Cape Medical MyHealth 200:
in-and-out of hospital benefits (2025)

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Cape Medical 200. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

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Terminology:

• PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
• DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
• Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
• All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

In-hospital Procedures (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Cape Medical : MyHealth 200
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	100% scheme rate
Hospital Choice:	Any Life Health, Mediclinic or Netcare hospital
Penalty for using other hospital:	n/a
Co-payments:	Laparoscopic and Endoscopic procedures: R1,500 co-payment Specialised radiology procedures: R1,700 co-payment, out of hospital Note: A co-payment is a fee your medical aid can insist you pay, regardless of how much the doctor/charges. It's not the same as an "excess" payment (which is when a doctor charges more than the medical aid rate). If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here There might be other co-payments if you don't use a DSP, especially if you are being treated for a PMB or when buying medicine.
Specialised Radiology:	Covered
Scopes:	R1,500 co-payment
Supplementary Services: (Physio, etc)	100% scheme rate
Transplants:	PMBs only
Dialysis:	PMBs only
Exclusions:	Pathology: If you don't use Lancet or Pathcare, only the first 24 hours of tests after admission are covered by scheme Hip and knee replacement: PMBs only NB: See scheme's rules for all exclusions. All schemes have plenty!
Alternatives to hospitals:	Step-down facilities, hospices, registered nurses and rehabilitation centres: 15 days per person
Casualty/ER:	From day-to-day benefit
Other:
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Out-of-hospital Procedures (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Cape Medical : MyHealth 200
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child: Savings (per year): No savings account option on this plan The scheme might still cover some or all day-to-day claims. See below, and see benefits.
PMBs out of hospital:	All schemes must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here. This can include consults with specialists, blood or other tests, radiology and medicine PMB benefits must never be paid from your savings account Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here. See our Guide to PMBs for more information.
GP consultations:	Consult and procedures: 2 per adult and 4 per child, paid by scheme Then, from day-to-day benefit
Childcare:	Paediatric consults: R1,178 per child, paid by scheme Immunisations: R1,000 per child Eye exam: : R500 per child Then, from day-to-day benefit
Specialists consultations:	Gynaecologist: 1 consult per female Consult and procedures: From day-to-day benefit
Pathology:	R5,000 per family if you use Lancet or Pathcare
General radiology:	From day-to-day benefit
Specialised radiology:	Angiograms, CT scans, duplex doppler scans, interventional radiology, MRI, and nuclear medical investigations: R15,425 per person, with R1,700 co-payment, in and out of hospital
Scopes:	R1,500 co-payment
Supplementary Services: (Physio, etc)	From day-to-day benefit
General Appliances:	In-hospital: Covered at scheme rate. Limits apply. External: From day-to-day benefit
1.1. Hearing Aids:	From day-to-day benefit
1.2. Wheelchairs:	No benefit
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Medication Benefit (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Cape Medical : MyHealth 200
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child: Savings (per year): No savings account option on this plan The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here.
Acute (prescribed) medication:	R838 per family, paid by scheme Then, From day-to-day benefit
Over-the-counter:	From day-to-day benefit
Birth Control:	From day-to-day benefit
On Discharge:	From day-to-day benefit
Biological:
View other benefits for this plan: In-hospital | Out-of-hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics You can also: Compare any two plans, side by side | View all the Cape Medical plans, with costs and brief summary. Find all other open medical aid plans here.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider