What is a deductible?

A deductible is an upfront payment that you need to make if you are admitted to a hospital or day clinic for specified procedures. There are specific deductibles applicable per Plan type and you will find this detailed information in your Benefits and Contributions Schedule.

The Benefit tables in the Benefits and Contributions Schedule briefly outline the deductibles applicable per Plan type whilst detailed information about deductibles is provided in the deductibles section of the Benefits and Contributions Schedule.

A beneficiary will be responsible for a deductible in respect of the hospital account for specific hospital events, unless the admission is related to a Prescribed Minimum Benefit (“PMB”) diagnosis, typically as a result of an emergency.

You need to pre-authorise for all hospital events or events scheduled to take place at a day clinic.  At this point, Bankmed will inform you of the deductible applicable to you.  You will need to pay this deductible to the hospital/day clinic upfront. 

When is a deductible waived?

1. When your admission is due to a PMB condition and you have been admitted to a non-DSP on an involuntary basis. In the case of a PMB condition, where a non-DSP has been used on a voluntary basis, the deductible will be applied.
2. Confinements are excluded from deductibles.
3. Re-admissions to hospital within 6 weeks of discharge following complications directly related to a prior admission in respect of which a deductible was levied.
4. Admissions to a State Hospital/Facility.
5. Admissions to authorised day clinics for specified procedures, as communicated to members from time to time.

How to calculate the deductible

If you have an upfront payment, you will only have to pay one deductible for each admission. However, we calculate the upfront payment according to the highest deductible for the admission.

Example 1:

A Traditional Plan member going to a non-network hospital for dental treatment will pay R4 750 upfront for not using a network hospital as this is more than the dental upfront payment.

Example 2:

A Comprehensive Plan member going a non-network hospital for dental treatment will pay R1 690 upfront for the dental procedure as this is more that the non-network upfront payment.