Description

Value Care Plan provides primary healthcare through a network of Prime Cure facilities and providers only.

In return for receiving quality, basic healthcare at the Scheme's most affordable contribution rate, members of this plan may only obtain healthcare services from a Prime Cure facility or network provider.

Standard Care Plan is a traditional medical plan with defined benefits and Out Of Hospital Family Limits.

Out of hospital benefits are limited and grouped by service under individual limits. Unless it is a Prescribed Minimum Benefit (PMB), all benefits are paid at 100% of the Scheme Reimbursement Rate (SRR)

Managed Care Plan offers a Medical Savings Account for out of hospital services and discretionary spend, a Top-Up rate for specialist services in hospital, extensive chronic medication, and additional benefits, such as unlimited radiology and pathology, frail care where clinically required.

Type of plan

Provides primary healthcare through a network of Prime Cure facilities and providers only

Is a traditional medical plan with defined benefits and Out of hospital Family Limits

Offers comprehensive benefits with a Medical Savings Account

Providers and Designated Service Providers

Prime Cure providers and facilities only

Your choice of healthcare service providers

For certain benefits there are designated service providers you can use without experiencing a co-payment

Your choice of healthcare service providers

For certain benefits there are designated service providers you can use without experiencing a co-payment

Tariff

Prime Cure Tariff

Scheme Reimbursement Rate (SRR)

GP rate 100% of SRR, or
GP network rate (negotiated Discovery Health Rate) with no co-payments
Specialists excluding Pathology and Radiology:

- In hospital: Top-Up rate up to 230% (100% of SRR and 130%)

- Out of hospital: Up to 125% of SRR

Benefits

Primary healthcare

Hospital:

Family Hospital Limit:

R189 900 (non-PMB)

Private hospital sub-limit:
R82 300 per family.

Out of hospital benefits:

Limited

Hospital:

Unlimited

Medical Savings Account for Out of hospital benefits

Hospital:

Unlimited

Medicines

Formulary medicine
dispensed by network
provider/pharmacy

Strict protocol management

Moderate protocol management

More information

Visit the Value Care Plan page

Visit the Standard Care Plan page

Visit the Managed Care Plan page