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
Chronic medication limit:
Limited to R25 355 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, except for emergencies, readmissions within six weeks of discharge, confinements and PMB-related conditions
- Day clinics: R240 per admission
- Private hospitals: R600 per admission
- Dental admissions to private hospitals: R1 775 per admission.
- Non-day surgery network for certain procedure: R1 500 per procedure
Comprehensive Plan
110% of Scheme Rate for non-DSPs
Chronic medication limit:
Limited to R21 260 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, except for emergencies, readmissions within six weeks of discharge, confinements and PMB-related conditions
- Day clinics: R240 per admission
- Private hospitals: R600 per admission
- Dental admissions to private hospitals: R1 775 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, except for emergencies, readmissions within six weeks of discharge, confinements and PMB-related conditions
- Day clinics: R240 per admission
- Private hospitals: R600 per admission.