Comprehensive cover for hospitalisation and most in-hospital services via a restricted hospital network (DSPs)
Certain categories subject to Rand limits
Hospital network more restricted than for the Traditional Plan
Organ transplants, oncology and renal dialysis limited to PMBs

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

Chronic medication limit:

Access to 27 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. Funded at 100% of Scheme Rate subject to Designated Service Providers (DSPs) and Scheme-approved medicine list (formulary).

Access to Additional Disease List (ADL) condition, Major Depression, funded at 100% of Scheme Rate subject to Designated Service Providers (DSPs) and Scheme-approved medicine list (formulary)

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: R325 per admission
• Private hospitals: R810 per admission