A Comparison of Hospital Plans - 2015

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 Bon Essential
FedHealth Entryzone
Momentum Custom Opt 1 Discovery Essen Delta Core Discovery Coastal Core
Resolution Hospital Plan Momentum Custom Opt 2 FedHealth Maxima Core
Medihelp Necessee Medihelp Dimension Prime 1 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 33,300  
  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 R3,000  
   per person per annum. Must be  
   referred by GP  
     
     
     
     
     
     
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
               
               
  MONTHLY CONTRIBUTIONS  
  Income p/m: R0 - R7,050  
  Principal Member R 611  
  Spouse /Adult R 611  
  dependant    
  Per Child (Max 3) R158  
       
  Income p/m: R7,051 - R10,000  
  Principal Member R 762  
  Spouse /Adult R 762  
  dependant    
  Per Child (Max 3) R 187  
       
  Income p/m: R10,000+  
  Principal Member R 1,176  
  Spouse /Adult R 1,176  
  dependant    
  Per Child (Max 3) R 265  
       
       
       
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 280,800  
  Psychiatric Treatment R 26,300  
  Hospice Care R 13,500  
       
       
       
       
       
       
               
               
  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 1,191  
  Spouse/Adult dependant R 991  
  Per Child R 349  
       
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
FEDHEALTH
ENTRYZONE
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No overall annual limit  
  Network hospitals to be used  
  R5,000 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  
  Hospital Care - R26,500  
  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)
 
 
Does not apply
 
     
     
     
     
     
     
     
     
     
     
       
  ANNUAL THRESHOLD BENEFIT  
                  Does not apply    
     
     
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,073  
  Spouse/Adult dependant R 802  
  Per Child R 361  
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
.
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 R28,500  
  Hospice Care (including R39,100  
   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 1,068  
  Spouse/Adult dependant R 807  
  Per Child (Max 3) R 378  
     
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 44,000  
  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 1,110  
  Spouse/Adult dependant R 833  
  Per Child (Max 3) R 445  
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 44,000  
  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 1,195  
  Spouse/Adult dependant R 896  
  Per Child (Max 3) R 477  
       
.
RESOLUTION HEALTH
HOSPITAL PLAN
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
     
  Co-payments are due for certain  
  procedures (e.g. R3,370 Arthroscopy)  
     
  *7 days Take Home Medicine  
     
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment PMB  
  Hospice Care 10 days  
  Oncology (subject to ICON R153,363  
   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 1 233  
  Spouse/Adult dependant R 1 049  
  Per Child (max 3) R 460  
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 R28,500  
  Hospice Care (including R39,100  
   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 1,443  
  Spouse/Adult dependant R 1,138  
  Per Child (Max 3) R 509  
FEDHEALTH
MAXIMA CORE
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Co-payments are due for certain  
  procedures  
  (e.g R2,500 Anthroscopy)  
  *30 days Post Hospital Cover  
  *7 days Take Home Medicine  
  Oral Contraceptives  
  *Emergency Trauma at Out Patients  
       
  Psychiatric Treatment R 21,500  
  Hospice care R 26,500  
  Oncology (only at DSP) R213,000  
  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 1,529  
  Spouse/Adult dependant R 1,295  
  Per Child R 534  
 
MEDIHELP
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Network Hospitals to be used  
  Take home medicine limited to  
  R290 per admission  
     
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment PMB  
  Hospice Care n/a  
  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)
 
  100% Scheme rate  
  GP's: 9 Visits from Necessee  
    Network Providers  
  Specialists: R 2,500 per person and  
    R3 ,500 per family from  
    Network providers (20%  
    (co-payment if not  
    referred by Necesse  
    Network GP  
     
  Conservative Dentistry:  
     - 1 Consulation, scale  
       and polish  
    - 2 root canals per person  
       per annum  
    - Fillings on 4 teeth, once  
       per tooth in 365 days  
    - 1 set plastic dentures  
      per family every 2 years  
    - 4 Infra-oral xrays per  
       person per annum  
    - 1 Extra infra-oral xray  
       per person per annum  
     
     
     
     
     
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
               
               
  MONTHLY CONTRIBUTIONS  
  Income p/m:            R0 - R7,500  
  Principal Member                 R1,152    
  Spouse /Adult                        R912  
  dependant  
  Per Child (Max 2)                   R492  
     
  Income p/m:    R7,501 - R11,000  
  Principal Member R1,362  
  Spouse /Adult R 1,062  
  dependant    
  Per Child (Max 2) R 594  
       
  Income p/m:                R11,001+  
  Principal Member R 1,584  
  Spouse /Adult R 1,236  
  dependant    
  Per Child (Max 2) R 684  
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  
   R290 per admission  
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment R22,400  
   (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  
     
       
   Conservative Dentistry: removal of  
   impacted wisdom teeth only  
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
               
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,320  
  Spouse/Adult dependant R 1,080  
  Per Child (max 2) R 396  
       
       
       
       
       
       
       
       
       
       
       
       
       
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 44,000  
  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 1,617  
  Spouse/Adult dependant R 1,272  
  Per Child (Max 3) R 646  
       
       
       
       
       
       
       
       
       
       
       
       
       
       
.
 
 

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.