Comprehensive cover for hospitalisation and most in-hospital services via a restricted hospital network (DSPs)
Certain categories subject to Rand limits
Wider hospital network than for Essential and Basic Plans

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

In-Hospital GP procedures are covered at 100% of Scheme Rate for non-DSPs and at 125% of contracted rate for DSPs

In-Hospital consultations are covered at 100% of Scheme Rate fort non-DSPs and 100% of contracted rate for DSPs

Chronic medication limit:

Limited to R25 300 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

This Plan does not have a Medical Savings Account (MSA) or an Above Threshold Benefit

This Plan has access to Bankmed Hospital Network DSPs

Deductibles: Member to pay hospital or day clinic on admission (HR)

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: R310 per admission
• Private hospitals: R6 425 per admission
• Dental admissions to private hospitals: R2 295 per admission
• R6 425 for voluntary admissions to non-DSPs