06 Jan Exclusions & Limitations 2025
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- Create Date January 6, 2025
- Last Updated January 6, 2025
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Network Hospital: DSP hospital group is Netcare – No limits |
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Attending Doctors: 100% CBT only at DSP |
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27 Chronic Conditions: medication and consultations. |
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Radiology Advanced scans limited to R49 965 per family (combined limit for in and out of hospital.) Limit before PMB/CDL applies. R5 845 per beneficiary for basic radiology (on referral by nominated GP or specialist for out of hospital) |
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Screening Benefits: PSA, Pap Smear, Mammogram |
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Vaccines |
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Any Private Hospital –Â No limits |
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Attending Doctors and Specialists: 100%Â CBT |
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27 Chronic Conditions: medication and consultations. |
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Radiology Advanced scans limited to R49 965 per family (combined limit for in and out of hospital.) Limit before PMB/CDL applies. R5 845 per beneficiary for basic radiology |
 |
Screening Benefits: PSA, Pap Smear, Mammogram |
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80% of GP, Specialists, Dental, Optometry, Checkups, ECG, Vaccines |
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Essential Plus: Any Private Hospital – No limits Essential Network: DSP hospitals are Life Healthcare and Netcare – No limits 20% co-payment applies for utilisation of non-DSP hospitals for non-emergencies. |
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Attending Doctors and Specialists: 200% of CBT |
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27 Chronic Conditions: Medication and consultations |
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Unlimited X-Rays and Blood Tests IN hospital including MRI and CT scans |
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Screening Benefits: Melanoma, PSA, Pap Smear, Mammogram |
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Checkups and Vaccines: GP, Specialist, Dental, Optometry, ECG |
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Vital Plus: Any Private Hospital – No limits Vital Network: DSP hospitals are Life Healthcare and Netcare – No limits 20% co-payment applies for utilisation of non-DSP hospitals for non-emergencies. |
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Attending Doctors and Specialists: 300% of CBT |
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60 Chronic Conditions: Medication and consultations. Covers the medication and necessary consultations and procedures |
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Unlimited X-Rays and Blood Tests IN hospital, limits apply to advanced scans |
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Screening Benefits: Melanoma, PSA, Pap Smear, Mammogram |
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3 Months post-hospitalisation benefit |
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External Appliances: Wheelchair, hearing aid (DSP is HearConnect), breast pump, baby sleep monitor, Insulin pump |
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Checkups and Vaccines: GP, Specialist, Dental, Optometry, ECG |
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Double Plus: Any Private Hospital – No limits Double Network: DSP hospitals are Life Healthcare and Netcare – No limits 20% co-payment applies for utilisation of non-DSP hospitals for non-emergencies. |
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Attending Doctors and Specialists: 300% CBT |
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64 Chronic Conditions Medication and Consultations. Biological medication for non-PMB conditions is available in exceptional cases on Alliance options, a 20% co-payment will apply (not on biologics approved for CDL conditions) |
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Unlimited X-rays and Blood Tests In and Out of Hospital including MRI and CT Scans |
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Screening Benefits Melanoma, PSA, Pap Smear, Mammogram |
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3 Months post-hospitalisation benefit |
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External Appliances: wheelchair, Insulin pump, hearing aid (DSP is HearConnect), breast pump, baby sleep monitor (on referral from a nominated network GP or a specialist for Double Network) |
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Checkups and Vaccines: GP (nominated network GP referral applies for Double Network), Specialist, Dental, Optometry (PPN optometrist for Double Network), ECG |
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Infertility R83 050 per family |
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Alliance Plus: Any Private Hospital – No limits. Private wards for childbirth confinements (subject to availability and pre-authorisation) Alliance Network: DSP hospitals are Life Healthcare and Netcare – No limits, private wards for childbirth confinements (subject to availability and pre-authorisation) (20% co-payment applies for utilisation of non-DSP hospitals for non-emergencies) |
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Attending Doctors and Specialists: 300%Â CBT |
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65 Chronic Conditions medication and consultations. Biological medication for non-PMB conditions is available in exceptional cases on Alliance options, a 20% co-payment will apply (not on biologics approved for CDL conditions) |
 |
Unlimited X-Rays and Blood Tests IN and OUT of hospital including MRI and CT scans |
 |
Screening Benefits: Melanoma, PSA, Pap Smear, Mammogram |
 |
3 Months post-hospitalisation benefit |
 |
External Appliances: Wheelchair, Insulin pump, hearing aid (DSP is HearConnect), breast pump, baby sleep monitor (on referral from a nominated network GP or a specialist for Alliance Network) |
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Checkups and Vaccines: GP (nominated network GP referral applies for Alliance Network), Specialist, Dental, Optometry (PPN optometrist for Alliance Network), Dermatologist, ECG, Dietician |
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Infertility R117 760 per family |
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Network Hospital: DSP hospital group is Netcare – No limits |
|
Attending Doctors: 100% CBT only at DSP |
|
27 Chronic Conditions: medication and consultations. |
|
Radiology Advanced scans limited to R47 586 per family and R5 565 per beneficiary for basic radiology (on referral by nominated GP or specialist for out of hospital) |
|
Screening Benefits: PSA, Pap Smear, Mammogram |
|
Vaccines |
|
Any Private Hospital –Â No limits |
|
Attending Doctors and Specialists: 100%Â CBT |
|
27 Chronic Conditions: medication and consultations. |
|
Radiology Advanced scans limited to R47 586 per family and R5 565 per beneficiary for basic radiology |
|
Screening Benefits: PSA, Pap Smear, Mammogram |
|
80% of GP, Specialists, Dental, Optometry, Checkups, ECG, Vaccines |
|
Essential Plus: Any Private Hospital – No limits Essential Network: DSP hospitals are Life Healthcare and Netcare – No limits 20% co-payment applies for utilisation of non-DSP hospitals for non-emergencies. |
|
Attending Doctors and Specialists: 200% of CBT |
|
27 Chronic Conditions: Medication and consultations |
|
Unlimited X-Rays and Blood Tests IN hospital including MRI and CT scans |
|
Screening Benefits: Melanoma, PSA, Pap Smear, Mammogram |
|
Checkups and Vaccines: GP, Specialist, Dental, Optometry, ECG |
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Vital Plus: Any Private Hospital – No limits Vital Network: DSP hospitals are Life Healthcare and Netcare – No limits 20% co-payment applies for utilisation of non-DSP hospitals for non-emergencies. |
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Attending Doctors and Specialists: 300% of CBT |
|
60 Chronic Conditions: Medication and consultations. Covers the medication and necessary consultations and procedures. Includes appropriate biological medication for CDL chronic conditions and specialised technology |
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Unlimited X-Rays and Blood Tests IN hospital, limits apply to advanced scans |
|
Screening Benefits: Melanoma, PSA, Pap Smear, Mammogram |
|
3 Months post-hospitalisation benefit |
|
External Appliances: Wheelchair, hearing aid (DSP is HearConnect), breast pump, baby sleep monitor, Insulin pump |
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Checkups and Vaccines: GP, Specialist, Dental, Optometry, ECG |
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Double Plus: Any Private Hospital – No limits Double Network: DSP hospitals are Life Healthcare and Netcare – No limits 20% co-payment applies for utilisation of non-DSP hospitals for non-emergencies. |
|
Attending Doctors and Specialists: 300% CBT |
|
64 Chronic Conditions Medication and Consultations. Includes unlimited appropriate biological medication for CDL chronic conditions, limited benefits for additional chronic conditions and specialised technology |
|
Unlimited X-rays and Blood Tests In and Out of Hospital including MRI and CT Scans |
|
Screening Benefits Melanoma, PSA, Pap Smear, Mammogram |
|
3 Months post-hospitalisation benefit |
|
External Appliances: wheelchair, Insulin pump, hearing aid (DSP is HearConnect), breast pump, baby sleep monitor (on referral from a nominated network GP or a specialist for Double Network) |
|
Checkups and Vaccines: GP (nominated network GP referral applies for Double Network), Specialist, Dental, Optometry (PPN optometrist for Double Network), ECG |
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Infertility R79 095 per family |
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Alliance Plus: Any Private Hospital – No limits. Private wards for childbirth confinements (subject to availability) Alliance Network: DSP hospitals are Life Healthcare and Netcare – No limits, private wards for childbirth confinements (subject to availability) (20% co-payment applies for utilisation of non-DSP hospitals for non-emergencies) |
|
Attending Doctors and Specialists: 300%Â CBT |
|
65 Chronic Conditions medication and consultations. Includes unlimited appropriate biological medication for CDL chronic conditions, limited benefits for additional chronic conditions and specialised technology |
|
Unlimited X-Rays and Blood Tests IN and OUT of hospital including MRI and CT scans |
|
Screening Benefits: Melanoma, PSA, Pap Smear, Mammogram |
|
3 Months post-hospitalisation benefit |
|
External Appliances: Wheelchair, Insulin pump, hearing aid (DSP is HearConnect), breast pump, baby sleep monitor (on referral from a nominated network GP or a specialist for Alliance Network) |
|
Checkups and Vaccines: GP (nominated network GP referral applies for Alliance Network), Specialist, Dental, Optometry (PPN optometrist for Alliance Network), Dermatologist, ECG, Dietician |
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Infertility R112 152 per family |
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