Plus Plan
300% of Scheme Rate for non-DSPs
Certain categories subject to Rand limits In-hospital GP/specialist procedures covered at 300% of Scheme Rate.
DSP specialist claims will fund at 100% of scheme rate.
Chronic medication limit:
Limited to R32 665 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
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. This excludes emergencies, readmissions within six weeks of discharge, confinements and PMB-related conditions
- Day clinics: R310 per admission
- Private hospitals: R775 per admission
- Dental admissions to private hospitals: R2295 per admission.
- Non-day surgery network for certain procedure: R4100 per procedure
Comprehensive Plan
100% of Scheme Rate for non-DSPs
Chronic medication limit:
Limited to R27 395 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 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. This excludes emergencies, readmissions within six weeks of discharge, confinements and PMB-related conditions
- Day clinics: R310 per admission
- Private hospitals: R775 per admission
- Dental admissions to private hospitals: R2295 per admission.
Core Saver Plan
Certain categories subject to Rand limits
Organ transplants and oncology limited to PMBs
100% of Scheme Rate for non-DSPs
Chronic medication limit:
Limited to Core Saver formulary for PMB conditions 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
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. This excludes emergencies, readmissions within six weeks of discharge, confinements and PMB-related conditions
- Day clinics: R310 per admission
- Private hospitals: R775 per admission.