frequently asked questions

Do you have a question about how to contact us, how to join a medical scheme, how to make a medical aid claim or how you’re covered by your medical scheme? Here, we answer some frequently asked questions.

Contact Medihelp

Questions Answers
What is Medihelp’s telephone number? You can reach our Customer Care centre on 086 0100 678. For specific contact numbers, please view our contact list.
Who can I contact in the event of a medical emergency? Dial 084 124. Medihelp members have 24-hour access to ER24.

Join Medihelp

Questions Answers
How do I apply for membership to Medihelp? Ask an adviser to contact you or apply online
Who can become a member of Medihelp Medical Scheme? Any South African citizen can join Medihelp Medical Scheme. We provide affordable healthcare cover for private individuals and families, as well as corporate groups and companies.
I want an adviser to contact me about Medihelp membership. How can I do that? Simply complete the online form and an adviser will get in touch with you.

Membership subscription

Questions Answers
How do I change my banking details? Please download, complete and sign this form. If you’re not the bank account holder, then please make sure the account holder signs it, as well as you. Email the form to medihelp@medihelp.co.za or fax it to 012 336 9540.
What is a Late Joiner Penalty? If you join a medical aid later in life, you have to pay a late joiner penalty. This premium penalty varies between 5% and 75% of the monthly premium and is payable for the duration of membership. All medical aids charge late joiner penalties and they may be carried over from one scheme to another.

My membership

Questions Answers
When will I receive a Medihelp medical aid membership card? Immediately after we’ve activated your membership, your medical aid membership card will be posted to you.
Who may use my medical aid membership card? Only the principal member and the dependents indicated on the membership card may use it.
Who may I register as my dependents? You may register any of the following as your dependents, if you’re liable for their family care and support and they’re not a member or a dependent of a member on another medical scheme:
  • Your spouse
  • Your life partner – whether the same or opposite gender
  • Your children – whether natural, stepchildren, adopted or foster children, or a child in your temporary safe care.
    * Children dependents may remain on your membership up to age 26 on our Dimension range benefit options.
  • Your father or mother
  • Your brother(s) or sister(s)
  • Your grandchildren.
*As set out by the Children’s Act No. 28 of 2005. For further information, please refer to the Medihelp Rules.
What should I do if the principal member passes away? Please supply us with a copy of the death certificate, plus the name and contact details of the person who has been appointed to administer the estate. Please call our Customer Care centre on 086 0100 678 for further assistance.

My benefits

Questions Answers
Why are my limits calculated on a pro-rata basis? If you haven’t been a member of Medihelp Medical Scheme from 1 January, then the annual benefits to which you’re entitled are adjusted pro rata, relative to your period of membership in the year of the services rendered.
Are all emergency visits to emergency units covered from the benefits for emergency services? Not necessarily. Only emergencies which meet the definition of an emergency medical condition, as defined in the Medical Schemes Act No. 131 of 1998, are covered by Emergency Services Benefits.

Emergency medical conditions are subject to the following:
  • The onset of the health condition must be sudden and unexpected
  • It must require immediate medical or surgical treatment
  • Failure to provide such treatment would result in serious impairment to bodily functions; serious dysfunction of a bodily organ or part or would place the person’s life in serious jeopardy
  • 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 which does not conform to these requirements will receive the normal benefits available for doctors’ consultations. Emergency units at most hospitals are a separate practice to the hospital and the doctors at the emergency unit will decide whether a patient must be admitted to hospital.

For more information, please read our Emergency Benefits Page.
Does Medihelp have a hospital plan? All Medihelp’s benefit options offer comprehensive benefits for hospitalisation, in addition to other benefits. However, if you need a hospital plan only, have a look at the Dimension Prime 1 benefit option. In addition to benefits for hospitalisation, we offer preventative care in the form of the Health and Benefit Booster. This provides for certain services focused on the early detection and prevention of common medical conditions.
What will happen if I do not pre-register my admission to hospital? If you don’t pre-register your hospital admission, you will have to pay a penalty fee! This fee is equal to 20% of the benefit amount of the hospital account 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 admissions must be registered on the first working day following the admission. This can be done by the member, a relative, the hospital or attending doctor.
What if I am hospitalised after-hours for a medical emergency? You will still need to register your admission. Simply contact Medihelp on the first working day following your admission. Read more about how to do this...
Some of my benefits are ‘pooled’. What does that mean? This means that the benefits available to each beneficiary are added together (pooled). This total amount may be used by any beneficiary.
What does Medihelp consider to be Chronic Medicine? Chronic Medicine is used to treat chronic diseases; that is, long-term treatments (three months or longer) of a chronic condition which meets the following requirements:
  • The medicine is used to prevent a serious medical condition
  • The medicine is used for an uninterrupted period of three months or longer
  • The medicine is used to sustain life, delay the progress of a disease and/or to repair natural physiology
  • The medicine is registered in South Africa for the treatment of the medical condition for which it’s prescribed
  • The medicine is the accepted treatment, according to local and international treatment protocols and algorithms.
Benefits for chronic medicine differes between the various Medihelp products.

Read more about Chronic Medicine.
Does Medihelp grant benefits for services not mentioned in the Rules or in the benefit brochures (ex gratia benefits)? No, we do not. Medihelp’s benefit options are registered by the Registrar of Medical Schemes and form part of the Rules of Medihelp, which are 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.

About claims

Questions Answers
How long do I have to submit claims to Medihelp after receiving treatment? All claims must be submitted to Medihelp, its collector or contracted managed healthcare organization by no later than the last day of the fourth month following the month in which the service was rendered.
How often does Medihelp pay claims? Medihelp pays claims in three cycles per month – on or around the 10th, 20th and last working day of the month.