Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Unlimited at 100% of Bonitas Rate(BR)
Upfront Payments to hospitals:
Co-payments apply for certain procedures, varying between R1 570 and R7 840. See 2021 brochure for details
Casualty / Emergency Visits:
Specialists:
Unlimited at 100% of BR. Network specialists covered in full, non-network specialists paid at 100% of the BR
Other healthcare professionals eg. Physio, Occupational, Dietician:
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
Co-payment of R1 570 in a network day hospital. An additional co-payment of R2 200 may apply if performed in hospital
MRI and CT scans:
Subject to pre-authorisation. Co-payment of R1 500 per scan, except for PMBs. R16 620 per family, in- and out-of-hospital
Dialysis:
Unlimited at DSPs, otherwise a 20% co-payment will apply
Oncology / Cancer:
PMBs only at a DSP. Sub-limit of R44 200 per beneficiary for Brachytherapy
Neck and Back Operations:
Subject to registration and a personalised treatment plan on the Documentation Based Care(DBC) Managed Care Programme
Joint Replacements:
PMB cover only. Managed Care protocols apply
Medical and Surgical Appliances:
Rehabilitation, Hospice and Step-down facilities:
Physical rehabilitation limited to R52 320 per family. Hospice and Step-down facilities: R17 450 per family, subject to Managed Care protocols
Treatment for Mental Health:
R33 310 per family. No cover for physiotherapy
HIV / AIDS:
Unlimited, subject to registration on the HIV/Aids Managed Care Programme. Medication must be obtained from the DSP
International Travel Benefit:
Up to R10m cover per family for medical emergencies when you travel outside South Africa. Subject to registration prior to departure
