For all enquiries please contact 0860 100 678. If you want to register your hospital admission, please phone 086 0200 678.
Simply click here to view the different ways to contact Medihelp.
Medihelp's general fax number is 012 336 9540. Any member related queries, new applications, claims etc can be faxed to this number.
Medihelp’s members have 24-hour access to Netcare 911 at 082 911, where a number of medically-trained personnel are ready to assist you in your emergency. They will arrange for emergency transport services, if necessary.
If you are a Medihelp member, select 1, and then:
- Select 1 for hospital admissions for Unify members;
- Select 2 for enquiries about claims and PMB;
- Select 3 for membership enquiries;
- Select 4 for enquiries about chronic and PMB medicine;
- Select 5 for any other pre-authorisations; or
- Select 6 for general information such as bank- and contact details.
If you are a doctor or other healthcare provider, select 2 and then:
- Select 1 for hospital admissions for Unify members;
- Select 2 for enquiries about claims and PMB;
- Select 3 for membership enquiries;
- Select 4 for enquiries about chronic and PMB medicine;
- Select 5 for any other pre-authorisations; or
- Select 6 for general information such as bank- and contact details.
If you are a broker, select 3 and then you will be transferred to a Medihelp consultant
If you want to join Medihelp, select 4 and you will be transferred to a Medihelp consultant.
If you want general information such as bank- and contact details, press 5 and you will receive Medihelp’s general information.
Any South African citizen is welcome to join Medihelp Medical Scheme. We provide affordable healthcare cover for private individuals and families, as well as corporate groups and companies.
Just a click or two with your mouse and one of our brokers will contact you.
Your membership card will be posted to you immediately after we have finalised your membership.
Only the member and his/her dependants indicated on the card may use the membership card.
You need to notify Medihelp that you are going to retire and make a choice with regards to continued membership of Medihelp. A form, that contains 3 options to choose from, needs to be completed. You may qualify for State subsidy according to the policy of the State, therefore you also need to contact the National Treasury to obtain the relevant application form.
It is very easy: simply click here to register your dependent online.
See the definition of a dependant in the definition list or see the description in Medihelp’s Rules.
A copy of the death certificate as well as the contact details of the person appointed to administer the estate must be supplied to Medihelp.
The registered dependant(s) of the deceased member is entitled to continued membership without any break in coverage and an application form for membership must be completed. The application form must reach Medihelp within 90 days from the date that Medihelp notifies the dependant(s) in writing that he/she is entitled to continued membership.
If the application form is not received within the 90 day period, the dependant(s) will be enrolled/registered from a current date in terms of Medihelp's Rules and conditions of membership such as waiting periods and/or late-joiner penalties may be applicable due to the lapse in membership.
All accounts for services rendered until the date of death must be submitted under the deceased member's membership number and accounts for services rendered to the registered dependant(s) after the date of death must be submitted under the new membership number.
- Click here for online deregistration.
- Phone Medihelp on 086 0100 678 and request the deregistration telephonically.
- Send an e-mail to medihelp@medihelp.co.za.
- Send a fax to 012 336 9540.
It is very easy: simply click here to download the form. You can e-mail the completed form with your signature and that of the account holder (if you are not also the account holder) on the form to medihelp@medihelp.co.za or fax it to 012 336 9540.
It is very easy: simply click here to download the form. You can e-mail the completed form with your signature and that of the account holder (if you are not also the account holder) on the form as well as a copy of your identity document to medihelp@medihelp.co.za or fax it to 012 336 9540.
Medihelp’s Rules determines that subscription is payable retroactively at the end of each calendar month, but no later than the first workday following the end of each calendar month. Medihelp may therefore only recover the subscription from your bank account on the last workday of each month, or on the first workday following the end of the month.
Medihelp’s Rules determines that subscription is payable for every month of membership. You may therefore not suspend your membership temporarily.
- You can pay your subscription in arrears directly into Medihelp’s bank account.
- Do an Internet payment to credit Medihelp’s bank account .
- Whatever option you choose, remember to use your membership number as reference to allow us to allocate the payment to your subscription account.
Tax certificates are mailed to members in April/May of every year. Click here and complete the online request to receive your duplicate certificate.
All claims must be submitted to Medihelp, its collector or it’s contracted managed healthcare organisation not later than the last day of the fourth calendar month following the month in which the service was rendered.
Medihelp pays claims in three cycles per month – more or less on the 10th, 20th and the last working day of every month.
- Click here to complete the form and select the applicable options.
- Phone Medihelp on 086 0100 678 and request to change your address and/or contact details.
- Send e-mail to medihelp@medihelp.co.za.
- Send a fax to (012) 336 9540.
A late joiner penalty is `n premium penalty payable by a member who joins Medihelp late in life and is payable for the duration of membership. The penalty varies between 5% and 75% of the monthly premium.
Medihelp Medical Scheme entered the medical schemes industry in 1905, making it the second-oldest open medical scheme in the country. Members have entrusted their healthcare needs to us for almost 105 years, because they are assured of affordable medical scheme coverage and award-winning customer care.
Financially speaking, Medihelp Medical Scheme is one of the healthiest medical schemes in South Africa. Excellent planning, effective management and responsible usage by members have ensured that our reserve level (a measurement initiated by the Registrar of Medical Schemes to ensure a healthy private healthcare industry) remains above the statutory required 25% level. Our reserve level at the end of 2009 – generally considered to have been one of the most difficult financial years in recent history – stands at a healthy 31.48%.
Medihelp Medical Scheme belongs to its members. Therefore, the Scheme holds an Annual General Meeting (AGM) in June of every year, where members have the opportunity to take part in the management of their Scheme. Members who cannot attend the AGM have the option of participating by means of proxy voting.
At the helm of Medihelp’s management is its Board of Trustees, an experienced team of six members. Elected by members, the trustees have impressive careers in a variety of fields and represent the public service as well as private sector. Furthermore, four provinces are represented by the Board: Gauteng, Mpumalanga, the Western and Northern Cape. The Board meets up to six times per year and Board members also serve on various committees of Medihelp. Special Board meetings can also be arranged to discuss urgent matters if necessary.
Medihelp’s head office is located in the suburb of Arcadia in Pretoria, Gauteng and is easily accessible from all the main routes to Pretoria. In addition, Medihelp has regional offices in Bloemfontein, Durban, Port Elizabeth and Cape Town.
Medihelp assesses and pays more than 253,000 claims per month, ensuring peace of mind for our members and earning us the trust of the medical profession. In fact, the internationally renowned Global Credit Rating Co. recently upgraded Medihelp's claims-paying ability to an AA- rating, which is indeed a remarkable achievement in a highly competitive market.
Medihelp currently has a workforce of just more than 700 well-trained and experienced employees.
Apart from the AGM, Medihelp holds a number of regional information sessions across South Africa in cities and towns where large numbers of our members reside. These information sessions are informal meetings where members can meet Medihelp’s Board of Trustees and executive management. Serving as a forerunner to the AGM, members can also learn more about Medihelp’s achievements during the past year and our plans for the future at these sessions.
Members receive information throughout the year by means of personalised letters and newsletters, SMSs, monthly summarised statements and a health magazine called élan.
Medihelp medical Scheme offers an extensive range of affordable benefit options designed to meet the healthcare needs of different people with different incomes. Our product offering includes a benefit option with comprehensive benefits for services rendered during and not during hospitalisation (Medihelp Plus), a range of benefit options designed to meet the healthcare needs of young families (the Dimension range) and two network benefit options for lower-income groups (Necesse and Unify benefit options).
A network benefit option offers benefits to members in collaboration with a medical service provider network (and normally includes hospitals, doctors, pharmacies, dentists and other healthcare providers). In the case of the Necesse benefit option, services are rendered by the Medihelp network of service providers which includes a network of private and State hospitals, whereas UDIPA renders services to members of the Unify benefit option. Members must make use of the network doctors to qualify for benefits. Benefits are also subject to the protocols and formularies of the particular network.
Familiarise yourself with the benefits regarding out-of-network consultations, which could include a limit and or co-payment per event.
All Medihelp’s benefit options offer comprehensive benefits for hospitalisation. However, if you are looking for only a hospital plan, the Dimension Prime 1 benefit option is right for you. We offer our members additional peace of mind in the form of the health and benefit booster to provide for certain services that focus mainly on the early detection and prevention of conditions, to facilitate complete recovery or successful management of the condition.
Information about the following year’s benefit options are mailed to members in October/November every year. Check our website regularly for updates.
Designated Service Providers (DSPs) are healthcare providers or groups of providers appointed by Medihelp as preferred provider(s) to provide services to members. Members must visit these healthcare providers to qualify for benefits.
In the case of the Dimension Prime 1, 2 and 3 as well as the Necesse benefit options, benefits for chronic medicine will only be considered if used for a PMB (Prescribed Minimum Benefit) condition. Click here to read more.
If you have not been a member of Medihelp Medical Scheme from 1 January, the annual benefits to which you are entitled may be adjusted pro-rata relative to your period of membership in the year of the services rendered.
Chronic medicine cannot be funded from the acute benefit because chronic medicine is for medicine that is used as long term treatment of chronic conditions; the medicine has been identified as chronic medicine and will only be paid from the chronic medicine limit. Newly diagnosed condition’s medicine can be obtained from the acute benefit for the first 2 months (maximum of two claims allowed from non-chronic medicine benefits) of treatment, after which a chronic medicine application form has to be completed to apply to have the medicine registered on chronic. When the chronic medicine limit is depleted, and the condition and medicine is not registered for PMB, the member is liable for payment, until the following benefit year.
All members on the same benefit option have access to the same benefits.
Because Medihelp Medical Scheme handles its own administration, it is prevented by law from offering any service which is not part of the core business of a medical scheme. However, we do offer certain services as part of our benefits to enrich your membership of Medihelp:
• A 24-hour emergency road and air transport service to members who reside in South Africa, Lesotho, Swaziland, Lesotho, Mozambique and Namibia in their country of residence by phoning 082 911 (the Medihelp Plus and Dimension range of benefit options).
• A 24-hour emergency road transport service to members who reside in South Africa, Lesotho or Swaziland in their country of residence by phoning 082 911 (the Necesse and Unify benefit options).
• A 24-hour emergency advice service manned by medical personnel in case of after-hours emergencies.
• A gift pack to welcome newborn babies to Medihelp (from January 2011).
• A comprehensive HIV/Aids programme for members living with HIV/Aids. To register on the programme, send an e-mail to medihelp@optipharm.co.za or phone 0860 90 60 90 during office hours and 083 564 9978 after hours. All information is treated confidentially.
• A post-exposure prophylaxis programme to decrease the changes of contracting HIV/Aids. Phone Optipharm on 011 251 9400 or 0860 90 60 90, or on 083 564 9978 after hours. You may also leave a “please call me” message on this number.
• A brilliant alternative to back surgery: a back treatment programme in cooperation with an interdisciplinary team of experts in the field of spinal chord health.
Only emergency situations which meet the definition of an emergency medical condition in the Medical Schemes Act, 1998 (Act No 131 of 1998) will be covered from the emergency services benefits. Emergency medical conditions are subject to the following requirements:
• It must be the sudden and unexpected onset of a health condition;
• It must require immediate medical or surgical treatment;
• Failure to provide such treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person’s life in serious jeopardy; and
• It must be certified as such by a medical practitioner.
Emergencies qualify for Prescribed Minimum Benefits (PMB) and must therefore also be registered for PMB.
Any visit to an emergency room or emergency medical unit that does not conform to these requirements will receive the normal benefits available for doctors’ consultations.
Medihelp’s health and benefit booster is unique in the medical schemes industry. It offers benefits for preventative care by means of selected risk assessment tests to ensure the early detection of conditions that may be completely cured or successfully managed if treated early. In the case of the Dimension Prime range of benefit options, the health and benefit booster also provides benefits to assist families who are expecting or have just had a baby.
When we indicate that benefits are pooled, it means that the benefits available per beneficiary are added together and any beneficiary may make use of this total amount.
Chronic medicine is medicine used for the long-term treatment (three months or longer) of a chronic condition, and which meets the following requirements:
• It must be used to prevent a serious medical condition;
• It must be used for an uninterrupted period of three months or longer;
• It must be used to sustain life, to delay the progress of a disease, and to repair natural physiology;
• It must be registered in South Africa for the treatment of the medical condition for which it is prescribed; and
• It must be the accepted treatment according to local and international treatment protocols and algorithms.
Medihelp’s benefit options are registered by the Registrar of Medical Schemes and form part of the Rules of Medihelp, which is also approved and registered by the Registrar. As the Rules are binding on all members, the Scheme cannot and may not grant benefits for any service not covered by the particular benefit option.
If you do not preregister your hospital admission, a penalty fee of 10% of the benefit amount of the hospital account will be payable by the member if the medical condition is not a benefit exclusion in terms of the Medihelp Rules in which case the total account will be excluded from benefits. Emergency admission may be registered on the first working day following the admission by the member, a relative, the hospital or attending doctor.
Yes, authorisation for hospitalisation is always required. Click here to read more.
Paper claims from healthcare providers registered for electronic submission (QEDI) are destroyed to avoid duplication of claims. However, paper claims will be accepted under cover of a letter stating the reasons for the manual submission.
Medihelp Medical Scheme produced a series of 13 DVDs on various mental health conditions in cooperation with Katinka Heyns of Sonneblom Films. Each DVD highlights a different condition by telling the real-life story of a person living with the disorder, and includes a handy information guide packed with additional information about the condition. The series is ideal for support groups and family members.
Click here to read more about Medihelp’s “Living With” series or to order a DVD.