A Comparison of Hospital Plans - 2014

A Hospital Plan will cover all the services provided in a hospital including the anesthetist and surgeon. You would have to be admitted to a hospital, out patients and trauma units are generally not considered a hospital event if you are not admitted.

The anesthetist and surgeon charge separately and have the choice of charging anywhere between NRPL (National Reference Price List) and Private Rates, which are generally three times higher than the NRPL Rate. Some plans pay at NRPL Rate and some at Private Rates. Hospitals normally have an agreed tariff with the medical aids and if this is the case, the hospital and related bills will be paid in full.

 
Hospital
Plans:
Discovery Health Coastal Core Resolution Health Hospital
Momentum Custom Option 1
Bonitas Bonessential
Discovery Keycare Core Discovery Classic Core
Medihelp Dimension Prime 1
Fedhealth Maxima Core
 
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 40,000  
  Oncology R200 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit schedule  
       
  Designed for members in coastal  
  provinces using a Network of  
  Coastal Hospitals  
     
     
     
     
     
     
     
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions   
  Subject to scheme formulary  
     
     
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  No Benefit  
               
               
               
               
               
               
               
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1087  
  Spouse/Adult dependant R 815  
  Per Child (Max 3) R 434  
       
       
       
RESOLUTION HEALTH
HOSPITAL PLAN
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
     
  Co-payments are due for certain  
  procedures (e.g. R3,180 Arthroscopy)  
     
  *7 days Take Home Medicine  
     
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment PMB  
  Hospice Care 10 days  
  Oncology (subject to ICON R68,900  
   network & scheme    
   protocols    
   Internal Prosthesis    
    (see detailed benefits)    
       
       
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
     
       
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
     
  Does not apply  
     
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1 117  
  Spouse/Adult dependant R 941  
  Per Child (max 3) R 413  
       
               
               
MOMENTUM CUSTOM OPTION
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  *7 days Take Home Medicine  
  *R1000 co-payment except for  
  Emergencies, MVA's and maternity  
  Associated Hospitals to be used  
  (Life and Mediclinics)  
  Annual Sub-limits :
 
     
  Psychiatric Treament R26,900  
  Hospice Care (including R36,900  
   rehab & step-down    
    facilities)    
       
       
  Oncology R30]0,000    
   thereafter 20% co-pay    
  Internal Prostheses:    
    see detailed benefits    
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 Chronic Disease Conditions  
  Subject to scheme formulary  
   Only from state hospitals  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  Does not apply   
       
       
  For more savings, please enquire  
  about the Health Saver  
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 978  
  Spouse/Adult dependant R 739  
  Per Child (Max 3) R 346  
       
       
       
.
BONITAS
BONESSENTIAL
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Co-payments apply for certain  
  procedures  
  *R290 Take Home Medicine  
  Annual Sub-limits:  
  Oncology R 264,500  
  Psychiatric Treatment R 24,800  
  Hospice Care R 12,700  
       
       
       
       
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary,  
  only from Pharmacy Direct  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
 

 
  Does not apply  
       
       
       
       
       
     
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,085  
  Spouse/Adult dependant R 830  
  Per Child R 318  
       
     
     
     
     
     
     
     
     
     
     
     
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Network Hospitals to be used  
  Certain procedure only covered  
  at Network Day Clinics  
  Annual Sub-limits per person:  
     
     
  Psychiatric Treatment 21 days  
  Hospice Care R 28,500  
  Oncology PMB  
     
     
     
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
  Only from DSP  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
     
       
   Specialist Benefit limited to  
   R2 750 per person per annum,  
   must be referred by GP.  
     
     
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
     
  MONTHLY CONTRIBUTIONS  
  Income: R0-R6,650  
  Principal Member R 556  
  Spouse/Adult dependant R 556  
  Per Child (Max 3) R 143  
       
  Income: R6,651-R8,800
 
  Principal Member R 693  
  Spouse/Adult dependant R 693  
  Per Child (Max 3) R 171  
       
  Income: R8,801 +  
  Principal Member R 1 070  
  Spouse/Adult dependant R 1 070  
  Per Child (Max 3) R 241  
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 40,000  
  Oncology R200 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit schedule  
       
     
     
     
     
     
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions   
  Subject to scheme formulary  
     
     
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  No Benefit  
               
               
               
               
               
               
               
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1 471  
  Spouse/Adult dependant R 1 157  
  Per Child (Max 3) R 587  
       
       
       
       
       
       
       
       
       
       
       
       
.
MEDIHELP
DIMENSION PRIME 1
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
     
  Co-payments on specified  
  procedures may apply  
     
  *Take Home Medicine limited to  
   R270 per admission  
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment R21,100  
   (per family)    
  Hospice Care Unlimited  
  Oncology (PMB) Unlimited  
       
       
       
       
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
            Only from DSP    
       
       
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
     
     
   GP's: Limited to R820 per person and  
            R1,540 per family    
     
   Specialists: shared limit with GP's  
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,146  
  Spouse/Adult dependant R 936  
  Per Child (max 2) R 342  
       
FEDHEALTH
MAXIMA CORE
  IN HOSPITAL BENEFIT  
  100% Scheme  
  No Overall Annual Limit  
  Co-payments are due for certain  
  procedures  
  (e.g R1,900 Anthroscopy)  
  *30 days Post Hospital Cover  
  *7 days Take Home Medicine  
  Oral Contraceptives  
  *Emergency Trauma at Out Patients  
       
  Psychiatric Treatment R 20,300  
  Hospice care R 25,000  
  Oncology (only at DSP) R201,000  
  Internal Prosthesis:    
  See detailed benefits    
       
       
       
       
  CHRONIC MEDICATION BENEFIT  
  100% Medicine Price  
  27 PMB Chronic Disease Conditions  
  Only from MED-Rite Pharmacies  
       
       
               
  ANNUAL DAY TO DAY BENEFIT (including savings)  
  Does not apply   
     
     
     
     
     
     
     
     
     
     
       
  ANNUAL THRESHOLD BENEFIT  
                 Does not apply    
     
  MONTHLY CONTRIBUTIONS  
  Member R 1, 370  
  Spouse/Adult dependant R 1, 161  
  Per Child R 479  
     
 
 
     
     
     
     
     
     
     
     
     
     
       
       
       
       
       
       
       
       
       
       
  CHRONIC MEDICATION BENEFIT  
     
     
     
       
       
               
  ANNUAL DAY TO DAY BENEFIT (including savings)  
     
     
     
     
     
     
     
     
     
     
     
       
  ANNUAL THRESHOLD BENEFIT  
       
     
  MONTHLY CONTRIBUTIONS  
       
       
       
       
 
 

As additional standard Hospital Plans become available we will continue to update this page in our effort to provide our clients with the most up to date information and advice on the medical aid industry in South Africa. If you are still deciding which plan type is best suited to your situation, why not take a look at the Medical Aid Plans page to see the full range of plans.

For more detailed information on any of the above plans, just click on the name of the relevant hospital plan in the tables above. If you already know what you want, why not make use of our site to download the relevant Medical Aid Application form and then fax it back to us on 0866 200 320 . Alternatively, if you would like us to confirm some of the finer details or pricing, just fill in our Medical Aid Quote Request form and we will get back to you promptly.

Finally, we invite you to contact us on +27 21 712-8866 at any point in your decision making process for further information on these Hospital Plans.