Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Unlimited at 100% of Bonitas Rate (BR)
Upfront Payments to hospitals:
If you use a hospital outside of the Primary Select network a co-payment of 30% will apply.
Co-payments apply to certain procedures performed in hospital: R1 520 for minor procedures;
R3 850 for Arthroscopy, Diagnostic Laparoscopy, Laparoscopic Hysterectomy and Percutaneous Rhizotomies;
R7 580 for Back Surgery including Spinal Fusions, Laparoscopic Pyeloplasty, Laparoscopic Radical Prostatectomy and Reflux surgery
Other healthcare professionals eg. Physio, Occupational, Dietician:
Subject to available savings, except for PMB
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
Co-payment of R1 520 applies if performed in-hospital
MRI and CT scans:
R16 070 per family available. Subject to pre-authorisation
Dialysis:
Unlimited at 100% of BR. You must use a Designated Service Provider(DSP), or a 20% co-payment will apply
Oncology / Cancer:
R344 500 available per family. Subject to the use of a preferred provider. Sub-limit of R44 200 per beneficiary for Brachytherapy
Neck and Back Operations:
Co-payment of R7 580. Managed Care Protocols apply and the use of a preferred supplier
Medical and Surgical Appliances:
Subject to available savings
Take home Medicine:
R390 per beneficiary, per hospital stay
Rehabilitation, Hospice and Step-down facilities:
Physical rehabilitation R50 600 per family. Hospice and step-down facilities; R16 880 per family. Terminal Care; unlimited
Treatment for Mental Health:
Hospitalisation; R32 210 per family. PMB only for In- or out-of-hospital consultations, included in the hospital benefit. No cover for physiotherapy for mental health admissions. Subject to the use of a DSP
HIV / AIDS:
Unlimited if you register on the HIV/AIDS programme. Chronic medicine must be obtained from Pharmacy Direct
International Travel Benefit:
Cover for medical emergencies when you travel outside South Africa. Subject to registration