Upfront payments

You may have to pay an amount to a hospital or a day clinic before specific procedures or if you do not use a network hospital if you are on a Plan that makes use of hospital networks. We call this amount an upfront payment or deductible. The facility will not admit you until you pay the amount. You do not have any upfront payments for emergency admissions, readmissions within six weeks of discharge or childbirth.

Only one upfront payment (deductible) for each admission.

For example:

  • A Traditional Plan member going to a non-network hospital (R5 475 upfront) for dental treatment (R1 950 upfront) pays R5 475 upfront for not using a network hospital as this is more than the dental upfront payment
  • A Comprehensive Plan member going to a non-network hospital (R660 upfront) for dental treatment (R1 950) pays R1 950 upfront for the dental procedure as this is more than the non-network upfront payment
You do not have to pay an amount upfront if:
  • You are admitted to a non-network hospital in a medical emergency (as a Prescribed Minimum Benefit). If you do not use a network hospital or day clinic, and it is not a medical emergency, you have to make an upfront payment
  • You are admitted to hospital for childbirth
  • You are admitted to hospital again within six weeks of being sent home if you have complications from a procedure that you already paid an amount upfront for
  • You are admitted to a state hospital
  • We inform you that you do not have an upfront payment if you are admitted to a day clinic for specific procedures

Upfront payment (deductible) for not using a network facility

Unless it is a medical emergency, you have an upfront payment before you can receive treatment or care in a day clinic or hospital that is not in our network.

Basic, Core Saver, Comprehensive and Plus Plans

Day clinic: R260 for each admission

Hospital: R660 for each admission

Traditional Plan

Day clinic: R260 for each admission

Hospital: R5 475 for each admission

Essential Plan

No cover outside our hospital and day clinic networks.

Avoid upfront payments (deductibles) for specific procedures

You have to contact us to get pre-authorisation before you go to a day clinic or hospital for a procedure. Specific procedures can be performed in a day clinic instead of in-hospital so you can avoid having an upfront payment by using a day clinic in our network.

Basic, Core Saver, Traditional, Comprehensive and Plus Plans

Network day clinic: No upfront payment

Non-network day clinic or network hospital: R1 725 for each admission.

Essential Plan

Network day clinic: No upfront payment for Prescribed Minimum Benefit conditions

Non-network day clinic or network hospital: R1 725 for each admission for Prescribed Minimum Benefit conditions

You only have cover for procedures to treat Prescribed Minimum Benefit conditions. If the condition is not a Prescribed Minimum Benefit, you have to pay for all the procedure and related costs yourself.

For full list of deductibles refer to the 2021 Benefit and contributions schedule.

Please ensure you have the required authorisation for any procedures performed In-hospital or a Day Surgery Facility. Call: 0800 BANKMED (0800 226 5633)