from savings, from extended fund or from out of pocket, unless PMB.
    1. GP consultations:
    • Limited to M =R3,450 and M1+ =R7,150
    • Paid from day-to-day benefit
    • Shared with specialist benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,243 R3,394 R725
    Children: Pay for maximum 4 children
    Income limit: R0-R8,208 (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Preventative dentistry, optometry, maternity, specialised radiology, contraceptives, medicine, trauma rehab and preventative benefits. Limits apply. All else paid from savings, from extended fund or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R7,632 R6,108 R1,416
    Extended Fund: R15,000 (main) R31,000 (family) R

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    2. Specialists consultations:
    • Shared with GP benefits, see above
    3. Pathology:
    • Limited to M =R2,850 and M1+ =R5,500
    • Paid from day-to-day benefit
    • Shared with radiology benefit
    4. General radiology:
    • Limited to M =R2,850 and M1+ =R5,500
    • Paid from day-to-day benefit
    • Shared with pathology benefit
    5. Specialised radiology:
    • 3 MRI/CT scans and 1 PET scan per family, paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Limited to M =R2,100 and M1+ =R4,200
    • Paid from day-to-day benefit
    • Shared with radiology benefit

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

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

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

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

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

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

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

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

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

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

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    Cape Medical Select 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,998 R4,998 R809
    Children: Pay for all children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R3,600 R3,600 R586
    Extended Fund: R4,800 R4,800 R1,200

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

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    Suremed Challanger 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: medication, appliances, dentistry, GPs and specialists, maternity, non surgical procedures, optometry, supplementary services, pathology, radiology, specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
    1. GP consultations:
    • R4,500 per person and R12,300 per family
    • Shared with Specialist and Casualty Benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,000 R3,000 R800
    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 pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • R4,500 per person and R12,300 per family
    • Shared with GP and Casualty Benefit
    3. Pathology:
    • Unlimited
    4. General radiology:
    • Unlimited
    5. Specialised radiology:
    • R16,900 per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • R2,100 per person and R5,300 per family
    • Includes mental health

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R23,500 per family
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Bonitas BonClassic 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Over and above the savings fund, scheme pays out-of-hospital claims for: specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,648 R3,132 R900
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, mental health, medical appliances, hearing aids, optometry, 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: R6,192 R5,316 R1,524

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • R2,800 per person, and R6,200 per family, paid by scheme
    4. General radiology:
    • R2,800 per person and R4,340 per family, paid by scheme
    5. Specialised radiology:
    • R26,100 per family, in-and-out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid by scheme to these sub limits
    • Physical Therapy: R2,800 per person, and R14,300 per family
    • Otherwise:
      Main M+1 M+2 M+3 M+4
      R2,670 R4,090 R4,720 R5,040 R5,400

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

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

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

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

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    Momentum Extender Network hospital (and Network provider for chronic) 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Network hospitals. Chronic benefits from Network provider. Comprehensive plan, with out of hospital benefits paid by scheme from threshold (with sub-limits), once savings run out and self payment gap has been paid.
    1. GP consultations:
    • Paediatrician: 2 consults for infants up to 1yr
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,304 R3,433 R1,352
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: comprehensive plan, with out of hospital benefits paid by scheme from threshold (with sub-limits), once savings run out and self payment gap has been paid.
    Main: Adult: Child:
    (S) Savings: R12,912 R10,299 R4,056
    (SP) Self Payment: R4,188 R4,501 R1,044
    Threshold (S+SP): R17,100 R14,800 R5,100
    Above Threshold: No limit No limit No limit

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

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    Keyhealth Gold 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), dentistry, medicine, optometry, maternity, medical appliances, hearing aids, preventative benefits. Limits apply. All else paid from savings, from fund or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,143 R2,802 R812
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), dentistry, medicine, optometry, maternity, medical appliances, hearing aids, preventative benefits. Limits apply. All else paid from savings, from fund or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R4,968 R3,360 R972
    Extended Fund: R4,190 R3,120 R1,000

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • 30% co-payment
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • MRI and CT scans: R13,900 per family with R1,400 co-payment, in and out of hospital
    • PET scans: R30,800 per person. Maximum R15,400 per scan
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Discovery Essential Comprehensive 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Comprehensive cover with savings, extended fund, and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    • While in the Self Payment Gap, face-to-face and video call consultations with a GP in Premier Plus Network are paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,787 R3,580 R762
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Comprehensive cover that covers most out-of-hospital benefits (with sub limits). Extended benefit covers some claims while in self-payment gap. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R6,816 R6,444 R1,368
    (SP) Self Payment: R8,684 R9,056 R1,582
    Threshold (S+SP): R15,500 R15,500 R2,950
    Above Threshold: No limit No limit No limit

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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    Bestmed Pace 3 B 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: preventative dentistry, optometry, maternity, specialised radiology, contraceptives, some medicine, trauma rehab and preventative benefits. Limits apply. All else paid from savings, from extended fund or from out of pocket, unless PMB.
    1. GP consultations:
    • Limited to M =R3,450 and M1+ =R7,150
    • Paid from day-to-day benefit
    • Shared with specialist benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R5,097 R4,066 R853
    Children: Pay for maximum 4 children
    Income limit: R8,209+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Preventative dentistry, optometry, maternity, specialised radiology, contraceptives, medicine, trauma rehab and preventative benefits. Limits apply. All else paid from savings, from extended fund or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R9,180 R7,320 R1,536
    Extended Fund: R28,000 (main) R45,100 (family) R

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    2. Specialists consultations:
    • Shared with GP benefits, see above
    3. Pathology:
    • Limited to M =R2,850 and M1+ =R5,500
    • Paid from day-to-day benefit
    • Shared with radiology benefit
    4. General radiology:
    • Limited to M =R2,850 and M1+ =R5,500
    • Paid from day-to-day benefit
    • Shared with pathology benefit
    5. Specialised radiology:
    • 3 MRI/CT scans and 1 PET scan per family, paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Limited to M =R2,100 and M1+ =R4,200
    • Paid from day-to-day benefit
    • Shared with radiology benefit

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    Bestmed Pulse 2 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: GP and specialist consults, dentistry, optometry, appliances, wound care, maternity, radiology and pathology, specialised radiology, some medication, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • GP Network: unlimited GP consults
    • Out-of-network: R1,200 per family, limited to two consults
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,902 R3,902 R927
    Children: Pay for maximum 4 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: GP and specialist consults, dentistry, optometry, appliances, wound care, maternity, radiology and pathology, specialised radiology, medication, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-
    Extended Fund: R11,350 (main) R22,550 (family) R

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    2. Specialists consultations:
    • M= R2,350 and M1+ =R4,800
    • Paid from day-to-day benefit
    3. Pathology:
    • Cover from network, subject to protocols and day-to-day benefit
    4. General radiology:
    • Cover from network, subject to protocols and day-to-day benefit
    5. Specialised radiology:
    • Maximum 3 MRI/CT scans and 1 PET scan per person
    6. Supplementary Services: (Physio, etc)
    • M= R3,350 and M1+ =R6,600
    • Paid from day-to-day benefit

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    Spectramed Capri 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Gastroscopies, colonoscopies, plantar wart removal, removal of ingrown toenail, varicose vein injection/drainage: paid by scheme
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R2,003 R1,609 R909
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R2,400 R1,932 R1,092

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

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

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

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    Resolution Millennium 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,200 R3,598 R979
    Children: Pay for all children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R10,092 R8,628 R2,340
    (SP) Self Payment: R3,479 R2,629 R633
    Threshold (S+SP): R13,571 R11,257 R2,973
    Above Threshold: 5,544 4,728 774

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R15,003 per family with R1,892 co-payment. In and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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. Specialists consultations:
    • M =3 visit, M+1= 5 visits, M2+ =7 visits
    • Applies to GPs and Outpatient Facilities
    3. Pathology:
    • R2,385 per person
    4. General radiology:
    • R1,855 per person
    5. Specialised radiology:
    • 2 scans per person
    6. Supplementary Services: (Physio, etc)
    • Alternative services: R3,220 per family
    • Remedial and other therapies: R3,110 per family
    • Physiotherapy and Biokinetics: R1,460 per person limited to R2,420 per family

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    Bonitas BonComprehensive 2017: Out Of Hospital Benefits
    In brief: 300% scheme rate. Over and above the savings/threshold benefit, scheme pays out-of-hospital claims for: specialised radiology, mental health, refractive surgery, medical appliances, hearing aids, optometry, maternity, infant paediatrics and preventative benefits. Limits apply. Unlimited threshold with a self payment gap and sub-limits. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Paediatric consults: Three per infant under 1yr; two per child 1-2yrs; two GP consults per child 2-12yrs
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R5,254 R4,956 R1,069
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, mental health, refractive surgery, medical appliances, hearing aids, optometry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings, above threshold or from out of pocket.
    Main: Adult: Child:
    (S) Savings: R11,892 R11,220 R2,424
    (SP) Self Payment: R3,600 R2,980 R1,370
    Threshold (S+SP): R15,492 R14,200 R3,794
    Above Threshold: No limit No limit No limit

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R28,200 per family, in-and-out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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

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

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

    Compare with these plans:

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

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    Momentum Extender (State provider for chronic) 2017: Out Of Hospital Benefits
    In brief: 00% scheme rate. Chronic benefits from State provider. Comprehensive plan, with out of hospital benefits paid by scheme from threshold (with sub-limits), once savings run out and self payment gap has been paid.
    1. GP consultations:
    • Paediatrician: 2 consults for infants up to 1yr
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,309 R3,507 R1,323
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: comprehensive plan, with out of hospital benefits paid by scheme from threshold (with sub-limits), once savings run out and self payment gap has been paid.
    Main: Adult: Child:
    (S) Savings: R12,927 R10,521 R3,969
    (SP) Self Payment: R4,173 R4,279 R1,131
    Threshold (S+SP): R17,100 R14,800 R5,100
    Above Threshold: No limit No limit No limit

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

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    Keyhealth Platinum 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. This is a comprehensive plan. Scheme pays out-of-hospital claims for: specialised radiology (co-payment), dentistry, medicine, optometry, maternity, medical appliances, hearing aids, oncology, sub-acute facilities, preventative benefits. Limits apply. All else paid from fund, from above threshold benefit or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R6,796 R4,764 R1,433
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (co-payment), dentistry, medicine, optometry, maternity, medical appliances, sub-acute facilities, preventative benefits. Limits apply. All else paid from fund, from above threshold benefit or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-
    Extended Fund: R9,115 R8,840 R2,160
    (SP) Self Payment: R3,190 R2,840 R1,045
    Threshold (S+SP): R12,305 R11,680 R3,205
    Above Threshold: No limit No limit No limit

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Limited to R11,900 per family, with a 20% co-payment
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • MRI and CT scans: R20,800 per family with R1,400 co-payment, in and out of hospital
    • PET scans: R30,800 per person. Maximum R15,400 per scan
    6. Supplementary Services: (Physio, etc)
    • Physiotherapy limited to R11,900 per family. Otherwise unlimited.
    • Paid from day-to-day benefit

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

    Compare with these plans:

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

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

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

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

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

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

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

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

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

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

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

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    Bestmed Pace 4 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: optometry, maternity, specialised radiology, trauma rehab, some medication, contraceptives and preventative benefits. Limits apply. All else paid from extended fund, from savings or out of pocket, unless PMB.
    1. GP consultations:
    • Limited to M =R4,400 and M1+ =R7,150
    • Paid from day-to-day benefit
    • Shared with specialist benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R6,096 R6,096 R1,428
    Children: Pay for maximum 4 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Optometry, maternity, specialised radiology, trauma rehab, medication, contraceptives and preventative benefits. Limits apply. All else paid from extended fund, from savings or out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R996 R996 R516

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    2. Specialists consultations:
    • Shared with GP benefits, see above
    3. Pathology:
    • Limited to M =R4,400 and M1+ =R8,650
    • Paid from day-to-day benefit
    • Shared with radiology benefit
    4. General radiology:
    • Limited to M =R4,400 and M1+ =R8,650
    • Paid from day-to-day benefit
    • Shared with pathology benefit
    5. Specialised radiology:
    • 3 MRI/CT scans and 1 PET scan per family, paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Limited to M =R4,400 and M1+ =R8,650
    • Paid from day-to-day benefit
    • Shared with radiology benefit

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

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

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

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

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    Resolution Millennium Select 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,819 R3,271 R890
    Children: Pay for all children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R9,180 R7,848 R2,124
    (SP) Self Payment: R4,391 R3,409 R849
    Threshold (S+SP): R13.571 R11,257 R2,973
    Above Threshold: 5,544 4,728 774

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R15,003 per family with R1,892 co-payment. In and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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

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

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

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

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

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

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    Hosmed Plus 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: GPs, specialists, medicine, pathology, radiology, specialised radiology, optometry, dentistry, appliances, mental health, supplementary services, maternity benefits, preventative benefits, Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • 16 visits per person, and 26 visits per family
    • Applies to GPs, Specialists and Outpatient Facilities
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,184 R3,115 R700
    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 from 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
    R10,960 R23,090 R25,200 R27,750
    2. Specialists consultations:
    • See GP benefit, above
    3. Pathology:
    • R4,360 per person
    4. General radiology:
    • R3,210 per person
    5. Specialised radiology:
    • 2 scans per person
    6. Supplementary Services: (Physio, etc)
    • Alternative services: R3,495 per family
    • Remedial and other therapies: R4,430 per family
    • Physiotherapy and Biokinetics: R2,340 per person limited to R3,750 per family

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

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

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

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

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    Momentum Extender Network hospital (and State provider for chronic) 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate for specialists. Network hospitals. Chronic benefits from State provider. Comprehensive plan, with out of hospital benefits paid by scheme from threshold (with sub-limits), once savings run out and self payment gap has been paid.
    1. GP consultations:
    • Paediatrician: 2 consults for infants up to 1yr
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,732 R2,805 R1,149
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: comprehensive plan, with out of hospital benefits paid by scheme from threshold (with sub-limits), once savings run out and self payment gap has been paid.
    Main: Adult: Child:
    (S) Savings: R11,196 R8,415 R3,447
    (SP) Self Payment: R5,904 R6,385 R1,653
    Threshold (S+SP): R17,100 R14,800 R5,100
    Above Threshold: No limit No limit No limit

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

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    Topmed Executive 2017: Out Of Hospital Benefits
    In brief: 200% scheme rate fro specialists. Scheme pays most out-of-hospital claims for: maternity, scopes, alternatives to hospitalisation, extended rehab benefits, preventative benefits. All else paid for from day-to-day benefits, which include an unlimited above threshold benefit or out-of-pocket unless PMB. Sub-limits apply.
    1. GP consultations:
    • Paid from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,453 R3,554 R1,355
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (with co-payment), maternity, scopes, alternatives to hospitalisation, extended rehab benefits, preventative benefits. Limits apply. All else paid for from day-to-day benefits, which include an unlimited above threshold benefit or out-of pocket, unless PMB. Sub-limits apply.
    Main: Adult: Child:
    (S) Savings: R12,356 R10,656 R4,044

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R2,500 co-payment per scan
    6. Supplementary Services: (Physio, etc)
    • From day-to-day benefit, and limited to R5,748 per person and R16,980 per family

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

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

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

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

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    Resolution Supreme 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • Paid from limit below
    • Limit shared with GPs, specialists, dentistry and optometry
    MainAdultChild
    R14,157R10,618R1,481
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,565 R4,345 R1,130
    Children: Pay for all children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • M= 4 consults, M1 =5 consults, M2+ =6 consults, subject to limits below
    • Limit shared with GPs, specialists, dentistry and optometry
    MainAdultChild
    R14,157R10,618R1,481
    3. Pathology:
    • Paid from limit below, with these sub limits: M =R3,183; M1 =R3,907; M2+ =R4,719
    • Limit below shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
    MM1M2+
    R7,424R13,067R14,191
    4. General radiology:
    • Paid from limit below, with these sub limits: M =R3,183; M1 =R3,907; M2+ =R4,719
    • Limit below shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
    MM1M2+
    R7,424R13,067R14,191
    5. Specialised radiology:
    • R18,755 per family with R1,892 co-payment. In and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from limit below, with these sub limits: M =R3,183; M1 =4,719; M2+ =R6,244
    • Physio: R1,392 per family sub-limit
    • Speech therapy and audiology: R1,592 per family sublimit
    • Limit below shared with supplementary health, std radiology and pathology, physio, mental health, speech therapy and audiology, acute medication
    MM1M2+
    R7,424R13,067R14,191

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    Medshield MediBonus 2017: Out Of Hospital Benefits
    In brief: Up to 200% scheme rate. Scheme pays out-of-hospital claims for: specialised radiology, maternity, alternative to hospitalisation, optometry, some non-surgical procedures including scopes, preventative benefits. Limits apply. All else paid from extended fund or out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
    • Scopes: most paid by scheme if done in rooms
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,119 R2,829 R819
    Children: Pay for three children only
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, alternative to hospitalisation, 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: RM =R9,300
    M1 = R13,040
    M2 =R14,460
    M3 = R15,930
    M4 = R17,240    		 R R

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
    • Scopes: most paid by scheme if done in rooms
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    • 1 Bone densitometry scan per person
    5. Specialised radiology:
    • R18,030 per family, with 10% co-payment for non-PMBs
    • In and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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

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

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    Selfmed 80% 2017: Out Of Hospital Benefits
    In brief:
    1. GP consultations:
    • 20% co-payment and limited to M =consults, M1 = 30 consults and M2+ =45 consults
    • Shared with GP and Specialist consults>/li>
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R6,335 R5,485 R1,100
    Children: Pay for maximum 3 children
    Day-to-Day Benefit:
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • 20% co-payment and limited to M =consults, M1 = 30 consults and M2+ =45 consults
    • Shared with GP and Specialist consults>/li>
    3. Pathology:
    • 20% co-payment
    4. General radiology:
    • 20% co-payment
    5. Specialised radiology:
    6. Supplementary Services: (Physio, etc)
    • Medical and clinical technology: 20% co-payment
    • Physio, speech therapy, occupational therapy, podiatry, orthotic treatment, hearing aid acoustics, dieticians, chiropractors, osteopaths, homeopaths, naturopaths, herbalists and biokinetics: 20% co-payment and limited to R4,800 per person and R13,600 per family

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    Medihelp Dimension Elite 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Scheme pays out-of-hospital claims for: radiology (co-payment), pathology, GPs, specialists, supplementary services, psychologists, medicine, optometry, dentistry, maternity, infant paediatrics, medical appliances. Limits apply. All else paid from out of pocket, unless PMB.
    1. GP consultations:
    • Shared with: GPs, specialists, psychology, physiotherapy, supplementary health services
    Main M1 M2 M3+
    R2,450 R4,100 R5,050 R6,100
    • 2 consultations for babies under 1yr old, paid by scheme
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,972 R3,714 R1,080
    Children: Pay for all children.
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: radiology (co-payment), pathology, GPs, specialists, supplementary services, psychologists, medicine, optometry, dentistry, maternity, infant paediatrics, medical appliances. Limits apply. All else paid from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • See GP benefit, above
    3. Pathology:
    • R2,450 per family
    4. General radiology:
    • R2,450 per family
    5. Specialised radiology:
    • Paid by scheme, with a R1,000 co-payment, in or out of hospital
    6. Supplementary Services: (Physio, etc)
    • See GP benefit, above
    • Also, speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge following hospital admission. Limited to R1,650 per person and R2,200 per family

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    Topmed Comprehensive 2017: Out Of Hospital Benefits
    In brief: 300% scheme rate. Scheme pays most out-of-hospital claims for: maternity, scopes, alternatives to hospitalisation, extended rehab benefits, preventative benefits. All else paid for from day-to-day benefits, which include an unlimited above threshold benefit (paid at 80% scheme rate) or out-of-pocket, unless PMB. Sub-limits apply.
    1. GP consultations:
    • Paid from day-to-day benefit, at 80% scheme rate when from above threshold benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R6,070 R5,010 R1,425
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology (with co-payment), maternity, scopes, alternatives to hospitalisation, extended rehab benefits, preventative benefits. Limits apply. All else paid for from day-to-day benefits, which include an unlimited above threshold benefit or out-of pocket, unless PMB. Sub-limits apply.
    Main: Adult: Child:
    (S) Savings: R0- R0- R0-

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    2. Specialists consultations:
    • Paid from day-to-day benefit, at 80% scheme rate when from above threshold benefit
    3. Pathology:
    • Paid from day-to-day benefit, with 80% scheme rate when from above threshold benefit
    4. General radiology:
    • Paid from day-to-day benefit, with 80% scheme rate when from above threshold benefit
    5. Specialised radiology:
    • R2,500 co-payment per scan
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit, with 80% scheme rate when from above threshold benefit

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    Bestmed Beat 4 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Some co-payments. Scheme pays out-of-hospital claims for: preventative dentistry, optometry, maternity, specialised radiology, contraceptives, some medicine and preventative benefits. Limits apply. All else paid from savings, from extended fund or from out of pocket, unless PMB.
    1. GP consultations:
    • Limited to M =R2,550 and M1+ =R4,550
    • Paid from day-to-day benefit
    • Shared with specialist benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,618 R2,988 R895
    Children: Pay for maximum 4 children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: Preventative dentistry, optometry, maternity, specialised radiology, contraceptives, some medicine and preventative benefits. Limits apply. All else paid from savings, from extended fund or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R6,516 R5,376 R1,608
    Extended Fund: R10,000 (main) R20,000 (family) R

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    2. Specialists consultations:
    • Shared with GP benefits, see above
    3. Pathology:
    • Paid from day-to-day benefit
    • Shared with general radiology benefit
    • Limited to M =R2,550 and M1+ =R5,200
    4. General radiology:
    • Paid from day-to-day benefit
    • Shared with pathology benefit
    • Limited to M =R2,550 and M1+ =R5,200
    5. Specialised radiology:
    • R13,200 per family paid by scheme
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit
    • Limited to M= R3,900 and M1+ =R7,900

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    Spectramed Azure C 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: mental health, specialised dentistry and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Gastroscopies, colonoscopies, plantar wart removal, removal of ingrown toenail, varicose vein injection/drainage: paid by scheme
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R3,651 R2,582 R1,282
    Children: Pay for max 3 children, with 2nd and 3rd child=R1,175pm
    Income limit: R11,500+ (other limits)
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: mental health, specialised dentistry and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R8,100 R5,736 R2,844

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

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    Medshield Premium Plus 2017: Out Of Hospital Benefits
    In brief: Up to 200% scheme rate. Scheme pays out-of-hospital claims for: specialised radiology, maternity, alternative to hospitalisation, some non-surgical procedures including scopes, preventative benefits. Limits apply. All else paid from savings, from threshold benefit or from out of pocket, unless PMB.
    1. GP consultations:
    • Paid from day-to-day benefit
    • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
    • Scopes: most paid by scheme if done in rooms
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R4,284 R3,909 R792
    Children: Pay for three children only
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: specialised radiology, maternity, alternative to hospitalisation, some non-surgical procedures including scopes, preventative benefits. Limits apply. All else paid from savings, from threshold benefit or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R12,852 R11,736 R2,376
    Threshold (S+SP): R12,730 R11,770 R2,350
    Above Threshold: 4,280 3,210 2,140

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R21,550 per family, in and out of hospital
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Spectramed Cobalt 2017: Out Of Hospital Benefits
    In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: mental health, appliances, optometry, specialised dentistry and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    1. GP consultations:
    • Gastroscopies, colonoscopies, plantar wart removal, removal of ingrown toenail, varicose vein injection/drainage: paid by scheme
    • Otherwise, from day-to-day benefit
    Overall Annual Limit (OAL):
    Unlimited overall, with sub-limits
    Contributions:
    Main: Adult: Child:
    Total Cost: R5,321 R4,831 R1,865
    Children: Pay for all children
    Day-to-Day Benefit:
    Out-of-hospital, scheme pays for some: mental health, appliances, optometry, specialised dentistry and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
    Main: Adult: Child:
    (S) Savings: R14,688 R13,332 R5,148

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    2. Specialists consultations:
    • Paid from day-to-day benefit
    3. Pathology:
    • Paid from day-to-day benefit
    4. General radiology:
    • Paid from day-to-day benefit
    5. Specialised radiology:
    • R20,700 per family with a R1,500 co-payment
    6. Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit

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    Income limited plans

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