No matter your age, if you are looking to be covered for life’s unexpected tumbles, our hospital plans give unlimited cover for planned and unplanned hospital stays.
Accommodation (hospital stay) and theatre fees
100% Scheme tariff.
Take-home medicine
100% Scheme tariff. Limited to 7 days' medicine
Biological medicine during hospitalisation
Limited to R10 000 per family per annum. Subject to pre-authorisation and funding guidelines.
Treatment in mental health clinic
100% Scheme tariff. Limited to 21 days' per beneficiary
Treatment of chemical and substance abuse
100% Scheme tariff. Limited to 21 days or R33 655 per beneficiary. Subject to network facilities.
Consultations and procedures
100% Scheme tariff.
Surgical procedures and anaesthetics
100% Scheme tariff.
Organ transplants
100% Scheme tariff. (PMBs only)
Major medical maxillo-facial surgery strictly related to certain conditions
No benefit. (PMBs only at DSP day hospitals).
Dental and oral surgery (In- or out of hospital)
PMBs only at DSP day hospitals.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R82 158 per family.
Prosthesis – Internal Note: Sub-limit subject to the overall annual prosthesis limit. *Functional: Items utilised towards treating or supporting a bodily function
Sub-limits per beneficiary:
*Functional R14 698 Pacemaker (dual chamber) R44 791
Vascular R32 792
Endovascular and catheter-based procedures - no benefit
Spinal R32 792
Artificial disc - no benefit
Drug-eluting stents - PMBs and DSP products only
Mesh R11 508
Gynaecology/Urology R9 404
Lens implants R7 176 a lens per eye
Prosthesis – External
No benefit. (PMBs only).
Exclusions Limits and co-payments apply. Preferred provider network available.
Joint replacement surgery (except for PMBs). PMBs subject to prosthesis limits:
Hip replacement and other major joints R34 522
Knee replacement R42 564
Minor joints R13 240
Orthopaedic and medical appliances
100% Scheme tariff.
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies).
100% Scheme tariff.
Oncology
100% Scheme tariff. Subject to pre-authorisation. DSP applies.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Confinements (Birthing)
100% Scheme tariff.
HIV and AIDS
100% Scheme tariff. Subject to preauthorisation and DSPs.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
PMBs only
Midwife-assisted births
100% Scheme tariff.
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff.
Palliative care and Home-based care in lieu of hospitalisation
100% Scheme tariff, limited to R60 000 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan.
Day procedures at a day-hospital facility
Day procedures at a day-hospital facility funded at 100% Scheme tariff. Subject to pre-authorisation. DSPs apply for PMBs
International travel cover
Leisure Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 90 days, with R5 million for one member and R10 million for principal member and dependants.
Business Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 45 days, with R5 million for one member and R10 million for principal member and dependants.
Co-payments
Co-payment for voluntary use of non-network hospital R12 373 for Beat1 Network option.
Family Practitioner (FP) and specialist consultations
None.
Diabetes primary care consultation
100% of Scheme tariff subject to registration with Halocare. 2 primary care consultations at Dis-Chem Pharmacies.
Medical Savings
None.
Medical aids, apparatus and appliances including wheelchairs and hearing aids (Hearing aids are subject to pre-authorisation)
None.
Supplementary services
None.
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
100% Scheme tariff. Limited to R 3 675 per family.
Basic and Specialised Dentistry
None.
Optometry Services
None.
Basic radiology and pathology
None.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. PET scans excluded)
100% Scheme tariff. Limited to R5 567 per family.
Oncology
Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation and DSP.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
HIV/AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Rehabilitation services after trauma
PMBs only. Subject to pre-authorisation and DSPs.
CDL and PMB chronic medicine
100% Scheme tariff. Co-payment of 30% for non-formulary medicine.
Non-CDL chronic medicine
No benefit.
Biologicals and other high-cost medicine
PMBs only as per funding protocol. Subject to pre-authorisation
Acute medicine
No benefit.
Over-the-counter (OTC) medicine
No benefit.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits
Add Dependants
No matter your age, if you are looking to be covered for life's unexpected tumbles, our hospital plans give unlimited cover at any of our network hospitals for planned and unplanned hospital stays.
You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.
Contributions
Member: R1 570
Adult dependant: R1 220
Child dependant: R661
Maximum child dependants: 3
Child dependants under the age of 24 years and registered students up to the age of 26 years, in accordance with the Rules, are regarded as child dependants.
Get personalised pricing
call for more information 
Accommodation (hospital stay) and theatre fees
100% Scheme tariff.
Take-home medicine
100% Scheme tariff. Limited to 7 days' medicine
Biological medicine during hospitalisation
Limited to R10 000 per family per annum. Subject to pre-authorisation and funding guidelines.
Treatment in mental health clinic
100% Scheme tariff. Limited to 21 days' per beneficiary
Treatment of chemical and substance abuse
100% Scheme tariff. Limited to 21 days or R33 655 per beneficiary. Subject to network facilities.
Consultations and procedures
100% Scheme tariff.
Surgical procedures and anaesthetics
100% Scheme tariff.
Organ transplants
100% Scheme tariff. (PMBs only)
Major medical maxillo-facial surgery strictly related to certain conditions
PMBs only at DSP day hospitals.
Dental and oral surgery (In- or out of hospital)
PMBs only at DSP day hospitals.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R82 158 per family.
Prosthesis – Internal Note: Sub-limit subject to the overall annual prosthesis limit. *Functional: Items utilised towards treating or supporting a bodily function
Sub-limits per beneficiary:
*Functional R14 698 Pacemaker (dual chamber) R44 791
Vascular R32 792
Endovascular and catheter-based procedures - no benefit
Spinal R32 792
Artificial disc - no benefit
Drug-eluting stents - PMBs and DSP products only
Mesh R11 508
Gynaecology/Urology R9 404
Lens implants R7 176 a lens per eye
Prosthesis – External
No benefit. (PMBs only).
Exclusions Limits and co-payments apply. Preferred provider network available.
Joint replacement surgery (except for PMBs). PMBs subject to prosthesis limits:
Hip replacement and other major joints R34 522
Knee replacement R42 564
Minor joints R13 240
Orthopaedic and medical appliances
100% Scheme tariff.
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging (including MRI scans, CT scans and isotope studies).
100% Scheme tariff.
Oncology
100% Scheme tariff. Subject to pre-authorisation and DSP.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSP.
Confinements (Birthing)
100% Scheme tariff.
HIV and AIDS
100% Scheme tariff. Subject to preauthorisation and DSPs.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
PMBs only
Midwife-assisted births
100% Scheme tariff.
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff.
Palliative care and Home-based care in lieu of hospitalisation
100% Scheme tariff, limited to R60 000 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan.
Day procedures at a day-hospital facility
Day procedures at a day-hospital facility funded at 100% Scheme tariff. Subject to pre-authorisation. DSPs apply for PMBs
International travel cover
Leisure Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 90 days, with R5 million for one member and R10 million for principal member and dependants.
Business Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 45 days, with R5 million for one member and R10 million for principal member and dependants.
Co-payments
Co-payment for voluntary use of non-network hospital R12 373 for the Beat1 Network option.
Family Practitioner (FP) and specialist consultations
None.
Diabetes primary care consultation
100% of Scheme tariff subject to registration with Halocare. 2 primary care consultations at Dis-Chem Pharmacies.
Medical Savings
None.
Medical aids, apparatus and appliances including wheelchairs and hearing aids (Hearing aids are subject to pre-authorisation)
None.
Supplementary services
None.
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
100% Scheme tariff. Limited to R 3 675 per family.
Basic and Specialised Dentistry
None.
Optometry Services
None.
Basic radiology and pathology
None.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. PET scans excluded).
100% Scheme tariff. Limited to R5 567 per family.
Oncology
Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation and DSPs.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
HIV/AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Rehabilitation services after trauma
PMBs only. Subject to pre-authorisation and DSPs.
CDL and PMB chronic medicine
100% Scheme tariff. Co-payment of 30% for non-formulary medicine.
Non-CDL chronic medicine
No benefit.
Biologicals and other high-cost medicine
PMBs only as per funding protocol. Subject to pre-authorisation
Acute medicine
No benefit.
Over-the-counter (OTC) medicine
No benefit.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits
Add Dependants
No matter your age, if you are looking to be covered for life's unexpected tumbles, this hospital plan gives unlimited cover for unplanned hospital stays.
You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.
Contributions
Member: R1 746
Adult dependant: R1 354
Child dependant: R734
Maximum child dependants: 3
Child dependants under the age of 24 years and registered students up to the age of 26 years, in accordance with the Rules, are regarded as child dependants.
Get personalised pricing
call for more information
