BENEFITS
BCIMA Basic Option
BCIMA Basic Option Benefits 2026
Benefits
Unlimited, subject to be Registered on the program / with Life Sense
COVID-related Admissions and Treatment.
PMB = BT +200%
Unlimited PMB, subject to Pre-authorisation
Preventative Care Benefit
Unlimited, subject to Pre-authorisation
Hospital Limit
R 1 118 000 per family, per year
Annual Limit: Day-to-Day Expenses
R 23 600 per family, per year
Chronic Medicine Limit Benefit Paid According to Reference Pricing (RP)
R 18 100 per family, per year
Preventative Care Benefits
Dentistry for Beneficiaries Under Age 6
100% at BCIMA Tariff
Mental Health Benefit
100% at BCIMA Tariff
1 Clinical Psychologist Consultation per
beneficiary per year
Alcohol and Drug Abuse
100% at BCIMA Tariff
21 days per beneficiary per year – if pre-authorised
Health-on-Line Assistance
Call 082 911 – 24-hour Emergency/Non-Emergency Telephonic Medical Advice and Information
Hospital Benefits
Hospitalisation
R 1 118 000 per family
Pre-authorisation Required
R 1 000 levy if not pre-authorised
In-Hospital and Day Clinics
The Following Services are Covered, Including all Relevant Accounts
- Ward fees – General, ICU, High Care
- Theatre fees
- Medication (while in hospital)
- Surgical procedures
- GP and specialist visits
- Surgical prostheses
- Oncology
- MRI and CT scans
- Electronic/nuclear appliances and/or prostheses, subject to prior approval by the Board of Trustees and hospital limit
- Alcohol and Drug Abuse/Addiction – 21 days per beneficiary per year
- Dentistry (in-hospital procedures, subject to pre-authorisation)
- Clinical technologists
- Radiology
- Pathology
- Confinements: Normal births
- Confinements: Caesarean sections
- Home confinements: Subject to pre-authorisation
- Blood transfusions
- Renal dialyses
- Psychiatric treatments – 21 days per family, per year
Private Nursing
Private Nursing Excluding Frail Care, Mother and Child Postpartum
Subject to pre-authorisation. Limited to 60 days per condition, 100% of the Agreed Tariff
Ambulance Services – Emergency Transport
Ambulance Services – Emergency Transport. Contracted to Netcare 911
100% of the Agreed Tariff
Chronic Medicine
Subject to Registration on the Chronic Conditions/ Medications Program for This Benefit
Benefit Paid according to Reference Pricing (RP)
R 18 100 per family, per year
Annual Limit
Day-to-Day Benefits
R 23 600 per family, per year
Medicine
Acute (Prescribed Medication)
Benefit Paid According to Reference Pricing (RP)
Subject to Annual Limit
85% of cost
Single Member R 7 970
M+ 1 R 8 910
M+ 2 R 9 980
M+ 3 R 11 000
M+ 4 R 12 000
M+ 5+ R 13 400
Pharmacy-Advised Therapy (PAT) or
Over-the-Counter Medication (OTC)
Subject to R 260 Per Script, Per Beneficiary, Per Day.
Subject to Annual Limit
Single member R 2 220 or Family R 3 610
Homeopathic Remedies
85% of cost
General Practitioners/
Specialists (Out-of-Hospital)
Visits and Consultations. 100% of BCIMA Tariff
Subject to Annual Limit
100% of the BCIMA Tariff
Single Member R 5 200
M+1 R 6 470
M+2 R 7 750
M+3 R 9 030
M+4 R 10 300
M+5+ R 11 600
Non-Surgical Procedures
100% of BCIMA Tariff. Subject to Annual DTD limit
Dentistry
Fillings, scaling & polishing, extractions, etc.
Subject to Annual Limit
R 4 950 per family, per year
Two consultations per beneficiary per annum
Specialised:
Crowns, bridgework, orthodontics, periodontics, prosthodontics, plastic dentures, maxillo-facial, oral surgery, etc.
Subject to Annual Limit
R 7 110 per family, per year
Optical
100% of the Agreed BT
A 24-month Optical cycle per beneficiary in the Universal Network range
Subject to Annual Limit
OR
Contact Lenses
R 1 200 per beneficiary per annum.
Refractive Eye Surgery
R 4 890 per family per year
Subject to pre-authorisation
Surgical and Medical Appliances
Hearing Aids, Wheelchairs, Crutches, Glucometers, etc. Subject to Annual Limit
100% of Agreed Tariff – R 5 300 per family, per year
Other Services –
Subject to Annual Limit
(Day-to-Day)
Psychiatric Treatments
R 5 200 per family, per year
Traditional Healers
R 1 810 per family, per year
Auxiliary Service –
Subject to Annual Limit
(Day-to-Day)
100% of the BCIMA Tariff
Single Member R 1 550
M+ 1 R 1 930
M+ 2 R 2 320
M+ 3 R 2 700
M+ 4 R 3 090
M+ 5+ R 3 480
Acupuncturist
Biokinetics
Chiropractors
Clinical services
Clinical technology
Dieticians
Hearing Aid Acoustician
Homeopaths
Medical Technology
Occupational Therapy
Orthotists & Prosthetists
Physiotherapists
Podiatry
Psychologists
Registered Counsellors
Registered nurses
Social workers
Speech therapy and Audiology
BCIMA Basic Option Contributions 1 January 2026
Contribution Schedule for Weekly and Monthly Paid Employees
Contributions payable per family, applicable as from January 2026
Weekly Contribution Schedule Site Employees
Contributions structured according to the employee’s hourly rate of pay.
Contribution Code
A
B
C
D
E
F
G
H
Weekly Income Band
R 1.00 – R 31.99
R 32.00 – R 35.99
R 36.00 – R 39.99
R 40.00 – R 60.99
R 61.00 – R 79.99
R 80.00 – R 100.99
R 101.00 – R 120.99
R 121.00+
50% of Contribution
R 282.45
R 333.80
R 359.80
R 387.05
R 488.60
R 556.65
R 620.60
R 708.00
Per Family Contribution
R564.90
R667.60
R 719.60
R 774.10
R 977.20
R 1 113.30
R 1 241.20
R 1 416.00
Monthly Contribution Schedule Employer, Administrative Staff and Site Employees
Contributions structured according to the employee’s monthly salary.
Contribution Code
A
B
C
D
E
F
G
H
Monthly Income Band
R 1.00 – R 5 546.99
R 5 547.00 – R 6 239.99
R 6 240.00 – R 6 932.99
R 6 933.00 – R 10 572.99
R 10 573.00 – R 13 866.99
R 13 867.00 – R 17 506.99
R 17 507.00 – R 20 972.99
R 20 973.00+
50% of Contribution
R 1 129.80
R 1 335.20
R 1 439.20
R 1 548.20
R 1 954.40
R 2 226.60
R 2 482.40
R 2 832.00
Per Family Contribution
R 2 259.60
R 2 670.40
R 3 096.40
R 3 908.80
R 4 453.20
R 4 964.80
R 5 664.00
Contribution Schedule for Continuation Members
Applicable as from January 2026 – Payable monthly and in advance
Contribution Code
L
M
N
P
Q
R
S
T
Monthly Income Band
R 1.00 – R 3 851.99
R 3 852.00 – R 5 598.99
R 5 599.00 – R 8 386.99
R 8 387.00 – R 10 479.99
R 10 480.00 – R 13 986.99
R 13 987.00 – R 17 590.99
R 17 591.00 – R 20 984.99
R 20 985.00+
Per Family Contribution
R 1 952.00
R 2 789.00
R 3 652.00
R 5 059.00
R 6 348.00
R 7 277.00
R 8 179.00
R 9 348.00
