Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Bonitas - Boncomprehensive - Chronic Benefit

27 CDL chronic conditions

BonComprehensive offers cover for the 60 chronic conditions listed below. Your chronic medicine benefit is R16 100 per beneficiary and R32 060 per family on the applicable medicine formulary. If you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment. Once the amount above is finished, you will still be covered for the 27 Prescribed Minimum Benefits, listed below.

Additional chronic conditions

***

Bonitas - Boncomprehensive - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	Avoid a R6 620 co-payment by using a Designated Service Provider
Medical Savings Account	***
Annual Threshold	Main member R24 564 Adult Dependent R22 634 Child dependent R5 810
Self Payment Gap	Main member R4 650 Adult Dependent R3 860 Child dependent R1 760
Above Threshold Benefit	Unlimited

Bonitas - Boncomprehensive - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	R2 500 co-payment per scan event except for PMB
MRI, CT & PET Scans	R2 500 co-payment per scan event except for PMB
Pathology	***
Internal Prosthesis	R60 380 for external prosthesis per family Sublimit of R5 760 per breast prosthesis (limited to 2 per year)
External Appliances/Prosthesis	R60 380 for external prosthesis per family Sublimit of R5 760 per breast prosthesis (limited to 2 per year)

Bonitas - Boncomprehensive - Hospital Benefits - Sub Acute Facilities

Hospice	R18 130 per family Managed Care protocols apply
Nursing	PALLIATIVE CARE (CANCER ONLY): Unlimited, subject to the DSP Including hospice/private nursing, home oxygen, pain management, psychologist and social worker support
Ambulance Services	Remote patient monitoring including 24/7 vital signs monitoring from our clinical command centre, continuous virtual visits and clinical support, continuous care from a doctor, short-term oxygen (as prescribed) and emergency ambulance services

Bonitas - Boncomprehensive - D2D - GP's and Medication

General Practitioners	Paid from available savings and/or above threshold benefit
Specialists	Paid from available savings and/or above threshold benefit You must get a referral from your GP
Prescribed Medication	***
Pharmacy Advised Medicine	***

Bonitas - Boncomprehensive - D2D - Radiology & Pathology

Basic Radiology	R34 340 per family, in and out-of-hospital Pre-authorisation required R2 500 co-payment per scan event except for PMB
MRI, CT & PET Scans	R34 340 per family, in and out-of-hospital Pre-authorisation required R2 500 co-payment per scan event except for PMB
Pathology	***

Bonitas - Boncomprehensive - D2D - Dental Benefit

Conservative Dentistry	Paid from available savings and/or above threshold benefit Subject to the Bonitas Dental Management Programme Covered at the Bonitas Dental Tariff
Specialised Dentistry	Paid from available savings and/or above threshold benefit Covered at the Bonitas Dental Tariff

Bonitas - Boncomprehensive - D2D - Optical Benefit

Examination	1 consultation per beneficiary, at a network provider or R365 per beneficiary for an eye examination, at a non-network provider
Lenses	Single Vision lenses: 100% towards the cost of clear lenses, limited to R215 per lens, per beneficiary, at a non-network provider Bifocal Lenses: 100% towards the cost of clear lenses, limited to R460 per lens, per beneficiary, at a non-network provider Multifocal Lenses: 100% towards the cost of base lenses at a network provider, or limited to a maximum of R860 per designer lens, per beneficiary, in and out of network
Frames	Paid from available savings and/or above threshold benefit (subject to optometry sublimit)
Contact Lenses	Paid from available savings and/or above threshold benefit (subject to optometry sublimit)

Bonitas - Boncomprehensive - D2D - Auxiliary Services

Physiotherapy	Unlimited, covered at 100% of the Bonitas rate
Psychiatry	***
Psychology	***
HIV/AIDS	Unlimited, if you register on the HIV/AIDS programme

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R8 990
Adult	R8 478
Child	R1 830

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Bonitas - Bonclassic - Chronic Benefit

27 CDL chronic conditions

BonClassic offers cover for the 47 chronic conditions listed below, limited to R13 190 per beneficiary and R27 270 per family on the applicable formulary. If you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment. You must get your medicine from the Bonitas Pharmacy Network. If you choose to use a non-network pharmacy, you will have to pay a 40% co-payment. Once the amount above is finished, you will still be covered for the 27 Prescribed Minimum Benefits, listed below, through Pharmacy Direct our Designated Service Provider. If you choose not to use Pharmacy Direct, you will have to pay a 40% co-payment.

Additional chronic conditions

***

Bonitas - Bonclassic - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Bonitas - Bonclassic - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	R33 740 per family, in and out-of-hospital R2 500 co-payment per scan event except for PMB
MRI, CT & PET Scans	R33 740 per family, in and out-of-hospital R2 500 co-payment per scan event except for PMB
Pathology	***
Internal Prosthesis	R63 540 per family, unless PMB Sublimit of R6 120 per breast prosthesis (limited to 2 per year)
External Appliances/Prosthesis	R63 540 per family, unless PMB Sublimit of R6 120 per breast prosthesis (limited to 2 per year)

Bonitas - Bonclassic - Hospital Benefits - Sub Acute Facilities

Hospice	ALTERNATIVES TO HOSPITAL (HOSPICE, STEP-DOWN FACILITIES) R19 250 per family
Nursing	PALLIATIVE CARE (CANCER ONLY) Unlimited, subject to the DSP
Ambulance Services	An alternative to general ward admission and stepdown facilities, allowing you to receive quality, safe healthcare in the comfort of your home • Remote patient monitoring including 24/7 vital signs monitoring from our clinical command centre, continuous virtual visits and clinical support, continuous care from a doctor, short-term oxygen (as prescribed) and emergency ambulance services

Bonitas - Bonclassic - D2D - GP's and Medication

General Practitioners	***
Specialists	***
Prescribed Medication	***
Pharmacy Advised Medicine	***

Bonitas - Bonclassic - D2D - Radiology & Pathology

Basic Radiology	R33 740 per family, in and out-of-hospital Pre-authorisation required R2 500 co-payment per scan event except for PMB
MRI, CT & PET Scans	R33 740 per family, in and out-of-hospital Pre-authorisation required R2 500 co-payment per scan event except for PMB
Pathology	Oral Pathology

Bonitas - Bonclassic - D2D - Dental Benefit

Conservative Dentistry	R5 457 per family
Specialised Dentistry	R6 570 per family, per year

Bonitas - Bonclassic - D2D - Optical Benefit

Examination	1 consultation per beneficiary, at a network provider or 1 consultation per beneficiary, at a network provider
Lenses	Single Vision lenses: 100% towards the cost of lenses at network rates or R215 per lens, per beneficiary, out of network Bifocal Lenses: 1100% towards the cost of lenses at network rates or R460 per lens, per beneficiary, out of network Multifocal Lenses: 100% towards the cost of base lenses at a network provider, or limited to a maximum of R860 per designer lens, per beneficiary, in and out of network Paid from available savings and/or above threshold benefit (subject to optometry sublimit)
Frames	R1 165 per beneficiary at a network provider or R874 per beneficiary at a non-network provider
Contact Lenses	R1 965 per beneficiary, included in family limit

Bonitas - Bonclassic - D2D - Auxiliary Services

Physiotherapy	Paid from available savings
Psychiatry	***
Psychology	***
HIV/AIDS	Unlimited, if you register on the HIV/AIDS programme

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R6 143
Adult	R5 273
Child	R1 516

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Bonitas - Standard - Chronic Benefit

27 CDL chronic conditions	Hospital Standard ensures that you are covered for the 27 Prescribed Minimum Benefits listed below on the applicable formulary. You must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment.
Additional chronic conditions	***

Bonitas - Standard - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Bonitas - Standard - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	R28 600 per family, in and out-of-hospital Pre-authorisation required R2 500 co-payment per scan event except for PMB
MRI, CT & PET Scans	R28 600 per family, in and out-of-hospital Pre-authorisation required R2 500 co-payment per scan event except for PMB
Pathology	***
Internal Prosthesis	***
External Appliances/Prosthesis	***

Bonitas - Standard - Hospital Benefits - Sub Acute Facilities

Hospice	ALTERNATIVES TO HOSPITAL (HOSPICE, STEP-DOWN FACILITIES) R18 130 per family
Nursing	PALLIATIVE CARE (CANCER ONLY) Unlimited, subject to the DSP Including hospice/private nursing, home
Ambulance Services	Remote patient monitoring including 24/7 vital signs monitoring from our clinical command centre, continuous virtual visits and clinical support, continuous care from a doctor, short-term oxygen (as prescribed) and emergency ambulance services

Bonitas - Standard - D2D - GP's and Medication

General Practitioners	***
Specialists	***
Prescribed Medication	***
Pharmacy Advised Medicine	***

Bonitas - Standard - D2D - Radiology & Pathology

Basic Radiology	R28 600 per family, in and out-of-hospital Pre-authorisation required R2 500 co-payment per scan event except for PMB
MRI, CT & PET Scans	R28 600 per family, in and out-of-hospital Pre-authorisation required R2 500 co-payment per scan event except for PMB
Pathology	***

Bonitas - Standard - D2D - Dental Benefit

Conservative Dentistry	***
Specialised Dentistry	***

Bonitas - Standard - D2D - Optical Benefit

Examination	***
Lenses	***
Frames	***
Contact Lenses	***

Bonitas - Standard - D2D - Auxiliary Services

Physiotherapy	PMB only Subject to referral by treating practitioner
Psychiatry	***
Psychology	***
HIV/AIDS	Unlimited, if you register on the HIV/AIDS programme Chronic medicine must be obtained from the Designated Service Provider

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R2 722
Adult	R2 293
Child	R1 035

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Bonitas - Standard Select - Chronic Benefit

27 CDL chronic conditions

Standard Select offers cover for the 45 chronic conditions listed below, limited to R11 180 per beneficiary and R22 440 per family on the applicable formulary. You must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment. Pre-authorisation is required. Once the amount above is finished, you will still be covered for the 27 Prescribed Minimum Benefits, listed below, through Pharmacy Direct our Designated Service Provider. If you choose not to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment.

Additional chronic conditions

***

Bonitas - Standard Select - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Bonitas - Standard Select - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	R30 370 per family, in and out-of-hospital Pre-authorisation required R1 660 co-payment per scan event except for PMB
MRI, CT & PET Scans	R30 370 per family, in and out-of-hospital Pre-authorisation required R1 660 co-payment per scan event except for PMB
Pathology	ORAL PATHOLOGY
Internal Prosthesis	Sublimit of R6 120 per breast prosthesis (limited to 2 per year)
External Appliances/Prosthesis	Sublimit of R6 120 per breast prosthesis (limited to 2 per year)

Bonitas - Standard Select - Hospital Benefits - Sub Acute Facilities

Hospice	ALTERNATIVES TO HOSPITAL (HOSPICE, STEP-DOWN FACILITIES) R19 250 per family Managed Care protocols apply
Nursing	PALLIATIVE CARE (CANCER ONLY) Unlimited, subject to the DSP Including hospice/private nursing, home oxygen, pain management, psychologist and social worker support
Ambulance Services	• Remote patient monitoring including 24/7 vital signs monitoring from our clinical command centre, continuous virtual visits and clinical support, continuous care from a doctor, short-term oxygen (as prescribed) and emergency ambulance services

Bonitas - Standard Select - D2D - GP's and Medication

General Practitioners	For specialist consultations you must get a referral from your GP. (Including virtual care consultations) On Standard Select: • You must nominate 2 GPs on our network for each beneficiary for the year • 2 non-nominated network GP visits allowed per family per year • Consultations with non-network GPs are limited to PMBs only
Specialists	For specialist consultations you must get a referral from your GP. (Including virtual care consultations) On Standard Select: • You must nominate 2 GPs on our network for each beneficiary for the year • 2 non-nominated network GP visits allowed per family per year • Consultations with non-network GPs are limited to PMBs only
Prescribed Medication	***
Pharmacy Advised Medicine	***

Bonitas - Standard Select - D2D - Radiology & Pathology

Basic Radiology	R30 370 per family, in and out-of-hospital Pre-authorisation required R1 660 co-payment per scan event except for PMB
MRI, CT & PET Scans	R30 370 per family, in and out-of-hospital Pre-authorisation required R1 660 co-payment per scan event except for PMB
Pathology	Oral Pathology

Bonitas - Standard Select - D2D - Dental Benefit

Conservative Dentistry	Covered at the Bonitas Dental Tariff Subject to the Bonitas Dental Management Programme and a Designated Service Provider
Specialised Dentistry	***

Bonitas - Standard Select - D2D - Optical Benefit

Examination	1 composite consultation per beneficiary, at a network provider or R365 per beneficiary for an eye examination, at a non-network provider
Lenses	Single Vision lenses: 100% towards the cost of lenses at network rates or R215 per lens, per beneficiary, out of network Bifocal Lenses: 100% towards the cost of lenses at network rates or R460 per lens, per beneficiary, out of network Multifocal Lenses: 100% towards the cost of base lenses at a network provider, or limited to a maximum of R860 per designer lens, per beneficiary, in and out of network Paid from available savings and/or above threshold benefit (subject to optometry sublimit)
Frames	340 per beneficiary at a network provider or R1 005 per beneficiary at a
Contact Lenses	R2 060 per beneficiary (included in the family limit)

Bonitas - Standard Select - D2D - Auxiliary Services

Physiotherapy	This category applies to physiotherapy, podiatry and biokinetics, allied medical professionals (such as dieticians, speech and occupational therapists) and alternative healthcare (20% co-payment applies to homoeopathic medicine).
Psychiatry	***
Psychology	***
HIV/AIDS	Unlimited, if you register on the HIV/AIDS programme Chronic medicine must be obtained from the Designated Service Provider

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R4 105
Adult	R3 552
Child	R1 202

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Bonitas - Primary - Chronic Benefit

27 CDL chronic conditions	Primary and Primary Select ensures that you are covered for the 27 Prescribed Minimum Benefits listed below on the applicable formulary. You must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment.
Additional chronic conditions	***

Bonitas - Primary - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Bonitas - Primary - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	R14 240 per family, in and out-of-hospital Pre-authorisation required R2 000 co-payment per scan event except for PMB
MRI, CT & PET Scans	R14 240 per family, in and out-of-hospital Pre-authorisation required R2 000 co-payment per scan event except for PMB
Pathology	Oral Pathology
Internal Prosthesis	***
External Appliances/Prosthesis	***

Bonitas - Primary - Hospital Benefits - Sub Acute Facilities

Hospice	ALTERNATIVES TO HOSPITAL (HOSPICE, STEP-DOWN FACILITIES) R18 130 per family Managed Care protocols apply
Nursing	PALLIATIVE CARE (CANCER ONLY) Unlimited, subject to the DSP Including hospice/private nursing, home oxygen, pain management, psychologist and social worker support
Ambulance Services	Remote patient monitoring including 24/7 vital signs monitoring from our clinical command centre, continuous virtual visits and clinical support, continuous care from a doctor, short-term oxygen (as prescribed) and emergency ambulance services

Bonitas - Primary - D2D - GP's and Medication

General Practitioners	For specialist consultations you must get a referral from your GP. (Including virtual care consultations) On Primary Select: • You must nominate 2 GPs on our network for each beneficiary for the year • 2 non-nominated network GP visits allowed per family per year • Consultations with non-network GPs are limited to PMBs only
Specialists	Unlimited, network specialists covered in full at the Bonitas Rate Unlimited, non-network specialists paid at 100% of the Bonitas Rate
Prescribed Medication	***
Pharmacy Advised Medicine	***

Bonitas - Primary - D2D - Radiology & Pathology

Basic Radiology	R14 240 per family, in and out-of-hospital Pre-authorisation required R2 000 co-payment per scan event except for PMB
MRI, CT & PET Scans	R14 240 per family, in and out-of-hospital Pre-authorisation required R2 000 co-payment per scan event except for PMB
Pathology	Oral Pathology

Bonitas - Primary - D2D - Dental Benefit

Conservative Dentistry	Covered at the Bonitas Dental Tariff Subject to the Bonitas Dental Management Programme and a Designated Service Provider
Specialised Dentistry	***

Bonitas - Primary - D2D - Optical Benefit

Examination	1 consultation per beneficiary, at a network provider or R365 per beneficiary for an eye examination, at a non-network provider
Lenses	Single Vision lenses: 100% towards the cost of lenses at network rates or R215 per lens, per beneficiary, out of network Bifocal Lenses: 100% towards the cost of lenses at network rates or R460 per lens, per beneficiary, out of network Multifocal Lenses: 100% towards the cost of base lenses at a network provider, or limited to a maximum of R860 per designer lens, per beneficiary, in and out of network
Frames	R550 per beneficiary at a network provider or R413 per beneficiary at a non-network
Contact Lenses	R1 360 per beneficiary (included in the family limit)

Bonitas - Primary - D2D - Auxiliary Services

Physiotherapy	This category applies to physiotherapy, podiatry and biokinetics, allied medical professionals (such as dieticians, speech and occupational therapists) and alternative healthcare (20% co-payment applies to homoeopathic medicine).
Psychiatry	***
Psychology	***
HIV/AIDS	Unlimited, if you register on the HIV/AIDS programme Chronic medicine must be obtained from the Designated Service Provider

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R2 792
Adult	R2 184
Child	R888

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Bonitas - Primary Select - Chronic Benefit

27 CDL chronic conditions	Primary and Primary Select ensures that you are covered for the 27 Prescribed Minimum Benefits listed below on the applicable formulary. You must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment.
Additional chronic conditions	***

Bonitas - Primary Select - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Bonitas - Primary Select - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	R14 240 per family, in and Pre-authorisation required R2 000 co-payment per scan event except for PMB
MRI, CT & PET Scans	R14 240 per family, in and Pre-authorisation required R2 000 co-payment per scan event except for PMB
Pathology	Oral Pathology
Internal Prosthesis	***
External Appliances/Prosthesis	***

Bonitas - Primary Select - Hospital Benefits - Sub Acute Facilities

Hospice	ALTERNATIVES TO HOSPITAL (HOSPICE, STEP-DOWN FACILITIES) R18 130 per family Managed Care protocols apply
Nursing	PALLIATIVE CARE (CANCER ONLY) Unlimited, subject to the DSP Including hospice/private nursing, home oxygen, pain management, psychologist and social worker support
Ambulance Services	Remote patient monitoring including 24/7 vital signs monitoring from our clinical command centre, continuous virtual visits and clinical support, continuous care from a doctor, short-term oxygen (as prescribed) and emergency ambulance services

Bonitas - Primary Select - D2D - GP's and Medication

General Practitioners	***
Specialists	***
Prescribed Medication	***
Pharmacy Advised Medicine	***

Bonitas - Primary Select - D2D - Radiology & Pathology

Basic Radiology	R14 240 per family, in and out-of-hospital Pre-authorisation required R2 000 co-payment per scan event except for PMB
MRI, CT & PET Scans	R14 240 per family, in and out-of-hospital Pre-authorisation required R2 000 co-payment per scan event except for PMB
Pathology	Oral Pathology

Bonitas - Primary Select - D2D - Dental Benefit

Conservative Dentistry	Covered at the Bonitas Dental Tariff Subject to the Bonitas Dental Management Programme and a Designated Service Provider
Specialised Dentistry	***

Bonitas - Primary Select - D2D - Optical Benefit

Examination	1 consultation per beneficiary, at a network provider or R365 per beneficiary for an eye examination, at a non-network provider
Lenses	Single Vision lenses: 100% towards the cost of lenses at network rates or R215 per lens, per beneficiary, out of network Bifocal Lenses: 100% towards the cost of lenses at network rates or R460 per lens, per beneficiary, out of network Multifocal Lenses: 100% towards the cost of base lenses at a network provider, or limited to a maximum of R860 per designer lens, per beneficiary, in and out of network
Frames	R550 per beneficiary at a network provider OR R413 per beneficiary at a non-network
Contact Lenses	R1 360 per beneficiary (included in the family limit)

Bonitas - Primary Select - D2D - Auxiliary Services

Physiotherapy	Limited to and included in the day-to-day benefit Subject to referral by treating practitioner
Psychiatry	***
Psychology	***
HIV/AIDS	Unlimited, if you register on the HIV/AIDS programme Chronic medicine must be obtained from the Designated Service Provider

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R2 443
Adult	R1 910
Child	R776

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Bonitas - Bonsave - Chronic Benefit

27 CDL chronic conditions	BonSave and BonFit Select ensure that you are covered for the 27 Prescribed Minimum Benefits listed below. You must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment. Pre-authorisation is required.
Additional chronic conditions	***

Bonitas - Bonsave - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Bonitas - Bonsave - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	R27 160 per family, in and out-of-hospital Pre-authorisation required R1 660 co-payment per scan event except for PMB
MRI, CT & PET Scans	R27 160 per family, in and out-of-hospital Pre-authorisation required R1 660 co-payment per scan event except for PMB
Pathology	***
Internal Prosthesis	R36 660 per family (no cover for joint replacement except for PMB) Managed Care protocols apply
External Appliances/Prosthesis	Paid from available savings

Bonitas - Bonsave - Hospital Benefits - Sub Acute Facilities

Hospice	ALTERNATIVES TO HOSPITAL (HOSPICE, STEP-DOWN FACILITIES) R19 250 per family Managed Care protocols apply
Nursing	PALLIATIVE CARE (CANCER ONLY) PALLIATIVE CARE (CANCER ONLY) Unlimited, subject to the DSP Including hospice/private nursing, home oxygen, pain management, psychologist and social worker support
Ambulance Services	Remote patient monitoring including 24/7 vital signs monitoring from our clinical command centre, continuous virtual visits and clinical support, continuous care from a doctor, short-term oxygen (as prescribed) and emergency ambulance services

Bonitas - Bonsave - D2D - GP's and Medication

General Practitioners	***
Specialists	Unlimited, network specialists covered
Prescribed Medication	***
Pharmacy Advised Medicine	***

Bonitas - Bonsave - D2D - Radiology & Pathology

Basic Radiology	R27 160 per family, in and out-of-hospital Pre-authorisation required R1 660 co-payment per scan event except for PMB
MRI, CT & PET Scans	R27 160 per family, in and out-of-hospital Pre-authorisation required R1 660 co-payment per scan event except for PMB
Pathology	***

Bonitas - Bonsave - D2D - Dental Benefit

Conservative Dentistry	Covered at the Bonitas Dental Tariff Managed Care protocols apply
Specialised Dentistry	No benefit

Bonitas - Bonsave - D2D - Optical Benefit

Examination	1 consultation per beneficiary, at a network provider or R365 per beneficiary for an eye examination, at a non-network provider
Lenses	Single Vision lenses: 100% towards the cost of lenses at network rates or R215 per lens, per beneficiary, out of network Bifocal Lenses: 100% towards the cost of lenses at network rates or R460 per lens, per beneficiary, out of network Multifocal Lenses: 100% towards the cost of base lenses at a network provider, or limited to a maximum of R860 per designer lens, per beneficiary, in and out of network
Frames	Paid from available savings
Contact Lenses	Paid from available savings

Bonitas - Bonsave - D2D - Auxiliary Services

Physiotherapy
Psychiatry
Psychology
HIV/AIDS

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R3 228
Adult	R2 500
Child	R966

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

[table “429” not found /]

Bonitas - Bonfit Select - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Bonitas - Bonfit Select - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	Paid from available savings Pre-authorisation required
MRI, CT & PET Scans	Paid from available savings Pre-authorisation required
Pathology	***
Internal Prosthesis	PMB only Managed Care protocols apply
External Appliances/Prosthesis	PMB only

Bonitas - Bonfit Select - Hospital Benefits - Sub Acute Facilities

Hospice	ALTERNATIVES TO HOSPITAL (HOSPICE, STEP-DOWN FACILITIES) R19 250 per family Managed Care protocols apply
Nursing	PALLIATIVE CARE (CANCER ONLY) Unlimited, subject to the DSP Including hospice/private nursing, home oxygen, pain management, psychologist and social worker support
Ambulance Services	Remote patient monitoring including 24/7 vital signs monitoring from our clinical command centre, continuous virtual visits and clinical support, continuous care from a doctor, short-term oxygen (as prescribed) and emergency ambulance services

Bonitas - Bonfit Select - D2D - GP's and Medication

General Practitioners	***
Specialists	Unlimited, network specialists covered in full at the Bonitas RateUnlimited, non-network specialists paid at 100% of the Bonitas Rate
Prescribed Medication	***
Pharmacy Advised Medicine	***

Bonitas - Bonfit Select - D2D - Radiology & Pathology

Basic Radiology	Paid from available savings Pre-authorisation required
MRI, CT & PET Scans	Paid from available savings Pre-authorisation required
Pathology	***

Bonitas - Bonfit Select - D2D - Dental Benefit

Conservative Dentistry	Covered at the Bonitas Dental Tariff Managed Care protocols apply
Specialised Dentistry	***

Bonitas - Bonfit Select - D2D - Optical Benefit

Examination	1 consultation per beneficiary, at a network provider or R365 per beneficiary for an eye examination, at a non-network provider
Lenses	Single Vision lenses: 100% towards the cost of lenses at network rates or R215 per lens, per beneficiary, out of network Bifocal Lenses: 100% towards the cost of lenses at network rates or R460 per lens, per beneficiary, out of network Multifocal Lenses: 100% towards the cost of base lenses at a network provider, or limited to a maximum of R860 per designer lens, per beneficiary, in and out of network
Frames	Paid from available savings
Contact Lenses	Paid from available savings

Bonitas - Bonfit Select - D2D - Auxiliary Services

Physiotherapy	No cover for physiotherapy
Psychiatry	***
Psychology	***
HIV/AIDS	***

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R2 236
Adult	R1 674
Child	R729

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Bonitas - Boncap - Chronic Benefit

27 CDL chronic conditions	Ulcerative Colitis BonCap ensures that you are covered for the 27 Prescribed Minimum Benefits listed below. You must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not to use Pharmacy Direct or if you choose to use medicine that is not on the BonCap formulary, you will have to pay a 40% co-payment.
Additional chronic conditions	***

Bonitas - Boncap - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	Bonitas and use of a network provider
Medical Savings Account	***
Annual Threshold	***
Self-Payment Gap	***
Above Threshold Benefit	***

Bonitas - Boncap - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	MRIs AND CT SCANS (SPECIALISED RADIOLOGY) R12 720 per family Pre-authorisation required R1 100 co-payment per scan event, except for PMB
MRI, CT & PET Scans	NETWORK SPECIALIST CONSULTATIONS (THIS BENEFIT INCLUDES ACUTE MEDICINE, BLOOD TESTS, X-RAYS, MRIs AND CT SCANS) Limited to 3 visits or R3 480 per beneficiary Limited to 5 visits or R5 170 per family Subject to the BonCap Specialist network and referral from a BonCap network GP Pre-authorisation required (including MRIs and CT scans)
Pathology	***
Internal Prosthesis	INTERNAL AND EXTERNAL PROSTHESES PMB only at the DSP Managed Care protocols apply Pre-authorisation required
External Appliances/Prosthesis	INTERNAL AND EXTERNAL PROSTHESES PMB only at the DSP Managed Care protocols apply Pre-authorisation required

Bonitas - Boncap - Hospital Benefits - Sub Acute Facilities

Hospice	ALTERNATIVES TO HOSPITAL (HOSPICE, STEP-DOWN FACILITIES) R15 660 per family Pre-authorisation required
Nursing	PALLIATIVE CARE (CANCER ONLY) Including hospice/private nursing, home oxygen, pain management, psychologist and social worker support
Ambulance Services	HOSPITAL-AT-HOME (SUBJECT TO PRE-AUTHORISATION) Remote patient monitoring including 24/7 vital signs monitoring from our clinical command centre, continuous virtual visits and clinical support, continuous care from a doctor, short-term oxygen (as prescribed) and emergency ambulance services

Bonitas - Boncap - D2D - GP's and Medication

General Practitioners	NETWORK GP CONSULTATIONS (INCLUDING VIRTUAL CARE CONSULTATIONS) Unlimited GP consultations, using a maximum of 2 nominated BonCap network GPs Approval is required from the 8th GP consultation per beneficiary
Specialists	SPECIALIST CONSULTATIONS Unlimited, covered at 100% of the BonCap Rate for BonCap specialists Non-network specialists are covered at 70% of the BonCap Rate
Prescribed Medication	Our hospital setup at home also includes remote patient monitoring, daily visits, laboratory services, blood tests, wound dressings, medication/fluids via a drip, allied healthcare services and physiotherapy (as prescribed)
Pharmacy Advised Medicine	OVER-THE-COUNTER MEDICINE Limited to R105 per event Maximum of R295 per beneficiary, per year Subject to the BonCap medicine formulary, Bonitas pharmacy network and use of a network provider

Bonitas - Boncap - D2D - Radiology & Pathology

Basic Radiology	MRIs AND CT SCANS (SPECIALISED RADIOLOGY) R12 720 per family Pre-authorisation required R1 100 co-payment per scan event, except for PMB
MRI, CT & PET Scans	NETWORK SPECIALIST CONSULTATIONS (THIS BENEFIT INCLUDES ACUTE MEDICINE, BLOOD TESTS, X-RAYS, MRIs AND CT SCANS) Limited to 3 visits or R3 480 per beneficiary Limited to 5 visits or R5 170 per family Subject to the BonCap Specialist network and referral from a BonCap network GP Pre-authorisation required (including MRIs and CT scans)
Pathology	***

Bonitas - Boncap - D2D - Dental Benefit

Conservative Dentistry	INHALATION SEDATION IN DENTAL ROOMS (LAUGHING GAS) Inhalation sedation limited to extensive conservative dental treatment only Managed Care protocols apply
Specialised Dentistry	***

Bonitas - Boncap - D2D - Optical Benefit

Examination	Eye Test - R365 per beneficiary for an eye examination, at a non-network provider
Lenses	Glasses or contact lenses are available through the contracted service provider once every 2 years (based on the date of your previous claim)
Frames	FRAMES R235 per beneficiary at a network provider OR R176 per beneficiary at a non-network provider
Contact Lenses	CONTACT LENSES R1 195 per beneficiary

Bonitas - Boncap - D2D - Auxiliary Services

Physiotherapy	PMB only Our hospital setup at home also includes remote patient monitoring, daily visits, laboratory services, blood tests, wound dressings, medication/fluids via a drip, allied healthcare services and physiotherapy (as prescribed) No cover for physiotherapy for mental health admissions
Psychiatry	***
Psychology	***
HIV/AIDS	CHRONIC BENEFITS

Financial and Demographic
Date of information	2023
Principle Members	JAN – MAR 2023 R0 TO R10 020 / R1 274 R10 021 TO R16 270 / R1 507 R16 271 TO R21 160 / R2 429 R21 161+ / R2 982 APR – DEC 2023 R0 TO R10 020 / R1 368 R10 021 TO R16 270 /R1 619 R16 271 TO R21 160 / R2 609 R21 161+ / R3 203
Administrator	***
Scheme (Option) Age Profile	DEPENDANTS WHO ARE FULL-TIME STUDENTS PAY CHILD RATES UP TO AGE 24 YEARS.
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	R0 TO R10 020 R10 021 TO R16 270 R16 271 TO R21 160 R21 161+
Principle	JAN – MAR 2023 R0 TO R10 020 / R1 274 R10 021 TO R16 270 /R1 507 R16 271 TO R21 160 / R2 429 R21 161+ / R2 982 APR – DEC 2023 R0 TO R10 020 / R1 368 R10 021 TO R16 270 / R1 619 R16 271 TO R21 160 / R2 609 R21 161+ / R3 203
Adult	JAN – MAR 2023 R0 TO R10 020 / R 1 274 R10 021 TO R16 270 / R1 507 R16 271 TO R21 160 / R2 429 R21 161+ / R2 982 APR – DEC 2023 R0 TO R10 020 / R 1 368 R10 021 TO R16 270 / R1 619 R16 271 TO R21 160 / R2 609 R21 161+ / R3 203
Child	JAN – MAR 2023 R0 TO R10 020 / R600 R10 021 TO R16 270 / R693 R16 271 TO R21 160 / R919 R21 161+ / R1 131 APR – DEC 2023 R0 TO R10 020 / R644 R10 021 TO R16 270 / R744 R16 271 TO R21 160 / R987 R21 161+/ R1 215

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Discovery - Executive - Chronic Benefit

27 CDL chronic conditions	The Chronic Illness Benefit (CIB) covers you for a defined list of 27 medical conditions known as the Chronic Disease List (CDL).
Additional chronic conditions	You have cover for 22 extra conditions set out on the list of additional diseases on the Additional Disease List (ADL).

Discovery - Executive - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	A healthcare provider (for example doctor, specialist, allied healthcare professional, pharmacist or hospital) who we have an agreement with to provide treatment or services at a contracted rate. Visit www.discovery.co.za or click on Find a healthcare provider on the Discovery app to view the full list of DSPs.
Medical Savings Account	The Medical Savings Account (MSA) is an amount that is allocated to you at the beginning of each year or when you join the Scheme. You pay this amount back in equal portions as part of your monthly contribution. We pay your day-to-day medical expenses such as GP and specialist consultations, acute medicine, radiology and pathology from the available funds allocated to your MSA. Any unused funds will carry over to the next year. Should you leave the Scheme or change your plan partway through the year and have used more of the funds than what you have contributed, you will need to pay the difference to us.
Annual Threshold	We set the Annual Threshold amount at the beginning of each year. The number and type of dependants (spouse, adult or child) on your plan will determine the amount. The Annual Threshold is an amount that your claims need to add up to before we pay your day-to-day claims from the Above Threshold Benefit (ATB).
Self Payment Gap	If your MSA runs out before you reach your Annual Threshold, you will have to pay for claims from your own pocket until your claims reach the Annual Threshold amount. This period is known as the Self- Payment Gap (SPG). It is important that you continue to send your claims during the SPG so that we know when you reach your Annual Threshold for claims.
Above Threshold Benefit	Once the day-to-day claims you have sent to us add up to the Annual Threshold, we pay the rest of your day-to- day claims from the Above Threshold Benefit (ATB), at the Discovery Health Rate (DHR) or a portion of it. The Executive plan has an unlimited ATB.

Discovery - Executive - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	Any account other than the hospital account for in-hospital care. This could include the accounts for the admitting doctor, anaesthetist and any approved healthcare expenses like radiology or pathology.
MRI, CT & PET Scans	Up to the Discovery Health Rate (DHR) if the scan is related to your hospital admission from your Hospital Benefit If it is not related to your admission or for conservative back and neck treatment, we pay the first R3,470 from your available day-to-day benefits and the balance from your Hospital Benefit, up to the Discovery Health Rate (DHR). For conservative back and neck scans a limit of one scan per spinal and neck region applies
Pathology	Any account other than the hospital account for in-hospital care. This could include the accounts for the admitting doctor, anaesthetist and any approved healthcare expenses like radiology or pathology.
Internal Prosthesis	Major joint surgery: No limit for planned hip and knee joint replacements if you use a provider in our network, or up to 80% of the Discovery Health Rate (DHR) if you use a provider outside our network up to a maximum of R30,900 for each prosthesis for each admission. The network does not apply to emergency or trauma-related surgeries.
External Appliances/Prosthesis	****

Discovery - Executive - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	***
Ambulance Services	What we pay for We pay for all of the following medical services that you may receive in an emergency: The ambulance (or other medical transport)

Discovery - Executive - D2D - GP's and Medication

General Practitioners	We pay your day-to-day medical expenses such as GP and specialist consultations, acute medicine, radiology and pathology from the available funds allocated to your MSA.
Specialists	We pay your day-to-day medical expenses such as GP and specialist consultations, acute medicine, radiology and pathology from the available funds allocated to your MSA.
Prescribed Medication	The tables below show you how much we pay for your day-to-day expenses on all the Executive plan. PRESCRIBED MEDICINE* (SCHEDULE 3 AND ABOVE) SINGLE MEMBER: R46,450 ONE DEPENDANT: R54,450 TWO DEPENDANTS: R62,350 THREE OR MORE DEPENDANTS: R70,300
Pharmacy Advised Medicine	Over-the-counter medicine, childhood vaccines, immunisations and lifestyle- enhancing products: We pay these claims from the available funds in your Medical Savings Account (MSA). These claims do not add up to the Annual Threshold and are not paid from the Above Threshold Benefit (ATB).

Discovery - Executive - D2D - Radiology & Pathology

Basic Radiology	We pay your day-to-day medical expenses such as GP and specialist consultations, medicine (excluding registered chronic medicine), radiology and pathology from your available funds allocated to your MSA.
MRI, CT & PET Scans	***
Pathology	We pay your day-to-day medical expenses such as GP and specialist consultations, medicine (excluding registered chronic medicine), radiology and pathology from your available funds allocated to your MSA.

Discovery - Executive - D2D - Dental Benefit

Conservative Dentistry	Dental appliances and orthodontic treatment: R32,600 per person
Specialised Dentistry	***

Discovery - Executive - D2D - Optical Benefit

Examination	***
Lenses	(this limit covers lenses, frames, contact lenses and surgery or any healthcare service to correct refractive errors of the eye) R9,550 per person
Frames	(this limit covers lenses, frames, contact lenses and surgery or any healthcare service to correct refractive errors of the eye) R9,550 per person
Contact Lenses	(this limit covers lenses, frames, contact lenses and surgery or any healthcare service to correct refractive errors of the eye) R9,550 per person

Discovery - Executive - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	Additional benefits for allied, therapeutic, psychology services and external medical items You have access to unlimited, clinically appropriate cover for biokineticists, acousticians, social workers, physiotherapists or chiropractors, psychologists, occupational therapists, speech and language therapists and external medical items, for a defined list of conditions. You need to apply for these benefits.
HIV/AIDS	***

Financial and Demographic
Date of information	***
Principle Members
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary
Principle	CONTRIBUTIONS (JANUARY 2023 - MARCH 2023) R8,298
Adult	CONTRIBUTIONS (JANUARY 2023 - MARCH 2023) R8,298
Child	CONTRIBUTIONS (JANUARY 2023 - MARCH 2023) R1,586

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Discovery - Classic Comprehensive - Chronic Benefit

27 CDL chronic conditions	Chronic conditions covered on all plans
Additional chronic conditions	***

Discovery - Classic Comprehensive - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	The medical savings account is an amount that is allocated to you at the beginning of each year or when you join the Scheme. You pay this amount back in equal portions as part of your monthly contribution.
Annual Threshold	We set the Annual Threshold amount at the beginning of each year. The number and type of dependents on your plan will determine the amount
Self Payment Gap	If your MSA runs out before you reach your Annual Threshold, you will have to pay for claims from your own pocket until your claims the annual threshold ammount.
Above Threshold Benefit	Once the day-to-day claims you have sent to us add up to the Annual Threshold, we pay the rest of your day-to-day claims from the Above Threshold Benefit (ATB), at the Discovery Health rate or a portion of it

Discovery - Classic Comprehensive - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	Up to the Discovery Health Rate (DHR) (100%)
MRI, CT & PET Scans	Up to the Discovery Health Rate (DHR) if the scan is related to your current and approved hospital admission from your Hospital Benefit. If it is not related to your admission, or for conservative back and neck treatment we pay the first R3470 from your available day-to-day benefits and the balance from your Hospital Benefit up to the Discovery Health. For the conservative back and neck scans a limit of one scan per spinal and neck region applies. On Classic Smart Comprehensive if not related to your hospital admission, your pay the first R3470 of yourMRI or CT scan until you reach the Annual Threshold. We cover the balance of the scan from the Hospital Benefit, up to the Discovery Health Rate.
Pathology	Up to the Discovery Health Rate (DHR) (100%)
Internal Prosthesis	***
External Appliances/Prosthesis	***

Discovery - Classic Comprehensive - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	***
Ambulance Services	Included

Discovery - Classic Comprehensive - D2D - GP's and Medication

General Practitioners	***
Specialists	Up to the rate we have agreed with the specialist
Prescribed Medication	***
Pharmacy Advised Medicine	***

Discovery - Classic Comprehensive - D2D - Radiology & Pathology

Basic Radiology	Up to the Discovery Health Rate (DHR) (100%)
MRI, CT & PET Scans	Up to the Discovery Health Rate (DHR) if the scan is related to your current and approved hospital admission from your Hospital Benefit.
Pathology	Up to the Discovery Health Rate (DHR) (100%)

Discovery - Classic Comprehensive - D2D - Dental Benefit

Conservative Dentistry	One dental check-up per year. You pay R115 and the balance of the check-up will be covered up to the DHR
Specialised Dentistry	***

Discovery - Classic Comprehensive - D2D - Optical Benefit

Examination	One eye test is covered per year with an upfront payment of R60
Lenses	You get a 20% discount for frames and lenses at an optometrist in your plan's network of optometrists. You will receive the discount immediately when you pay.
Frames	You get a 20% discount for frames and lenses at an optometrist in your plan's network of optometrists. You will receive the discount immediately when you pay.
Contact Lenses	***

Discovery - Classic Comprehensive - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	Additional benefits for allied, therapeutic, pyschology services and external medical items
HIV/AIDS	If you are registered on the HIV programme by your Premier Plus GP, you are covered for the care you need.

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R6810
Adult	R6441
Child	R1358

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Discover - Classic Delta Comprehensive - Chronic Benefit

27 CDL chronic conditions	***
Additional chronic conditions	***

Discover - Classic Delta Comprehensive - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Discover - Classic Delta Comprehensive - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	***
MRI, CT & PET Scans	***
Pathology	***
Internal Prosthesis	***
External Appliances/Prosthesis	***

Discover - Classic Delta Comprehensive - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	***
Ambulance Services	***

Discover - Classic Delta Comprehensive - D2D - GP's and Medication

General Practitioners	***
Specialists	***
Prescribed Medication	***
Pharmacy Advised Medicine	***

Discover - Classic Delta Comprehensive - D2D - Radiology & Pathology

Basic Radiology	***
MRI, CT & PET Scans	***
Pathology	***

Discover - Classic Delta Comprehensive - D2D - Dental Benefit

Conservative Dentistry	***
Specialised Dentistry	***

Discover - Classic Delta Comprehensive - D2D - Optical Benefit

Examination	***
Lenses	***
Frames	***
Contact Lenses	***

Discover - Classic Delta Comprehensive - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	***
HIV/AIDS	***

Financial and Demographic
Date of information	***
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	***
Adult	***
Child	***

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Discovery - Classic Priority - Chronic Benefit

27 CDL chronic conditions	***
Additional chronic conditions	***

Discovery - Classic Priority - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	The midical Savings Account is an amount that is allocated to you at the beginning of each year or when you join the Scheme. You pay this amount back in equal portions as part of your monthly contribution. We pay your day-to-day medical expenses such as GP and specialist consultations acute medicine radiology and pathology from the available funds allocated to your MSA. Any an-used funds will carry over to the next year.
Annual Threshold	We set the Annual Threshold amount at the beginning of each year. The number and type of dependents on your plan will determine the amount. The Annual Threshold is an amount that your claims need to add up to before we pay your day-to-day claims from the Above Threshold Benefit.
Self Payment Gap
Above Threshold Benefit	Once the day-to-day claims you have sent to us add up to the Annual Threshold, we pay the rest of your day-to-day claims from the Above Threshold Benefit, at the Discovery Health Rate or a portion of it. The Priority plans have a limited ATB.

Discovery - Classic Priority - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	Covered
MRI, CT & PET Scans	You need to pay an amount upfront to the hospital when one of the procedures is performed.
Pathology	Covered
Internal Prosthesis	***
External Appliances/Prosthesis	***

Discovery - Classic Priority - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	***
Ambulance Services	Included

Discovery - Classic Priority - D2D - GP's and Medication

General Practitioners	The Discovery Health Rate (DHR)(100%)
Specialists	Up to the rate we have agreed with the specialist
Prescribed Medication	The Discovery Health Rate (DHR)(100%)
Pharmacy Advised Medicine	Up to 75% of the Discovery Health Rate if the price of the medicine is within 25% of the preferred equivelent, or up to 50% of the DHR if the price of the medicine is more than 50% of the price of the preferred equivalent.

Discovery - Classic Priority - D2D - Radiology & Pathology

Basic Radiology	***
MRI, CT & PET Scans	***
Pathology	***

Discovery - Classic Priority - D2D - Dental Benefit

Conservative Dentistry	***
Specialised Dentistry	***

Discovery - Classic Priority - D2D - Optical Benefit

Examination	This limit covers lenses, frames contact lenses and surgery or any healthcare service to correct refractive errors of the eye R5950 per person
Lenses	This limit covers lenses, frames contact lenses and surgery or any healthcare service to correct refractive errors of the eye R5950 per person
Frames	This limit covers lenses, frames contact lenses and surgery or any healthcare service to correct refractive errors of the eye R5950 per person
Contact Lenses	This limit covers lenses, frames contact lenses and surgery or any healthcare service to correct refractive errors of the eye R5950 per person

Discovery - Classic Priority - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	Covered
HIV/AIDS	***

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R4362
Adult	R3440
Child	R1745

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Discovery - Classic Saver - Chronic Benefit

27 CDL chronic conditions	You and your doctor can manage your chronic condition through Connected Care in the comfort of your home. You have access to a range of digital services linked to smart remote monitoring and point-of-care devices and personalised coaching consultations, for qualifying members, to help you track and manage your chronic condition from home.
Additional chronic conditions	***

Discovery - Classic Saver - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	25% of your monthly contribution
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Discovery - Classic Saver - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	***
MRI, CT & PET Scans	Up to the Discovery Health Rate if the scan is related to your hospital admission from your Hospital Benefit. If it is not related to your admission or for conservative back and neck treatments, we pay the first R3470 from your available day-to-day benefits and the balance from your Hospital Benefit, up to the Discovery Health Rate Limited to one scan per spinal and neck region.
Pathology	***
Internal Prosthesis	***
External Appliances/Prosthesis	***

Discovery - Classic Saver - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	***
Ambulance Services	Included

Discovery - Classic Saver - D2D - GP's and Medication

General Practitioners	***
Specialists	***
Prescribed Medication	***
Pharmacy Advised Medicine	***

Discovery - Classic Saver - D2D - Radiology & Pathology

Basic Radiology	***
MRI, CT & PET Scans	Up to the Discovery Health Rate if the scan is related to your hospital admission from your Hospital Benefit.
Pathology	***

Discovery - Classic Saver - D2D - Dental Benefit

Conservative Dentistry	***
Specialised Dentistry	***

Discovery - Classic Saver - D2D - Optical Benefit

Examination	***
Lenses	You get a 20% discount for frames and lenses at an optometrist in your plan's network of optometrists. You will receive the discount immediately when you pay
Frames	You get a 20% discount for frames and lenses at an optometrist in your plan's network of optometrists. You will receive the discount immediately when you pay
Contact Lenses	***

Discovery - Classic Saver - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	***
HIV/AIDS	If you are registered on the HIV programme by your Premier Plus GP, you are covered for the care you need.

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R3763
Adult	R2968
Child	R1508

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Discovery - Classic Delta Saver - Chronic Benefit

27 CDL chronic conditions	You and your doctor can manage your chronic condition through Connected Care in the comfort of your home. You have access to a range of digital services linked to smart remote monitoring and point-of-care devices and personalised coaching consultations, for qualifying members, to help you track and manage your chronic condition from home.
Additional chronic conditions	***

Discovery - Classic Delta Saver - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Discovery - Classic Delta Saver - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	***
MRI, CT & PET Scans	Up to the Discovery Health Rate if the scan is related to your hospital admission from your Hospital Benefit.
Pathology	***
Internal Prosthesis	***
External Appliances/Prosthesis	***

Discovery - Classic Delta Saver - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	***
Ambulance Services	Included

Discovery - Classic Delta Saver - D2D - GP's and Medication

General Practitioners	***
Specialists	***
Prescribed Medication	***
Pharmacy Advised Medicine	***

Discovery - Classic Delta Saver - D2D - Radiology & Pathology

Basic Radiology	***
MRI, CT & PET Scans	Up to the Discovery Health Rate if the scan is related to your hospital admission from your Hospital Benefit.
Pathology	***

Discovery - Classic Delta Saver - D2D - Dental Benefit

Conservative Dentistry	***
Specialised Dentistry	***

Discovery - Classic Delta Saver - D2D - Optical Benefit

Examination	***
Lenses	You get a 20% discount for frames and lenses at an optometrist in your plan's network of optometrists. You will receive the discount immediately when you pay
Frames	You get a 20% discount for frames and lenses at an optometrist in your plan's network of optometrists. You will receive the discount immediately when you pay
Contact Lenses	***

Discovery - Classic Delta Saver - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	***
HIV/AIDS	If you are registered on the HIV programme by your Premier Plus GP, you are covered for the care you need.

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R3006
Adult	R2374
Child	R1206

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Discovery - Essential Saver - Chronic Benefit

27 CDL chronic conditions	You and your doctor can manage your chronic condition through Connected Care in the comfort of your home. You have access to a range of digital services linked to smart remote monitoring and point-of-care devices and personalised coaching consultations, for qualifying members, to help you track and manage your chronic condition from home.
Additional chronic conditions	***

Discovery - Essential Saver - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Discovery - Essential Saver - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	***
MRI, CT & PET Scans	Up to the Discovery Health Rate if the scan is related to your hospital admission from your Hospital Benefit.
Pathology	***
Internal Prosthesis	***
External Appliances/Prosthesis	***

Discovery - Essential Saver - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	***
Ambulance Services	Included

Discovery - Essential Saver - D2D - GP's and Medication

General Practitioners	***
Specialists	***
Prescribed Medication	***
Pharmacy Advised Medicine	***

Discovery - Essential Saver - D2D - Radiology & Pathology

Basic Radiology	***
MRI, CT & PET Scans	Up to the Discovery Health Rate if the scan is related to your hospital admission from your Hospital Benefit.
Pathology	***

Discovery - Essential Saver - D2D - Dental Benefit

Conservative Dentistry	***
Specialised Dentistry	***

Discovery - Essential Saver - D2D - Optical Benefit

Examination	***
Lenses	You get a 20% discount for frames and lenses at an optometrist in your plan's network of optometrists. You will receive the discount immediately when you pay
Frames	You get a 20% discount for frames and lenses at an optometrist in your plan's network of optometrists. You will receive the discount immediately when you pay
Contact Lenses	***

Discovery - Essential Saver - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	***
HIV/AIDS	If you are registered on the HIV programme by your Premier Plus GP, you are covered for the care you need.

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R2990
Adult	R2243
Child	R1198

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Discovery - Essential Delta Saver - Chronic Benefit

27 CDL chronic conditions	You and your doctor can manage your chronic condition through Connected Care in the comfort of your home. You have access to a range of digital services linked to smart remote monitoring and point-of-care devices and personalised coaching consultations, for qualifying members, to help you track and manage your chronic condition from home.
Additional chronic conditions	***

Discovery - Essential Delta Saver - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Discovery - Essential Delta Saver - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	***
MRI, CT & PET Scans	Up to the Discovery Health Rate if the scan is related to your hospital admission from your Hospital Benefit.
Pathology	***
Internal Prosthesis	***
External Appliances/Prosthesis	***

Discovery - Essential Delta Saver - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	***
Ambulance Services	Included

Discovery - Essential Delta Saver - D2D - GP's and Medication

General Practitioners	***
Specialists	***
Prescribed Medication	***
Pharmacy Advised Medicine	***

Discovery - Essential Delta Saver - D2D - Radiology & Pathology

Basic Radiology	***
MRI, CT & PET Scans	Up to the Discovery Health Rate if the scan is related to your hospital admission from your Hospital Benefit.
Pathology	***

Discovery - Essential Delta Saver - D2D - Dental Benefit

Conservative Dentistry	***
Specialised Dentistry	***

Discovery - Essential Delta Saver - D2D - Optical Benefit

Examination	***
Lenses	You get a 20% discount for frames and lenses at an optometrist in your plan's network of optometrists. You will receive the discount immediately when you pay
Frames	You get a 20% discount for frames and lenses at an optometrist in your plan's network of optometrists. You will receive the discount immediately when you pay
Contact Lenses	***

Discovery - Essential Delta Saver - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	***
HIV/AIDS	If you are registered on the HIV programme by your Premier Plus GP, you are covered for the care you need.

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	2023
Principle	R2385
Adult	R1800
Child	R957

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Discovery - Coastal Saver - Chronic Benefit

27 CDL chronic conditions	You and your doctor can manage your chronic condition through Connected Care in the comfort of your home. You have access to a range of digital services linked to smart remote monitoring and point-of-care devices and personalised coaching consultations, for qualifying members, to help you track and manage your chronic condition from home.
Additional chronic conditions	***

Discovery - Coastal Saver - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Discovery - Coastal Saver - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	***
MRI, CT & PET Scans	Up to the Discovery Health Rate if the scan is related to your hospital admission from your Hospital Benefit.
Pathology	***
Internal Prosthesis	***
External Appliances/Prosthesis	***

Discovery - Coastal Saver - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	***
Ambulance Services	Included

Discovery - Coastal Saver - D2D - GP's and Medication

General Practitioners	***
Specialists	***
Prescribed Medication	***
Pharmacy Advised Medicine	***

Discovery - Coastal Saver - D2D - Radiology & Pathology

Basic Radiology	***
MRI, CT & PET Scans	Up to the Discovery Health Rate if the scan is related to your hospital admission from your Hospital Benefit.
Pathology	***

Discovery - Coastal Saver - D2D - Dental Benefit

Conservative Dentistry	***
Specialised Dentistry	***

Discovery - Coastal Saver - D2D - Optical Benefit

Examination	***
Lenses	You get a 20% discount for frames and lenses at an optometrist in your plan's network of optometrists. You will receive the discount immediately when you pay
Frames	You get a 20% discount for frames and lenses at an optometrist in your plan's network of optometrists. You will receive the discount immediately when you pay
Contact Lenses	***

Discovery - Coastal Saver - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	***
HIV/AIDS	If you are registered on the HIV programme by your Premier Plus GP, you are covered for the care you need.

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	2023
Principle	R2983
Adult	R2242
Child	R1205

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Discovery - Classic Smart - Chronic Benefit

27 CDL chronic conditions	A defined list of 27 chronic conditions. You have cover for treatment for ongoing medical conditions (chronic conditions). You have cover for the 27 medical conditions set out in the list of chronic conditions known as the Chronic Disease List (CDL).
Additional chronic conditions	***

Discovery - Classic Smart - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	A healthcare provider (for example doctor, specialist, allied healthcare professional, pharmacist or hospital who we have an agreement with to provide treatment or services at a contracted rate. Visit www.discovery.co.za or click on Find a healthcare provider on the Discovery app to view the full list of DSPs.
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Discovery - Classic Smart - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	Up to the Discovery Health Rate (DHR) (100%)
MRI, CT & PET Scans	If not related to your admission, or for conservative back and neck treatment, you must pay the first R3,470 and the balance will be paid from your Hospital Benefit up to the Discovery Health Rate (DHR)
Pathology	***
Internal Prosthesis	***
External Appliances/Prosthesis	***

Discovery - Classic Smart - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	***
Ambulance Services	Covered

Discovery - Classic Smart - D2D - GP's and Medication

General Practitioners	You have full cover for GPs in the Smart GP Network, specialists or allied healthcare professionals who we have payment arrangements with.
Specialists	You have full cover for GPs in the Smart GP Network, specialists or allied healthcare professionals who we have payment arrangements with.
Prescribed Medication	***
Pharmacy Advised Medicine	***

Discovery - Classic Smart - D2D - Radiology & Pathology

Basic Radiology	Up to the Discovery Health Rate (DHR) (100%)
MRI, CT & PET Scans	If not related to your admission, or for conservative back and neck treatment, you must pay the first R3,470 and the balance will be paid from your Hospital Benefit up to the Discovery Health Rate (DHR)
Pathology	***

Discovery - Classic Smart - D2D - Dental Benefit

Conservative Dentistry	One defined dental check-up at any dentist, dental therapist or oral hygienist with a R115 co-payment for the check-up. Covered up to 100% of the Discovery Health Rate (DHR)
Specialised Dentistry	***

Discovery - Classic Smart - D2D - Optical Benefit

Examination	One eye test at a network optometrist with a payment of R60 for the test
Lenses	You get a 20% discount for frames and lenses at an optometrist in your plan’s network of optometrists.You will receive the discount immediately when you pay.
Frames	You get a 20% discount for frames and lenses at an optometrist in your plan’s network of optometrists.You will receive the discount immediately when you pay.
Contact Lenses	***

Discovery - Classic Smart - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	Once enrolled on the programme by your network psychologist or Smart Premier Plus GP, you have access to defined cover for the management of major depression. Enrolment on the programme unlocks cover for prescribed medicine, access to either individual or group psychotherapy sessions (virtual and face-to-face therapy) and additional GP consultations to allow for effective evaluation, tracking and monitoring of treatment. Qualifying members will also have access to a relapse prevention programme, which includes additional cover for a defined basket of care for psychiatry consultations, counseling sessions and care coordination services.
Psychology	Once enrolled on the programme by your network psychologist or Smart Premier Plus GP, you have access to defined cover for the management of major depression. Enrolment on the programme unlocks cover for prescribed medicine, access to either individual or group psychotherapy sessions (virtual and face-to-face therapy) and additional GP consultations to allow for effective evaluation, tracking and monitoring of treatment. Qualifying members will also have access to a relapse prevention programme, which includes additional cover for a defined basket of care for psychiatry consultations, counseling sessions and care coordination services.
HIV/AIDS	We cover preventative and condition-specific care programmes that help you to manage diabetes, mental health, HIV or heart-related medical conditions. You have to be registered on these condition-specific care programmes to unlock additional benefits and services.

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R2,235
Adult	R1,763
Child	R892

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Discovery - Essential Smart - Chronic Benefit

27 CDL chronic conditions	You have cover for treatment for ongoing medical conditions (chronic conditions). You have cover for the 27 medical conditions set out in the list of chronic conditions known as the Chronic Disease List (CDL).
Additional chronic conditions	***

Discovery - Essential Smart - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Discovery - Essential Smart - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	Up to the Discovery Health Rate (DHR) (100%)
MRI, CT & PET Scans	If not related to your admission, or for conservative back and neck treatment, you must pay the first R3,470 and the balance will be paid from your Hospital Benefit up to the Discovery Health Rate (DHR) If not related to your admission, or for conservative back and neck treatment, you will have to pay for it.
Pathology	Up to the Discovery Health Rate (DHR) (100%)
Internal Prosthesis	No limit for planned hip and knee joint replacements if you use a provider in our network, or up to 80% of the Discovery Health Rate (DHR) if you use a provider outside our network up to a maximum of R30,900 for each prosthesis for each admission. The network does not apply to emergency or trauma-related surgeries.
External Appliances/Prosthesis	***

Discovery - Essential Smart - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	***
Ambulance Services	Included

Discovery - Essential Smart - D2D - GP's and Medication

General Practitioners	You have full cover for GPs in the Smart GP Network, specialists or allied healthcare professionals who we have payment arrangements with.
Specialists	You have full cover for GPs in the Smart GP Network, specialists or allied healthcare professionals who we have payment arrangements with.
Prescribed Medication	***
Pharmacy Advised Medicine	Cover for defined set of day-to-day medical expenses such as GP consultations, acute and over-the-counter (OTC) medicine, eye and dental check-ups and sports- related injuries, with fixed co-payments and/or limits. Cover depends on the plan you choose.

Discovery - Essential Smart - D2D - Radiology & Pathology

Basic Radiology	Up to the Discovery Health Rate (DHR) (100%)
MRI, CT & PET Scans	If not related to your admission, or for conservative
Pathology	Up to the Discovery Health Rate (DHR) (100%)

Discovery - Essential Smart - D2D - Dental Benefit

Conservative Dentistry	Defined dental check-up at any dentist, dental therapist or oral hygienist One defined dental check-up per person per year with an upfront payment of: R170 The balance will be covered up to the Discovery Health Rate (DHR).
Specialised Dentistry	***

Discovery - Essential Smart - D2D - Optical Benefit

Examination	One eye test at a network optometrist with a payment of R60 for the test
Lenses	You get a 20% discount for frames and lenses at an optometrist in your plan’s network of optometrists.You will receive the discount immediately when you pay.
Frames	You get a 20% discount for frames and lenses at an optometrist in your plan’s network of optometrists.You will receive the discount immediately when you pay.
Contact Lenses	***

Discovery - Essential Smart - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	***
HIV/AIDS	If you are registered on the HIV programme by your Smart Premier Plus GP, you are covered for the care you need, which includes additional cover for social workers. You can be assured of confidentiality at all times. You need to get your medicine from a designated service provider (DSP) to avoid a 20% co-payment.

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R1,600
Adult	R1,600
Child	R1,600

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Discovery - Keycare Plus - Chronic Benefit

27 CDL chronic conditions	You have cover for treatment for ongoing medical conditions (chronic conditions). You have cover for the 27 medical conditions set out in the list of chronic conditions known as the Chronic Disease List (CDL).
Additional chronic conditions	***

Discovery - Keycare Plus - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Discovery - Keycare Plus - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	Up to the Discovery Health Rate (DHR)
MRI, CT & PET Scans	***
Pathology	Up to the Discovery Health Rate (DHR)
Internal Prosthesis	***
External Appliances/Prosthesis	***

Discovery - Keycare Plus - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	***
Ambulance Services	Included

Discovery - Keycare Plus - D2D - GP's and Medication

General Practitioners	***
Specialists	Full cover
Prescribed Medication	Use a pharmacy in our netwrok to get full cover and avoid co-payments when claiming for medicine on the prescribed medicine list.
Pharmacy Advised Medicine	Use a pharmacy in our netwrok to get full cover and avoid co-payments when claiming for medicine on the prescribed medicine list.

Discovery - Keycare Plus - D2D - Radiology & Pathology

Basic Radiology	Up to the Discovery Health Rate (DHR)
MRI, CT & PET Scans	***
Pathology	***

Discovery - Keycare Plus - D2D - Dental Benefit

Conservative Dentistry	We cover consultations, fillings and tooth removals at a dentist in our network. Certain rules and limits may apply.
Specialised Dentistry	***

Discovery - Keycare Plus - D2D - Optical Benefit

Examination	We cover one eye test per person every two years but you must go to an optometrist in the KeyCare Network.
Lenses	You get a 20% discount for frames and lenses at an optometrists in your plan's network of optometrists. You will receive the discount immediately when you pay.
Frames	You get a 20% discount for frames and lenses at an optometrists in your plan's network of optometrists. You will receive the discount immediately when you pay.
Contact Lenses	***

Discovery - Keycare Plus - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	***
HIV/AIDS	If you are registered on the HIV programme by your KeyCare Premier Plus GP, you are covered for the care you need.

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R2801
Adult	R2801
Child	R750

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Sizwe Hosmed- Plus - Chronic Benefit

27 CDL chronic conditions

Cover for 26 chronic conditions, Subject to registration and approval. • Addison’s disease • Asthma • Bipolar Mood Disorder • Bronchiectasis • Cardiac failure • Cardiomyopathy • Chronic obstructive pulmonary disease • Chronic renal disease • Coronary artery disease • Crohn’s disease • Diabetes insipidus • Diabetes mellitus types 1 & 2 • Dysrhythmias • Epilepsy • Glaucoma • Haemophilia • HIV/AIDS • Hyperlipidaemia • Hypertension • Hypothyroidism • Multiple sclerosis • Parkinson’s disease • Rheumatoid arthritis • Schizophrenia • Systemic Lupus Erythematosus • Ulcerative colitis

Additional chronic conditions

13 Additional Non PMB conditions may be paid from MSA • Attention Deficit Hyperactivity Disorder (ADHD) • Allergic Rhinitis • Anaemia: Vitamin B12 and Iron deficiency • Aplastic anaemia • Anti-phospholipid syndrome • Benign Prostatic Hypertrophy (BPH) • Cushing’s Disease • Cystic Fibrosis • Depression • Endometriosis • Gastro-oesophageal reflux disease (GORD) • Gout • Hyperthyroidism • Hypoparathyroidism • Menopause / Hormone Replacement Therapy (HRT) • Motor Neuron Disease • Myasthenia gravis • Obsessive Compulsive Disorder • Osteoarthritis • Osteoporosis • Paget’s Disease • Pituitary Microadenomas • Psoriasis • Pulmonary Interstitial fibrosis • Stroke (Cerebrovascular accident)

Sizwe Hosmed- Plus - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Sizwe Hosmed- Plus - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	Specialised radiology: MRI / PET / CT, 2 scans per beneficiary per annum. 10% co-pay for non PMB.
MRI, CT & PET Scans	Specialised radiology: MRI / PET / CT, 2 scans per beneficiary per annum. 10% co-pay for non PMB.
Pathology	***
Internal Prosthesis	Prosthesis R75 348 per family
External Appliances/Prosthesis	Prosthesis R75 348 per family

Sizwe Hosmed- Plus - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	Home Based Care – R8 217 per family
Ambulance Services	Ambulance Services –Europe Assist ( 0860 11 77 99)

Sizwe Hosmed- Plus - D2D - GP's and Medication

General Practitioners	GP & Specialists consultations, Pathology, Radiology and Chronic Medicine are collectively Limited to per Family per annum • Benefits ranging from R13 944 to R35 312 based on family size
Specialists	GP & Specialists consultations, Pathology, Radiology and Chronic Medicine are collectively Limited to per Family per annum • Benefits ranging from R13 944 to R35 312 based on family size
Prescribed Medication	***
Pharmacy Advised Medicine	***

Sizwe Hosmed- Plus - D2D - Radiology & Pathology

Basic Radiology	GP & Specialists consultations, Pathology, Radiology and Chronic Medicine are collectively Limited to per Family per annum • Benefits ranging from R13 944 to R35 312 based on family size
MRI, CT & PET Scans
Pathology	***

Sizwe Hosmed- Plus - D2D - Dental Benefit

Conservative Dentistry	Benefit cover for conservative dentistry per beneficiary • Consultations x 2 per beneficiary • Oral Hygiene. Root Canal treatment • Extractions, Fillings, Intra and extra oral x-rays • Plastic Dentures: 1 set, Full or partial in 4-year period
Specialised Dentistry	Specialised Dentistry – Crowns and Bridges: One crown per family per annum. Once per tooth in a 5-year period. • Orthodontics: Limited to ages 9 -21.

Sizwe Hosmed- Plus - D2D - Optical Benefit

Examination
Lenses	1 eye test per beneficiary.
Frames	Frames R1 007 per beneficiary
Contact Lenses	Contact lenses up to R1 825

Sizwe Hosmed- Plus - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	***
HIV/AIDS	1 HIV Test per beneficiary per Annum

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R6370
Adult	R6075
Child	R1190

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Sizwe Hosmed - Platinum Enhanced - Chronic Benefit

27 CDL chronic conditions

Cover for 26 chronic conditions, Subject to registration and approval. • Addison’s disease • Asthma • Bipolar Mood Disorder • Bronchiectasis • Cardiac failure • Cardiomyopathy • Chronic obstructive pulmonary disease • Chronic renal disease • Coronary artery disease • Crohn’s disease • Diabetes insipidus • Diabetes mellitus types 1 & 2 • Dysrhythmias • Epilepsy • Glaucoma • Haemophilia • HIV/AIDS • Hyperlipidaemia • Hypertension • Hypothyroidism • Multiple sclerosis • Parkinson’s disease • Rheumatoid arthritis • Schizophrenia • Systemic Lupus Erythematosus • Ulcerative colitis

Additional chronic conditions

13 Additional Non PMB conditions may be paid from MSA • Attention Deficit Hyperactivity Disorder (ADHD) • Allergic Rhinitis • Anaemia: Vitamin B12 and Iron deficiency • Aplastic anaemia • Anti-phospholipid syndrome • Benign Prostatic Hypertrophy (BPH) • Cushing’s Disease • Cystic Fibrosis • Depression • Endometriosis • Gastro-oesophageal reflux disease (GORD) • Gout • Hyperthyroidism • Hypoparathyroidism • Menopause / Hormone Replacement Therapy (HRT) • Motor Neuron Disease • Myasthenia gravis • Obsessive Compulsive Disorder • Osteoarthritis • Osteoporosis • Paget’s Disease • Pituitary Microadenomas • Psoriasis • Pulmonary Interstitial fibrosis • Stroke (Cerebrovascular accident)

Sizwe Hosmed - Platinum Enhanced - Day-to-day Benefit

Overall Annual Maximum	No overall annual limit
Preferred Provider	Free choice of service provider
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Sizwe Hosmed - Platinum Enhanced - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	Specialised radiology R34 434 per family combined limit
MRI, CT & PET Scans	***
Pathology	***
Internal Prosthesis	Prosthesis R51 743 per family
External Appliances/Prosthesis	Prosthesis R51 743 per family

Sizwe Hosmed - Platinum Enhanced - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	***
Ambulance Services	Ambulance Services –Europe Assist ( 0860 11 77 99)

Sizwe Hosmed - Platinum Enhanced - D2D - GP's and Medication

General Practitioners	GP & Specialist visits, Acute Medication, Physiotherapy, Radiology, Pathology • Subject to Medical Savings Account, Self Payment Gap and Above Threshold Benefits • Free choice of service provider
Specialists	GP & Specialist visits, Acute Medication, Physiotherapy, Radiology, Pathology • Subject to Medical Savings Account, Self Payment Gap and Above Threshold Benefits • Free choice of service provider
Prescribed Medication	***
Pharmacy Advised Medicine	***

Sizwe Hosmed - Platinum Enhanced - D2D - Radiology & Pathology

Basic Radiology	P & Specialist visits, Acute Medication, Physiotherapy, Radiology, Pathology • Subject to Medical Savings Account, Self Payment Gap and Above Threshold Benefits • Free choice of service provider
MRI, CT & PET Scans	***
Pathology	P & Specialist visits, Acute Medication, Physiotherapy, Radiology, Pathology • Subject to Medical Savings Account, Self Payment Gap and Above Threshold Benefits • Free choice of service provider

Sizwe Hosmed - Platinum Enhanced - D2D - Dental Benefit

Conservative Dentistry	enefit cover for conservative dentistry per beneficiary • Consultations x 2 per beneficiary • Oral Hygiene. Root Canal treatment • Extractions, Fillings, Intra and extra oral x-rays • Plastic Dentures: 1 set, Full or partial in 4-year period
Specialised Dentistry	Specialised Dentistry – Crowns and Bridges: One crown per family per annum. Once per tooth in a 5-year period.

Sizwe Hosmed - Platinum Enhanced - D2D - Optical Benefit

Examination	1 Eye test per beneficiary
Lenses	enses: R212 single vision. R460 bifocal. R844 multifocal
Frames	Frames R1 007 per beneficiary
Contact Lenses	Contact lenses up to R1 825

Sizwe Hosmed - Platinum Enhanced - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	R9 525 per family
Psychology	R9 525 per family
HIV/AIDS	***

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R4130
Adult	R3950
Child	R1050

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Sizwe Hosmed - Gold Ascend - Chronic Benefit

27 CDL chronic conditions

Cover for 26 chronic conditions, subject to registration and approval. Covered: Medication, Bloods and GP • Addison’s disease • Asthma • Bipolar Mood Disorder • Bronchiectasis • Cardiac failure • Cardiomyopathy • Chronic obstructive pulmonary disease • Chronic renal disease • Coronary artery disease • Crohn’s disease • Diabetes insipidus • Diabetes mellitus types 1 & 2 • Dysrhythmias • Epilepsy • Glaucoma • Haemophilia • HIV/AIDS • Hyperlipidaemia • Hypertension • Hypothyroidism • Multiple sclerosis • Parkinson’s disease • Rheumatoid arthritis • Schizophrenia • Systemic Lupus Erythematosus • Ulcerative colitis

Additional chronic conditions

***

Sizwe Hosmed - Gold Ascend - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	GP & Specialist visits (Excl. Psychiatrists), Acute Medication, Physiotherapy, Radiology, Pathology • Benefits ranging from R6 884 to R18 814 based on family size • Free choice of service provider
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Sizwe Hosmed - Gold Ascend - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	Specialised radiology R22 654 per family combined limit
MRI, CT & PET Scans	***
Pathology	***
Internal Prosthesis	Prosthesis R29 565 per family
External Appliances/Prosthesis	Prosthesis R29 565 per family

Sizwe Hosmed - Gold Ascend - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	Home Based Care R5 505 per family
Ambulance Services	Ambulance Services –Europe Assist (0860 11 77 99)

Sizwe Hosmed - Gold Ascend - D2D - GP's and Medication

General Practitioners	GP & Specialist visits (Excl. Psychiatrists), Acute Medication, Physiotherapy, Radiology, Pathology • Benefits ranging from R6 884 to R18 814 based on family size • Free choice of service provider
Specialists	GP & Specialist visits (Excl. Psychiatrists), Acute Medication, Physiotherapy, Radiology, Pathology • Benefits ranging from R6 884 to R18 814 based on family size • Free choice of service provider
Prescribed Medication	***
Pharmacy Advised Medicine	***

Sizwe Hosmed - Gold Ascend - D2D - Radiology & Pathology

Basic Radiology	GP & Specialist visits (Excl. Psychiatrists), Acute Medication, Physiotherapy, Radiology, Pathology • Benefits ranging from R6 884 to R18 814 based on family size • Free choice of service provider
MRI, CT & PET Scans	***
Pathology	GP & Specialist visits (Excl. Psychiatrists), Acute Medication, Physiotherapy, Radiology, Pathology • Benefits ranging from R6 884 to R18 814 based on family size • Free choice of service provider

Sizwe Hosmed - Gold Ascend - D2D - Dental Benefit

Conservative Dentistry	Benefit cover for conservative dentistry per beneficiary • 2 consultations per beneficiary • Oral Hygiene • Extractions • Fillings • Intra and extra oral X-rays • Root Canal treatment • Plastic Dentures: 1 set, full or partial in 4 year period
Specialised Dentistry	***

Sizwe Hosmed - Gold Ascend - D2D - Optical Benefit

Examination	1 Eye test per beneficiary
Lenses	Lenses R212 single vision and up to R460 per lens for bifocal & multifocal
Frames	Frames R660 per beneficiary
Contact Lenses	Contact lenses up to R1 456

Sizwe Hosmed - Gold Ascend - D2D - Auxiliary Services

Physiotherapy	GP & Specialist visits (Excl. Psychiatrists), Acute Medication, Physiotherapy, Radiology, Pathology • Benefits ranging from R6 884 to R18 814 based on family size • Free choice of service provider
Psychiatry	***
Psychology	***
HIV/AIDS	***

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R3000
Adult	R2880
Child	R824

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Sizwe Hosmed - Value - Chronic Benefit

27 CDL chronic conditions

Cover for 26 chronic conditions, Subject to registration and approval. • Addison’s disease • Asthma • Bipolar Mood Disorder • Bronchiectasis • Cardiac failure • Cardiomyopathy • Chronic obstructive pulmonary disease • Chronic renal disease • Coronary artery disease • Crohn’s disease • Diabetes insipidus • Diabetes mellitus types 1 & 2 • Dysrhythmias • Epilepsy • Glaucoma • Haemophilia • HIV/AIDS • Hyperlipidaemia • Hypertension • Hypothyroidism • Multiple sclerosis • Parkinson’s disease • Rheumatoid arthritis • Schizophrenia • Systemic Lupus Erythematosus • Ulcerative colitis

Additional chronic conditions

13 Additional Non PMB conditions may be paid from MSA • Attention Deficit Hyperactivity Disorder (ADHD) • Allergic Rhinitis • Anaemia: Vitamin B12 and Iron deficiency • Aplastic anaemia • Anti-phospholipid syndrome • Benign Prostatic Hypertrophy (BPH) • Cushing’s Disease • Cystic Fibrosis • Depression • Endometriosis • Gastro-oesophageal reflux disease (GORD) • Gout • Hyperthyroidism • Hypoparathyroidism • Menopause / Hormone Replacement Therapy (HRT) • Motor Neuron Disease • Myasthenia gravis • Obsessive Compulsive Disorder • Osteoarthritis • Osteoporosis • Paget’s Disease • Pituitary Microadenomas • Psoriasis • Pulmonary Interstitial fibrosis • Stroke (Cerebrovascular accident)

Sizwe Hosmed - Value - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	GP & Specialists consultations, Pathology, Radiology and Chronic Medicine are collectively Limited to per Family per annum • Benefits ranging from R13 944 to R35 312 based on family size
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Sizwe Hosmed - Value - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	Specialised radiology: MRI / PET / CT, 2 scans per beneficiary per annum.
MRI, CT & PET Scans	Specialised radiology: MRI / PET / CT, 2 scans per beneficiary per annum.
Pathology	***
Internal Prosthesis	Prosthesis R75 348 per family
External Appliances/Prosthesis	Prosthesis R75 348 per family

Sizwe Hosmed - Value - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	Home Based Care – R8 217 per family
Ambulance Services	• Ambulance Services –Europe Assist ( 0860 11 77 99)

Sizwe Hosmed - Value - D2D - GP's and Medication

General Practitioners	GP & Specialists consultations, Pathology, Radiology and Chronic Medicine are collectively Limited to per Family per annum • Benefits ranging from R13 944 to R35 312 based on family size
Specialists	GP & Specialists consultations, Pathology, Radiology and Chronic Medicine are collectively Limited to per Family per annum • Benefits ranging from R13 944 to R35 312 based on family size
Prescribed Medication	***
Pharmacy Advised Medicine	***

Sizwe Hosmed - Value - D2D - Radiology & Pathology

Basic Radiology	GP & Specialists consultations, Pathology, Radiology and Chronic Medicine are collectively Limited to per Family per annum • Benefits ranging from R13 944 to R35 312 based on family size
MRI, CT & PET Scans	***
Pathology	GP & Specialists consultations, Pathology, Radiology and Chronic Medicine are collectively Limited to per Family per annum • Benefits ranging from R13 944 to R35 312 based on family size

Sizwe Hosmed - Value - D2D - Dental Benefit

Conservative Dentistry	enefit cover for conservative dentistry per beneficiary • Consultations x 2 per beneficiary • Oral Hygiene. Root Canal treatment • Extractions, Fillings, Intra and extra oral x-rays • Plastic Dentures: 1 set, Full or partial in 4-year period
Specialised Dentistry	Specialised Dentistry – Crowns and Bridges: One crown per family per annum. Once per tooth in a 5-year period.

Sizwe Hosmed - Value - D2D - Optical Benefit

Examination	1 eye test per beneficiary.
Lenses	Lenses: R212 single vision. R460 bifocal. R844 multifocal
Frames	Frames R1 007 per beneficiary
Contact Lenses	Or choose Contact lenses up to R1 825

Sizwe Hosmed - Value - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	***
HIV/AIDS	***

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R6370
Adult	R6075
Child	R1190

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Sizwe Hosmed - Access Saver 25 - Chronic Benefit

27 CDL chronic conditions
Additional chronic conditions

Sizwe Hosmed - Access Saver 25 - Day-to-day Benefit

Overall Annual Maximum
Preferred Provider
Medical Savings Account
Annual Threshold
Self Payment Gap
Above Threshold Benefit

Sizwe Hosmed - Access Saver 25 - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology
MRI, CT & PET Scans
Pathology
Internal Prosthesis
External Appliances/Prosthesis

Sizwe Hosmed - Access Saver 25 - Hospital Benefits - Sub Acute Facilities

Hospice
Nursing
Ambulance Services

Sizwe Hosmed - Access Saver 25 - D2D - GP's and Medication

General Practitioners
Specialists
Prescribed Medication
Pharmacy Advised Medicine

Sizwe Hosmed - Access Saver 25 - D2D - Radiology & Pathology

Basic Radiology
MRI, CT & PET Scans
Pathology

Sizwe Hosmed - Access Saver 25 - D2D - Dental Benefit

Conservative Dentistry
Specialised Dentistry

Sizwe Hosmed - Access Saver 25 - D2D - Optical Benefit

Examination
Lenses
Frames
Contact Lenses

Sizwe Hosmed - Access Saver 25 - D2D - Auxiliary Services

Physiotherapy
Psychiatry
Psychology
HIV/AIDS

Financial and Demographic
Date of information
Principle Members
Administrator
Scheme (Option) Age Profile
Solvency Ratio | Scheme Growth
Past Scheme Increases

Contributions
Salary
Principle
Adult
Child

Hospital Benefit	No overall annual limit Day procedure network applies for certain day procedures Post-hospital benefit to help you recover after hospitalisation Full trauma and emergency medical cover Full cover for 271 PMB conditions and PMB chronic medicine Specialised radiology benefit
Private Hospital Care	***
Co-payment	***
Oncology	***
Organ Transplants	PMB only – unlimited Cornea implants – R32 600 per implant
Dialysis	Renal dialysis
Maternity - Natural Birth	• In hospital – unlimited • Home delivery – R14 900 per event
To take home medication	R475 for self-medication
Psychiatric Hospitalisation	R21 840 per person to a maximum of R33 180 per family

Medihelp - MedVital Elect - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	- Network GP consultations:Member = R2 110 Member +1 = R3 890 Member +2 = R4 570 Member +3 = R4 890 Member +4+ = R5 460 - Non-network GP consultations: Member = R1 300 Family = R2 600
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap
Above Threshold Benefit	***

Medihelp - MedVital Elect - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	Standard radiology: Unlimited during hospitalisation
MRI, CT & PET Scans	Specialised radiology: Angiography, MRI and CT imaging – unlimited
Pathology	***
Internal Prostheses	PMB only – unlimited
External Appliances/Prosthesis	***

Medihelp - MedVital Elect - D2D - GP's and Medication

General Practitioners	Network GPs & virtual consultations Provision for out-of-network GP visits
Specialists	Specialist consultations and services, standard radiology, pathology (Lancet/Pathcare), acute medicine and clinical psychology services: Subject to day-to-day benefit
Prescribed Medication	Self-medication (non-prescribed medicine): Member = R560 Family = R1 650 Subject to day-to-day benefit
Pharmacy Advised Medicine	****

Medihelp - MedVital Elect - D2D - Auxiliary Services

Physiotherapy	Consultations, acute medicine, immunisations, physiotherapy and visits to emergency units MedVital Elect - GP network and specialist referrals by a network GP apply: Member = R1 400 Family = R2 700
Psychiatry	***
Psychology	***
HIV/AIDS	Health screening tests: • One combo health screening (blood glucose, cholesterol, BMI & blood pressure measurement)** or an individual test (blood glucose or cholesterol) • HIV testing, counselling & support

Contributions
Salary	***
Principle	R1 776
Adult	R1 290
Child	Child dependant <26 years: R696

Medihelp - MedVital Elect - Financial and Demographic

Date of Information	***
Principal Members	***
Administrator	***
Scheme (Option) age profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme increases	***

Medihelp - MedVital Elect - D2D - Radiology & Pathology

Basic Radiology	R1 210 per family
MRI, CT & PET Scans	Specialised radiology: Angiography, MRI and CT imaging – unlimited
Pathology	***

Medihelp - MedVital Elect - D2D - Dental Benefit

Conservative Dentistry	Removal of impacted teeth in the dentist’s chair
Specialised Dentistry	***

Medihelp - MedVital Elect - D2D - Optical Benefit

Examination	***
Lenses	***
Frames	***
Contact Lenses	***

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Bestmed - Pace 1 - Chronic Benefit

27 CDL chronic conditions	100% Scheme tariff. Co-payment of 25% for non-formulary medicine.
Additional chronic conditions	***

Bestmed - Pace 1 - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	Benefits relating to conditions that meet the criteria for Prescribed Minimum Benefits (PMBs) will be covered in full when using designated service providers (DSPs). This will not affect your savings (annual or vested).
Medical Savings Account	Savings account available. Day-to-day benefits are available.
Annual Threshold	***
Self Payment Gap	Access to full savings for OTC purchases (after R1 057 limit) = self- payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary. Subject to the available savings.
Above Threshold Benefit	***

Bestmed - Pace 1 - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	100% Scheme tariff.
MRI, CT & PET Scans	100% Scheme tariff.
Pathology	100% Scheme tariff.
Internal Prosthesis	Sub-limits per beneficiary: • *Functional limited to R34 000. • Vascular R65 000. • Pacemaker (dual chamber) R61 862. • Endovascular and catheter-based procedures – no benefit. • Spinal including artificial disc R36 227. Drug-eluting stents - PMBs and DSP products only. • Mesh R13 602. • Gynaecology/Urology R9 809. • Lens implants R7 455 a lens per eye.
External Appliances/Prosthesis	***

Bestmed - Pace 1 - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	Wound care benefit (incl. dressings, negative pressure wound therapy treatment and related nursing services - out-of-hospital): 100% Scheme tariff. Savings first. Limited to R3 989 per family. (Subject to overall day-to-day limit)
Ambulance Services	***

Bestmed - Pace 1 - D2D - GP's and Medication

General Practitioners
Specialists	Day procedures at DSPs and/or day-hospitals will be funded at 100% network or Scheme tariffs. Voluntary use of non-DSP specialists and acute hospitals will result in a co-payment of R2 500.
Prescribed Medication	Members will not incur co-payments for Prescribed Minimum Benefit (PMB) medications that are on the formulary for which there is no generic alternative.
Pharmacy Advised Medicine	**Member choice: 1. R1 057 OTC limit OR 2. Access to full savings for OTC purchases (after R1 057 limit) = self- payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary. Subject to the available savings.

Bestmed - Pace 1 - D2D - Radiology & Pathology

Basic Radiology	100% Scheme tariff.
MRI, CT & PET Scans	100% Scheme tariff.
Pathology	100% Scheme tariff.

Bestmed - Pace 1 - D2D - Dental Benefit

Conservative Dentistry	Savings and then from day-to-day limits. Orthodontic: Subject to pre- authorisation. Limited to M = R4 550, M1+ = R9 234. (Subject to overall day-to-day limit)
Specialised Dentistry	***

Bestmed - Pace 1 - D2D - Optical Benefit

Examination	Benefits available every 24 months from date of service. Network Provider (PPN) • Consultation - 1 per beneficiary. • Frame = R1 000 covered AND • 100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR • Contact lenses = R1 840 OR Non-network Provider • Consultation - R365 fee at non- network provider • Frame = R750 AND • Single vision lenses = R215 OR • Bifocal lenses = R460 OR • Multifocal lenses = R982.50 In lieu of glasses members can opt for contact lenses, limited to R1 840
Lenses	Benefits available every 24 months from date of service. Network Provider (PPN) • Consultation - 1 per beneficiary. • Frame = R1 000 covered AND • 100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR • Contact lenses = R1 840 OR Non-network Provider • Consultation - R365 fee at non- network provider • Frame = R750 AND • Single vision lenses = R215 OR • Bifocal lenses = R460 OR • Multifocal lenses = R982.50 In lieu of glasses members can opt for contact lenses, limited to R1 840
Frames	Benefits available every 24 months from date of service. Network Provider (PPN) • Consultation - 1 per beneficiary. • Frame = R1 000 covered AND • 100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR • Contact lenses = R1 840 OR Non-network Provider • Consultation - R365 fee at non- network provider • Frame = R750 AND • Single vision lenses = R215 OR • Bifocal lenses = R460 OR • Multifocal lenses = R982.50 In lieu of glasses members can opt for contact lenses, limited to R1 840
Contact Lenses	Benefits available every 24 months from date of service. Network Provider (PPN) • Consultation - 1 per beneficiary. • Frame = R1 000 covered AND • 100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR • Contact lenses = R1 840 OR Non-network Provider • Consultation - R365 fee at non- network provider • Frame = R750 AND • Single vision lenses = R215 OR • Bifocal lenses = R460 OR • Multifocal lenses = R982.50 In lieu of glasses members can opt for contact lenses, limited to R1 840

Bestmed - Pace 1 - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	***
HIV/AIDS	100% Scheme tariff. Subject to pre- authorisation and DSPs.

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	Risk amount: R3 742 Medical savings account: R878 Total monthly contribution: R4 620
Adult	Risk amount: R2 629 Medical savings account: R616 Total monthly contribution: R3 245
Child	Risk amount: R944 Medical savings account: R222 Total monthly contribution: R1 166

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Bestmed - Pace 2 - Chronic Benefit

27 CDL chronic conditions	100% Scheme tariff. Co-payment of 20% for non-formulary medicine.
Additional chronic conditions	***

Bestmed - Pace 2 - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	Benefits relating to conditions that meet the criteria for Prescribed Minimum Benefits (PMBs) will be covered in full when using designated service providers (DSPs). This will not affect your savings (annual or vested).
Medical Savings Account	Note: • Some indicated benefits are paid from the annual savings at 100% Scheme tariff. • Once the annual savings account is depleted benefits will be paid from Scheme risk at 100% Scheme tariff (limits apply). • Should you not use all of the funds available in your savings account these funds will be transferred into a vested savings account after 5 months and will remain your property. • Any vested credit in your vested savings account may be used for out-of- hospital expenses that are not covered by the Scheme, or should you, for instance, have reached your out-of-hospital or day-to-day overall annual limit or the sub-limits as indicated in your benefit guide.
Annual Threshold	***
Self Payment Gap	Access to full savings for OTC purchases (after R1 057 limit) = self- payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary. Subject to the available savings.
Above Threshold Benefit	***

Bestmed - Pace 2 - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	100% Scheme tariff.
MRI, CT & PET Scans	100% Scheme tariff.
Pathology	100% Scheme tariff.
Internal Prosthesis	Sub-limits per beneficiary: • *Functional limited to R36 000. • Vascular R65 000. • Pacemaker (dual chamber) R68 989.
External Appliances/Prosthesis	Limited to R30 080 per family. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months.

Bestmed - Pace 2 - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	Wound care benefit (incl. dressings, negative pressure wound therapy treatment and related nursing services - out-of-hospital): Savings first. Limited to R7 176 per family. (Subject to overall day-to-day limit)
Ambulance Services	***

Bestmed - Pace 2 - D2D - GP's and Medication

General Practitioners
Specialists	Day procedures at DSPs and/ or day-hospitals will be funded at 100% network or Scheme tariffs. Voluntary use of non-DSP specialists and acute hospitals will result in a co-payment of R2 500.
Prescribed Medication	***
Pharmacy Advised Medicine	Member choice: 1. R1 057 OTC limit per family OR 2. Access to full savings for OTC purchases (after R1 057 limit) = self- payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary. Subject to the available savings.

Bestmed - Pace 2 - D2D - Radiology & Pathology

Basic Radiology	100% Scheme tariff.
MRI, CT & PET Scans	100% Scheme tariff.
Pathology	100% Scheme tariff.

Bestmed - Pace 2 - D2D - Dental Benefit

Conservative Dentistry	Savings and then from day-to-day limit. Limited to M = R7 628, M1+ = R15 256. (Subject to overall day-to-day limit)
Specialised Dentistry	Savings and then from day-to-day limit. Limited to M = R7 628, M1+ = R15 256. (Subject to overall day-to-day limit)

Bestmed - Pace 2 - D2D - Optical Benefit

Examination	Network Provider (PPN) • Consultation - 1 per beneficiary Non-network Provider • Consultation - R365 fee
Lenses	100% of cost of standard lenses (single vision OR bifocal OR multifocal)AND Lens enhancement = R750
Frames	Frame = R1 040 covered
Contact Lenses	Contact lenses = R2 010 OR

Bestmed - Pace 2 - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	***
HIV/AIDS	100% Scheme tariff. Subject to pre- authorisation and DSPs.

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R6 562
Adult	R6 435
Child	R1 447

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Bestmed - Beat 1 - Chronic Benefit

27 CDL chronic conditions	100% Scheme tariff. Co-payment of 30% for non-formulary medicine.
Additional chronic conditions	***

Bestmed - Beat 1 - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	Benefits below may be subject to pre-authorisation, clinical protocols, preferred providers (PPs), designated service providers (DSPs), formularies, funding guidelines and the Mediscor Reference Price (MRP).
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Bestmed - Beat 1 - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	100% Scheme tariff.
MRI, CT & PET Scans	100% Scheme tariff.
Pathology	100% Scheme tariff.
Internal Prosthesis	Sub-limits per beneficiary: • *Functional limited to R31 000. • Pacemaker (dual chamber) R47 344.
External Appliances/Prosthesis	No benefit. (PMBs only).

Bestmed - Beat 1 - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	***
Ambulance Services	***

Bestmed - Beat 1 - D2D - GP's and Medication

General Practitioners	***
Specialists	Day procedures at DSPs and/or day- hospitals will be funded at 100% network or Scheme tariffs. Voluntary use of non- DSP specialists and acute hospitals will result in a co-payment of R2 500.
Prescribed Medication	***
Pharmacy Advised Medicine	***

Bestmed - Beat 1 - D2D - Radiology & Pathology

Basic Radiology	100% Scheme tariff.
MRI, CT & PET Scans	100% Scheme tariff.
Pathology	100% Scheme tariff.

Bestmed - Beat 1 - D2D - Dental Benefit

Conservative Dentistry	PMBs only at DSP day hospitals.
Specialised Dentistry	PMBs only at DSP day hospitals.

Bestmed - Beat 1 - D2D - Optical Benefit

Examination	***
Lenses	***
Frames	***
Contact Lenses	***

Bestmed - Beat 1 - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	***
HIV/AIDS	100% Scheme tariff. Subject to pre- authorisation and DSPs.

Financial and Demographic
Date of information	2023
Principle Members	***
Administrator	***
Scheme (Option) Age Profile	***
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	R1 901
Adult	R1 475
Child	R799

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Bestmed - Beat 2 - Chronic Benefit

27 CDL chronic conditions	chronic
Additional chronic conditions	***

Bestmed - Beat 2 - Day-to-day Benefit

Overall Annual Maximum	***
Preferred Provider	***
Medical Savings Account	***
Annual Threshold	***
Self Payment Gap	***
Above Threshold Benefit	***

Bestmed - Beat 2 - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	100% Scheme tariff.
MRI, CT & PET Scans	100% Scheme tariff.
Pathology	100% Scheme tariff.
Internal Prosthesis	Sub-limits per beneficiary: • *Functional limited to R31 000. • Pacemaker (dual chamber) R47 344.
External Appliances/Prosthesis	No benefit. (PMBs only).

Bestmed - Beat 2 - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	***
Ambulance Services	***

Bestmed - Beat 2 - D2D - GP's and Medication

General Practitioners	***
Specialists	***
Prescribed Medication	***
Pharmacy Advised Medicine	***

Bestmed - Beat 2 - D2D - Radiology & Pathology

Basic Radiology
MRI, CT & PET Scans
Pathology

Bestmed - Beat 2 - D2D - Dental Benefit

Conservative Dentistry
Specialised Dentistry

Bestmed - Beat 2 - D2D - Optical Benefit

Examination
Lenses
Frames
Contact Lenses

Bestmed - Beat 2 - D2D - Auxiliary Services

Physiotherapy
Psychiatry
Psychology
HIV/AIDS

Financial and Demographic
Date of information
Principle Members
Administrator
Scheme (Option) Age Profile
Solvency Ratio | Scheme Growth
Past Scheme Increases

Contributions
Salary
Principle
Adult
Child

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Bestmed - Beat 3 - Chronic Benefit

27 CDL chronic conditions	CDL 27 Ulcerative colitis
Additional chronic conditions	***

Bestmed - Beat 3 - Day-to-day Benefit

Overall Annual Maximum	Prosthesis – Internal Note: Sub-limit subject to the overall annual prosthesis limit.
Preferred Provider	***
Medical Savings Account	On the Beat3 option in-hospital benefits are paid from Scheme risk. Some day- to-day benefits are paid from the Scheme risk and other services will be paid from the savings account. Some preventative care benefits are available from the Scheme risk benefit.
Annual Threshold	***
Self-Payment Gap	***
Above Threshold Benefit	***

Bestmed - Beat 3 - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	Basic radiology 100% Scheme tariff. Basic radiology and pathology Savings account.
MRI, CT & PET Scans	Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies). 100% Scheme tariff. Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. Excluding PET scans) 100% Scheme tariff. Limited to R12 361 per family.
Pathology	Pathology 100% Scheme tariff. Basic radiology and pathology Savings account.
Internal Prosthesis	Prosthesis – Internal Note: Sub-limit subject to the overall annual prosthesis limit. Sub-limits per beneficiary: • *Functional limited to R32 000. • Pacemaker (dual chamber) R47 344.
External Appliances/Prosthesis	Prosthesis – External No benefit (PMBs only).

Bestmed - Beat 3 - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	Wound care benefit (incl. dressings, negative pressure wound therapy treatment and related nursing services - out- of-hospital) 100% Scheme tariff. Limited to R3 885 per family.
Ambulance Services	***

Bestmed - Beat 3 - D2D - GP's and Medication

General Practitioners	***
Specialists	Day procedures at a day- hospital facility Day procedures at DSPs and/or day-hospitals will be funded at 100% network or Scheme tariffs. Voluntary use of non-DSP specialists and acute hospitals will result in a co-payment of R2 500. • Non-network pharmacies and non-network DSP specialists will be reimbursed at Scheme tariff, including for treatment of PMBs.
Prescribed Medication	Members will not incur co-payments for Prescribed Minimum Benefit (PMB) medications that are on the formulary for which there is no generic alternative.
Pharmacy Advised Medicine	Members choosing the network option are required to make use of Scheme- contracted pharmacies to obtain their medicine. Over-the-counter (OTC) medicine Savings account.

Bestmed - Beat 3 - D2D - Radiology & Pathology

Basic Radiology	Basic radiology 100% Scheme tariff. Basic radiology and pathology Savings account.
MRI, CT & PET Scans	Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies). 100% Scheme tariff.
Pathology	Pathology 100% Scheme tariff.

Bestmed - Beat 3 - D2D - Dental Benefit

Conservative Dentistry	Basic and specialised dentistry Basic: Preventative benefit or savings account. Specialised: Savings account. Orthodontic: Subject to pre-authorisation.
Specialised Dentistry	Basic and specialised dentistry Basic: Preventative benefit or savings account. Specialised: Savings account. Orthodontic: Subject to pre-authorisation.

Bestmed - Beat 3 - D2D - Optical Benefit

Examination	***
Lenses	***
Frames	***
Contact Lenses	***

Bestmed - Beat 3 - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	***
HIV/AIDS	HIV/AIDS 100% Scheme tariff. Subject to pre- authorisation and DSPs.

Financial and Demographic
Date of information	2023
Principle Members	Contributions Principal member Risk amount R2 890 / R2 659 Medical savings account R510 / R469 Total monthly R3 400 contribution R3 128
Administrator	***
Scheme (Option) Age Profile	Children under the age of 24 and registered students up to the age of 26 years qualify for child dependant rates.
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	Contributions Principal member Risk amount R2 890 Medical savings account R510 Total monthly R3 400 contribution R3 128
Adult	Contributions Adult dependant Risk amount R2 061 / R1 896 Medical savings account R364 / R335 Total monthly R2 425 contribution R2 231
Child	Contributions Child dependant Risk amount R1 020 / R938 Medical savings account R180 / R166 Total monthly R1 200 contribution R1 104

Hospital Benefit
Private Hospital Care	Any Private Hospital. Day Surgery Network for defined procedures (R5 700 co-pay for use of other facilities).
Co-payment	Dentistry (<13 years R1 240-R2 750, >13 years R4 500-R7 050), Scopes (R3 650 - Day clinic, R6 250 - Hospital/R4 450 - Day Clinic, R7 800 - Hopspital for gastro- and colonoscopy in same admission)
Oncology	R200 000 over 12 mth cycle -80% of cost thereafter. 20% co-payment on oncology medicine from non DSP.
Organ Transplants	Unlimited, R230 400 p/b limit for Cochlear or Brain implants
Dialysis	Unlimited at DSP for approved treatment, 80% of Scheme rate at non-DSP
Maternity - Natural Birth	Limited to 3 days/2 nights. 200% Specialist cover
To take home medication	Subject to MSA
Psychiatric Hospitalisation	Limited to 21 days p/b at DSP Hospital OR up to 15 out of hospital consultations for major affective disorders, anorexia and bulimia, and up to 12 out of hospital consultations for acute stress disorder after significant trauma

Bestmed - Beat 4 - Chronic Benefit

27 CDL chronic conditions	CDL 27 Ulcerative colitis
Additional chronic conditions	***

Bestmed - Beat 4 - Day-to-day Benefit

Overall Annual Maximum	Some indicated benefits are paid from the annual savings account first at 100% of the Scheme tariff. • Once the annual savings account is depleted benefits will be paid from Scheme’s day-to-day benefits (limits apply). • All unused funds in the annual savings account at the end of the year will be carried over to the vested savings account after 5 months and will remain your property. • Funds in the vested savings account will only be utilised when both the annual savings account and the Scheme risk benefits are depleted.
Preferred Provider	***
Medical Savings Account	Savings account/ Day-to-day benefits Savings account available. Day-to-day benefits are available. On the Beat4 option in-hospital benefits are paid from the Scheme risk. Some out-of-hospital benefits are paid from the savings first and, once depleted, will be paid from the day-to-day benefit. Once the day-to-day benefit is depleted claims can be paid from the available vested savings. Some preventative care benefits are available from the Scheme risk benefit. Benefits relating to conditions that meet the criteria for PMBs will be covered in full when using DSPs, this will not affect your savings (annual or vested).
Annual Threshold	***
Self Payment Gap	**Member choice: 1. R1 057 OTC limit per family OR 2. Access to full savings for OTC purchases (after R1 057 limit) = self-payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary. Subject to the available savings.
Above Threshold Benefit	***

Bestmed - Beat 4 - Hospital Benefit - Radiology/ Pathology/ Prosthesis

Basic Radiology	100% Scheme tariff.
MRI, CT & PET Scans	Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies). 100% Scheme tariff.
Pathology	Pathology 100% Scheme tariff.
Internal Prosthesis	Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply) 100% Scheme tariff. Limited to R107 122 per family.
External Appliances/Prosthesis	Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply) 100% Scheme tariff. Limited to R107 122 per family.

Bestmed - Beat 4 - Hospital Benefits - Sub Acute Facilities

Hospice	***
Nursing	Wound care benefit (incl. dressings, negative pressure wound therapy treatment and related nursing services- out-of-hospital) Savings first. 100% Scheme tariff. Limited to R5 493 per family. (Subject to overall day-to-day limit)
Ambulance Services	***

Bestmed - Beat 4 - D2D - GP's and Medication

General Practitioners	***
Specialists	Day procedures at DSPs and/or day-hospitals will be funded at 100% network or Scheme tariffs. Voluntary use of non-DSP specialists and acute hospitals will result in a co-payment of R2 500.
Prescribed Medication	Beat4 is Bestmed’s superior hybrid option for those with specific healthcare needs. It offers comprehensive in-hospital benefits at private hospitals. There is a generous amount of day-to-day medical cover for consultations, dentistry, chronic medications and a range of preventative care benefits.
Pharmacy Advised Medicine	Take-home medicine 100% Scheme tariff. Limited to 7 days’ medicine. **Member choice: 1. R1 057 OTC limit per family OR 2. Access to full savings for OTC purchases (after R1 057 limit) = self-payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary. Subject to the available savings.

Bestmed - Beat 4 - D2D - Radiology & Pathology

Basic Radiology	100% Scheme tariff.
MRI, CT & PET Scans	100% Scheme tariff.
Pathology	100% Scheme tariff.

Bestmed - Beat 4 - D2D - Dental Benefit

Conservative Dentistry	Beat4 is Bestmed’s superior hybrid option for those with specific healthcare needs. It offers comprehensive in-hospital benefits at private hospitals. There is a generous amount of day-to-day medical cover for consultations, dentistry, chronic medications and a range of preventative care benefits.
Specialised Dentistry	Savings and then from day-to-day limit. Orthodontics are subject to pre- authorisation. Limited to M = R6 223, M1+ = R12 499. (Subject to overall day-to-day limit)

Bestmed - Beat 4 - D2D - Optical Benefit

Examination	***
Lenses	Frame = R1 000 covered AND • 100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR • Contact lenses = R1 840
Frames	Frame = R1 000 covered
Contact Lenses	Contact lenses = R1 840

Bestmed - Beat 4 - D2D - Auxiliary Services

Physiotherapy	***
Psychiatry	***
Psychology	***
HIV/AIDS	100% Scheme tariff. Subject to pre- authorisation and DSPs.

Financial and Demographic
Date of information	2023
Principle Members	Risk amount R4 741 Medical savings account R772 Total monthly contribution R5 513
Administrator	***
Scheme (Option) Age Profile	Children under the age of 24 and registered students up to the age of 26 years qualify for child dependant rates.
Solvency Ratio | Scheme Growth	***
Past Scheme Increases	***

Contributions
Salary	***
Principle	Risk amount R4 741 Medical savings account R772 Total monthly contribution R5 513
Adult	Risk amount R3 916 Medical savings account R637 contribution R4 553
Child	Risk amount R1 172 Medical savings account R190 contribution R1 362