Comprehensive cover for hospitalisation and most in-hospital services via an unrestricted network of hospitals

100% of cost at contracted rate, unlimited for Bankmed Network Specialists (DSPs)
300% of Scheme Rate for non-DSPs

Certain categories subject to Rand limits in-hospital GP/specialist procedures covered at 300% of Scheme Rate

Chronic medication limit:

Limited to R29 070 pbpa (Insured Benefit) and paid as follows:

• 100% of the Scheme’s Maximum Medical Aid Prices (MMAP) for Bankmed Network GPs (DSPs) or Bankmed Pharmacy Network (DSP)
• 80% of Scheme’s Maximum Medical Aid Prices (MMAP) for non-DSPs
• Continued benefits for PMBs after depletion of annual limit, subject to PMB regulations

Continued benefits for PMBs after depletion of annual limit, subject to PMB regulations.

This Plan has a Medical Savings Account (MSA) and an Above Threshold Benefit (ATB). Claims paid from the MSA accumulate towards the Annual Threshold (AT) at 100% of the Scheme Rate

This Plan has access to all Netcare, National Hospital Network (NHN), Life Healthcare, Mediclinic and Clinix hospitals, any other independent private hospitals contracted to the Scheme

Deductibles: Member to pay hospital or day clinic on admission

For certain procedures performed in-hospital and at a day clinic a deductible will apply, except for emergencies, readmissions within six weeks of discharge, confinements and PMB-related conditions

• Day clinics: R275 per admission
• Private hospitals: R690 per admission
• Dental admissions to private hospitals: R2 040 per admission.
• Non-day surgery network for certain procedure: R1 805 per procedure