About us

about medihelp medical scheme

Who is Medihelp?
As one of the top open medical schemes in South Africa covering more than 198 000 lives, Medihelp makes it all about you! We believe everyone is unique, but we all have a need to ensure our well-being.

For this reason, Medihelp follows an individualised approach to meeting your healthcare needs by –
  • offering 10 benefit options, each one priced and structured differently, to provide you with more value and suit every stage of your life,
  • making a variety of engagement opportunities available on social media and through digital channels, and
  • delivering continuous service, both online and offline, including our user-friendly app for members, educational videos, dedicated call centre agents, five walk-in centres and a secured website for members.
We strive to make healthcare more affordable, which is why we manage the escalating cost of healthcare provision by ensuring appropriate and quality healthcare. We balance coverage, applicable care and cost, to give you the peace of mind that your healthcare needs are in safe hands.


We have the advantage of experience
We have more than 110 years’ experience and a solid reputation, proving that we are able to adapt successfully to a challenging healthcare industry. Medihelp is able to predict claims trends and to offer sustainable healthcare coverage in a rapidly changing and highly regulated environment.

Our strength is in our size
Medihelp is one of the largest open medical schemes in the country and renders a service to members from our head office in Pretoria and at regional offices in Cape Town, Durban, Bloemfontein and Port Elizabeth.
A good investment in your health
Medihelp meets all the requirements of a good investment, with a solvency level which continues to exceed the industry requirement despite the worldwide economic decline which affects the South African economy in general and the healthcare sector in particular.

Solvency

 
Medihelp’s 29,63% solvency ratio far exceeds the statutory required level of 25% as prescribed in the Medical Schemes Act. This constant healthy performance means our clients can rest assured that there is more than sufficient provision for their claims payments.

Administration costs

 
You deserve to be part of a medical scheme where the largest portion of your investment goes toward paying for healthcare costs instead of non-healthcare expenses. At Medihelp we strive to keep our administration costs as low as possible, so you get more healthcare cover for every rand you contribute.

Our claims payments
Medihelp again received an AA– rating in 2015 from Global Credit Rating for our claims-payment ability. This offers our clients the assurance that their claims will be paid. Medihelp was also one of only two schemes that managed to improve its service levels since 2013 while the rest of the industry fared worse, according to a SAcsi survey performed in 2015. Medihelp processed 2 624 088 claims in 2015 and paid out R3 316 317 698 in benefits. Our efficient and regular claims payments ensure that healthcare providers have no hesitation in treating Medihelp members.
Product presentation and performance
We have designed our 10 products on offer to meet the diverse healthcare and financial needs of our existing as well as potential new members. We offer a range of options to suit individual needs, from an affordable hospital plan with additional insured benefits for preventive care and pooled day-to-day benefits, to savings account options with hospital and trauma cover, and comprehensive cover with chronic medicine benefits.

Our unique approach to network options ensures a stable risk pool and offers cover at network providers at a 20–22% price difference, while our non-network alternatives allow members to use the service providers of their choice.

Read more about our benefit options.
Client satisfaction
Medihelp follows an individualised engagement approach, and by focusing on the needs and expectations of our clients we have created a culture where our clients’ needs are all-important and guide all our actions. We constantly measure our clients’ experiences and we use the results of these measurements to get better insight into how we can meet their expectations.

Employee satisfaction
We believe that client satisfaction can be accomplished by ensuring employee satisfaction. Medihelp currently employs 575 highly trained – and satisfied – staff members who are skilled, well-equipped, and have a passion for excellence.
Our services
The following is a summary of how we meet our clients’ needs:

Customer care

 
  • A walk-in service is available at our five offices across South Africa: In Pretoria (head office), Cape Town, Bloemfontein, Durban and Port Elizabeth.
  • Our Call Centre is staffed by 72 skilled consultants who handled almost 650 000 calls from members, service providers and advisers in 2015.
    Phone us on 086 0100 678 if you have an enquiry or need assistance.

Communication

 
  • Our communication with members covers all communication media, from printed letters and phone calls to electronic communication via email (newsletters and videos) and SMSs – in English and Afrikaans.
  • Visually impaired members receive special e-statements.
  • Medihelp’s presence on the major social media platforms encourages further engagement and interaction with all stakeholders.
  • Annual engagement events held in various regions across South Africa offer members the opportunity to engage in person with the Medihelp team and to get first-hand information and feedback.

Our website

 
Our website offers a host of information for potential members, while a secured environment is available for existing members, advisers, corporate groups and healthcare providers where they can manage their Medihelp business online.

Our secured services for members and advisers are supplemented by applications for smartphones and tablets using the Android, iOS and Windows operating systems. Members can do their Medihelp business when and where it suits them – our services include immediate locating of network healthcare providers, confirmation of benefits, pre-authorisation for hospital procedures, an electronic membership card and even submission of claims.

Audit services

 
We are serious about good governance and preventing fraud and abuse – with the help of our team of internal auditors and forensic auditors.

Corporate clients

 
A relationship of mutual trust develops by following an approach focused on personal involvement. To accomplish this, we strive to offer tangible value for our clients who are part of corporate groups:
  • Dedicated client relations consultants are trained in all aspects of our business and provide valuable assistance to HR departments, individual employees and appointed healthcare consultants.
  • Dedicated subscriptions recoveries staff assist with statements, reconciliations, enquiries about payments and membership changes.
  • Group profile reports contain vital statistics and information on employees’ membership, claims and health profiles, as well as service delivery feedback.
  • E-newsletters are sent to corporate groups regularly to keep them up to date with the latest news on Medihelp and the industry.
  • Medihelp sponsors wellness days for corporate groups as a fun way of making employees aware of the importance of a healthy lifestyle and possible health risks, and these events are very popular both with employees and employers.

Financial advisers and the Sales team

 
A group of accredited financial advisers and our Sales team are ready to provide prospective clients with any information they might need. They also offer training in our benefit options. A safe, interactive website assists advisers through access to the Adviser Toolbox.
Find out more about Medihelp…
Medihelp is registered in terms of the Medical Schemes Act, No 131 of 1998. Medihelp is a legal entity with no shareholders or owner’s interest, and need not therefore have its BEE status verified.