A Comparison of Hospital Plans - 2016

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 Keycare Core Genesis Private Choice
Discovery Essential Delta Core
Momentum Custom Opt 1 FedHealth Entryzone
Discovery Coastal Core
Bonitas Bon Essential Resolution Hospital
Discovery Smart Plan
Medihelp Dimension Prime 1
Discovery Essential Core
Genesis Private
Mometum Custom Opt 2
Fedhealth Maxima Core
Discovery Classic Core
 
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Network Hospitals to be used  
  Certain procedures only covered at  
  Network Day Clinics  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 34,000  
  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)
 
  Does not apply  
       
       
  Specialist benefit limited to R3,250  
   per person per annum. Must be  
   referred by GP  
     
     
     
     
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Income p/m: R0 - R7,550  
  Principal Member R 665  
  Spouse /Adult R 665  
  dependant    
  Per Child (Max 3) R173  
       
  Income p/m: R7,551 - R10,750  
  Principal Member R 830  
  Spouse /Adult R 830  
  dependant    
  Per Child (Max 3) R 204  
       
  Income p/m: R10,751+  
  Principal Member R 1,281  
  Spouse /Adult R 1,281  
  dependant    
  Per Child (Max 3) R 289  
       
       
       
GENESIS
PRIVATE CHOICE
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
     
     
     
  Annual Sub-limits:  
  Psychiatric Treatment: 3 days in  
   hospital, 18 days in registered  
   facility limited to R35,000  
   Hospice Care R50,000  
    (shared limit with Oncology)  
   Oncology R50,000  
    (shared limit with Hospice Care)  
       
   Internal Prosthesis R20 000  
    (50% of cost)    
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Medicine Price
 
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary,  
     
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
 

 
  Does not apply except for  
       
   Basic Dentistry limited to R25,000  
   per annum per person  
     
     
       
       
     
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 950  
  Spouse/Adult dependant R 950  
  1st Child R 320  
   /Each Additionah Child R 250  
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Network Hospitals to be used  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 48,000  
  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  
   Only from MedXpress  
     
     
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  No Benefit  
               
               
               
               
               
               
               
               
               
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,198  
  Spouse/Adult dependant R 900  
  Per Child (Max 3) R 480  
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
.
MOMENTUM CUSTOM OPTION
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  *7 days Take Home Medicine  
  *R1100 co-payment except for  
  Emergencies, MVA's and maternity  
  Associated Hospitals to be used  
  (Life and Mediclinics)  
  Annual Sub-limits :
 
     
  Psychiatric Treament R30,200  
  Hospice Care (including R41,400  
   rehab & step-down    
    facilities)    
       
       
  Oncology R300,000    
   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 1,152  
  Spouse/Adult dependant R 871  
  Per Child (Max 3) R 408  
FEDHEALTH
ENTRYZONE
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No overall annual limit  
  Network hospitals to be used  
  R5,270 co-payment on voluntary  
  non-network admissions  
  Co-payments are due for  
  certain procedures  
  (eg. R5,000 Anthroscopy)  
  *30 days Post Hospital Cover  
  *7 days Take Home Medicine  
  *Emergency Trauma at Out Patients  
  Psychiatric Treatment & Ocology PMB  
  Hospice Care - R27,900  
  Internal Prosthesis - PMB  
     
               
               
               
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Medicine Price  
  27 PMB Chronic Disease Conditions  
  Only from MED-Rite Pharmacies  
       
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
 
GP and Specialist benefit subject
 
       to PMB and pre-authorisation  
       only at contracted providers  
     
     
     
     
     
     
     
     
       
  ANNUAL THRESHOLD BENEFIT  
                  Does not apply    
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,179  
  Spouse/Adult dependant R 881  
  Per Child R 396  
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 48,000  
  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  
  Only from MedXpress  
     
     
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  No Benefit  
       
       
       
       
       
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,302  
  Spouse/Adult dependant R 976  
  Per Child (Max 3) R 519  
.
BONITAS
BONESSENTIAL
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Co-payments apply for certain  
  procedures  
  *R325 Take Home Medicine  
  Annual Sub-limits:  
  Oncology R 295,400  
  Psychiatric Treatment R 27,650  
  Hospice Care R 14,200  
       
       
       
       
       
       
       
       
       
       
       
               
               
  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 except for  
       
    6 Antenatal consultations  
    4 postnatal consultations,  
    with Midwife, 2 scans,  
    1 amniocentesis.  
       
       
       
       
       
       
       
     
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,316  
  Spouse/Adult dependant R 1,007  
  Per Child R 386  
RESOLUTION HEALTH
HOSPITAL PLAN
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
     
  Co-payments are due for certain  
  procedures (e.g. R3,539 Arthroscopy)  
     
  *7 days Take Home Medicine  
     
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment PMB  
  Hospice Care 10 days  
  Oncology (subject to ICON R161,031  
   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  
   GP and Specialist consultations  
    subject to PMB and    
    pre-authorisation only at    
    contracted providers    
       
       
       
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1 375  
  Spouse/Adult dependant R 1 170  
  Per Child (max 3) R 513  
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
  Network Hospitals to be used  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 48,000  
  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  
  Only from MedXpress, Clicks  
  or Dischem  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  Unlimited GP Benefit with  
  R50 co-payment for face-to-face  
     consultations  
     
     Video call consultations paid in full  
     
     Prescribed medications limited to  
     12 prescriptions per person per  
     annum with a R10    
     co-payment per item  
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,397  
  Spouse/Adult dependant R 1,099  
  Per Child (Max 3) R 557  
 
MEDIHELP
DIMENSION PRIME 1
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
     
  Co-payments on specified  
  procedures may apply  
     
  *30 days Post Hospital Cover  
  limited to R2 120 per family  
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment R23,750  
   (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)
 
     
  Does not Apply  
     
   Single:  R1,000  
   Family:  R2,000  
     
     
       
   Conservative Dentistry: removal of  
   impacted wisdom teeth only  
       
   Specialists: Shared limit with  
    GP consultatants    
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,452  
  Spouse/Adult dependant R 1,188  
  Per Child (max 2) R 438  
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
     
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 48,000  
  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  
  Only from MedXpress  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  No Benefit  
       
       
       
       
       
       
       
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,499  
  Spouse/Adult dependant R 1,123  
  Per Child (Max 3) R 601  
       
GENESIS
PRIVATE
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
     
     
     
  Annual Sub-limits:  
   Psychiatric Treatment: 3 days in  
    hospital, 18 days in registered  
    facility limited to R35,000  
    Hospice Care R550,000  
     (shared limit with Oncology)   
    Oncology      R550,000  
     (shared limit with Hospice Care)    
               
    Internal Prosthesis   R30,000  
               
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Medicine Price  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary,  
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
 
 
 
  Does not apply except for  
     
   Basic Dentistry limited to R25,000  
   per annum per person  
   AND  
   MRI and CT scans (excl back/neck)  
   paid at 50% of actual cost up to  
   Scheme rate limited to R6,000 per  
   person per annum    
       
       
     
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,420  
  Spouse/Adult dependant R 1,420  
  1st Child R 350  
   /Each Additionah Child R 275  
.d
MOMENTUM CUSTOM OPTION
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  *7 days Take Home Medicine  
  *R1100 co-payment except for  
  Emergencies, MVA's and maternity  
  Associated Hospitals to be used  
  (Life and Mediclinics)  
  Annual Sub-limits :
 
     
  Psychiatric Treament R30,200  
  Hospice Care (including R41,400  
   rehab & step-down    
    facilities)    
       
       
  Oncology R300,000    
   thereafter 20% co-pay    
  Internal Prostheses:    
     see detailed benefits    
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 Chronic Disease Conditions  
  Subject to scheme formulary  
     
     
               
  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 1,557  
  Spouse/Adult dependant R 1,228  
  Per Child (Max 3) R 549  
       
       
FEDHEALTH
MAXIMA CORE
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Co-payments are due for certain  
  procedures  
  (e.g R6,500 Anthroscopy hip & wrist)  
  *30 days Post Hospital Cover  
  *7 days Take Home Medicine  
  Oral Contraceptives  
  *Emergency Trauma at Out Patients  
       
  Psychiatric Treatment R 22,600  
  Hospice care R 27,900  
  Oncology (only at DSP) R250,000  
  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)  
  GP and Specialist benefit subject  
  to PMB and pre-authorisation  
  only at contracted providers  
     
     
       
  ANNUAL THRESHOLD BENEFIT  
                 Does not apply    
       
  MONTHLY CONTRIBUTIONS  
  Member R 1,695  
  Spouse/Adult dependant R 1,436  
  Per Child R 593  
               
               
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
     
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 48,000  
  Oncology R200 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit schedule  
               
               
               
               
               
               
               
               
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 MB Chronic Disease Conditions  
  Subject to scheme formulary  
  Only from MedXpress  
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
     
  Does not apply  
       
       
     
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
       
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,745  
  Spouse/Adult dependant R 1,373  
  Per Child (Max 3) R 698  
       
       
 

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.