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Medihelp news

Government to move ‘pre-1992 State pensioners’ to GEMS

National Treasury has decided to migrate a group of State pensioners who retired before 1992 to the Government Employees Medical Scheme (GEMS) with effect from 1 April 2012.

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oncology benefit table

 

 

Non-PMB
Medihelp PlusDimension EliteDimension Prime 3Dimension Prime 2Dimension Prime 1NecesseUnify
Surgical removal

(surgery and hospitalisation)

100% of the AT

 

No limit

100% of the AT

No limit
100% of the AT

No limit
100% of the AT

No limit
100% of the AT

No limit
100% of the AT

Subject to R800,000 limit per family
100% of the AT

Subject to R750,000 limit per family
Chemotherapy and radiotherapy 100% of the AT according to the OncoPlus protocol

No limit
100% of the AT according to the OncoElite protocol, limited to R17,870 per beneficiary per year For member's account Savings account For member's account For member's account 100% of the AT according to the OncoPrime protocol

Subject to R750,000 limit per family
If treatment deviates from the protocol 10% co-payment on the total account 10% co-payment on the total account N/a N/a N/a N/a N/a
If treatment is received outside the SAOC or ICON networks   
Is upgrading to Medihelp Plus allowed? N/a Yes Yes Yes Yes Yes Yes
PMB
Medihelp PlusDimension EliteDimension Prime 3Dimension Prime 2Dimension Prime 1NecesseUnify
Surgical removal
(surgery and hospitalisation)
100% of the AT

No limit
100% of the AT

No limit
100% of the AT

No limit
100% of the AT

No limit
100% of the AT

No limit
100% of the AT

No limit
100% of the AT

No limit
Chemotherapy 100% of the AT according to the OncoPlus protocol

No limit
100% of the AT according to the OncoElite protocol

No limit

Benefits are first paid from the limit of R17,870 and thereafter from the core benefits
100% of the AT according to the OncoPrime protocol

No limit
100% of the AT according to the OncoPrime protocol

No limit
100% of the AT according to the OncoPrime protocol

No limit
100% of the AT according to the ICON protocol

No limit
100% of the AT according to the OncoPrime protocol

No limit
 Radiotherapy  
If treatment deviates from the protocol 10% co-payment on the total account 15% co-payment on the total account 20% co-payment on the total account 20% co-payment on the total account. This co-payment may not be funded from the savings account 20% co-payment on the total account 25% co-payment on the total account25% co-payment on the total account
If treatment is received outside the SAOC or ICON network 10% co-payment on the total account 10% co-payment on the total account 10% co-payment on the total account 10% co-payment on the total account. This co-payment may not be funded from the savings account 10% co-payment on the total account 10% co-payment on the total account 10% co-payment on the total account
Is upgrading to Medihelp Plus allowed? N/a Yes Yes Yes Yes Yes Yes
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