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Comprehensive plans for 2019

Get insured family cover encompassing comprehensive benefits for hospitalisation, preventive care and day-to-day medical expenses, and the freedom to obtain services at any provider.

Plus product block

Our top-of-the-range option offers the most extensive cover for medical services. Its ample benefits include unlimited cover for medical emergencies, private hospitalisation and preventive care, as well as substantial provision for acute and chronic medicine, radiology, and day-to-day medical expenses.

Principal member Principal member R8 202
Dependant Dependant R8 202
Child dependant <26 years Child dependant R2 046

The monthly contribution does not take any employer subsidy into account

Core benefits

Plus Chronic illness/PMB - 2019
Chronic illness/PMB
  • 100% of the cost for 270 PMB and 26 chronic conditions (DSPs, networks, protocols and pre-authorisation apply)
  • Unlimited cover for trauma that necessitates hospitalisation

Plus Emergency - 2019
Emergency transport (Netcare 911)

In country of residence
(RSA, Lesotho, Swaziland, Mozambique, Namibia & Botswana)
Unlimited (road and air transport)

Outside country of residence

  • Road - R1 950 per case
  • Air - R13 000 per case

Plus Radiology - 2019
Specialised radiology

In and out of hospital

  • MRI, CT imaging and angiography
    • 100% of the MT
    • Unlimited
  • PET imaging(non-PMB)
    • 100% of the MT
    • R21 100 per case
Plus Psychiatric treatment - 2019
Psychiatric treatment

R40 900 per beneficiary per year
(maximum R55 800 per family per year)

Plus Oncology - 2019

In and out of hospital

  • 100% of the MT
  • Unlimited

Plus Confinement - 2019
Confinement (childbirth)
  • In hospital - 100% of the MT
  • Home delivery - R12 400 per event

  • Conventional/laparoscopic procedure - unlimited
  • Robotic assisted laparoscopy - hospitalisation: R105 400

Plus Organ transplant - 2019
Organ transplants

100% of the cost

  • Cornea implants - R27 400 per implant per year

Plus core benefits - 2019
Other core benefits

Renal dialysis, oxygen, hospice, sub-acute care and private nursing services as an alternative to hospitalisation

Plus Hospitalisation - 2019

100% of the MT
Any private hospital

Plus Post hospital care - 2019
Post-hospital care

Up to 30 days after discharge for speech therapy, occupational therapy and physiotherapy
Member = R1 750 per year
Member+ = R2 400 per year

Plus Prostheses - 2019
Prostheses benefits
  • Health-essential functional prosthesis: R58 800
    • Intra-ocular lenses – R3 950 per lens, 2 lenses per beneficiary per year, health-essential functional prosthesis benefit applies
  • EVARS prosthesis
    - R124 000
  • Vascular/cardiac prosthesis
    - R53 100
  • Prosthesis with reconstructive or restorative surgery and external breast prostheses (in and out of hospital)
    - R9 150 per family per year
  • Implantable hearing devices (including devices and components)
    - R99 800 per beneficiary per year

Added insured benefits

These benefits are provided in addition to other insured benefits and available annually unless otherwise indicated

Plus Women's health - 2019
Women's health
  • A pap smear requested by a medical doctor
  • A mammogram requested by a medical doctor for women 40 years and older
  • A flu vaccination at Clicks/Dis-Chem pharmacy clinics

Plus Maternity - 2019
Enhanced maternity benefits
  • Free registration for and participation in the Medihelp HealthPrint pregnancy and baby programme with support and baby goodies
  • Up to 12 antenatal and postnatal consultations per family at a gynaecologist, GP or midwife
  • One amniocentesis screening per pregnancy
  • 2D ultrasound scans unlimited
  • Flu vaccination during your pregnancy at Clicks/Dis-Chem pharmacy clinics

Plus Child benefits - 2019
Child benefits
  • Child flu vaccination at Clicks/Dis-Chem pharmacy clinics
  • Babies under a year receive two additional visits to a GP or specialist
  • Full schedule of standard child immunisations covered up to 7 years at Dis-Chem/Clicks pharmacy clinics
Plus Immunisation - 2019
Routine screening and immunisation benefits

Available at Clicks/Dis-Chem pharmacy clinics per person:

  • One combo test (blood glucose, cholesterol, BMI and blood pressure measurement) or individual blood glucose or cholesterol test
  • HIV testing, counselling and support
  • A tetanus vaccine
  • Two HPV vaccinations for girls and boys between 10-14 years or three between 15-26 years.

Plus Men's health - 2019
Men's health
  • A prostate test (PSA level) requested by a medical doctor for men 40 years and older
  • A flu vaccination at Clicks/Dis-Chem pharmacy clinics

Plus Additional screenings - 2019
Additional screenings and immunisation for over 50s
  • An FOBT test for people over 50 years
  • Women over 50 years have access to one bone mineral density test requested medical doctor
  • A Pneumovax vaccine in a 5-year cycle per person older than 55 years and registered on Medihelp’s asthma/COPD programme
  • A flu vaccination at Clicks/Dis-Chem pharmacy clinics
Plus Supporting wellness - 2019
Supporting wellness

Maintain a healthy weight

  • Free registration for and participation in Medihelp’s HealthPrint BMI programme
  • One dietician consultation per registered HealthPrint member if a BMI test result done at Clicks/Dis-Chem indicates a BMI higher than 30

An alternative to surgery

  • Back treatment at a Document-Based Care facility for patients who qualify for this benefit

Chronic Care programme

  • People who suffer from high blood pressure, high cholesterol and diabetes simultaneously have access to Medihelp's Chronic Care programme which will provide personal support through a care coordinator to assist in maintaining and optimising their well-being

Day-to-day benefits

Plus day-to-day benefits - 2019
Insured day-to-day benefits
  • 100% of the MT
  • R3 400 per beneficiary per year, pooled per family

GP and specialist consultations, physiotherapy, clinical psychology and psychiatric nursing and supplementary health services

Standard radiology & pathology
  • 100% of the MT
  • Unlimited

Plus optometry benefits - 2019

PPN network applies

Spectacles or contact lenses per beneficiary per 24-month cycle

  • R1 000 for a frame
  • R1 660 for contact lenses
Plus medicine benefits - 2019

Acute medicine
R5 900 per beneficiary per year, pooled per family

Chronic medicine (non-PMB)
R17 200 per beneficiary per year

PMB chronic medicine
100% of the MHRP

Plus dental benefits - 2019
Insured dental benefits

Subject to DSP's managed care protocols

  • Conservative & specialised services
Plus medical appliances - 2019
External prostheses and medical appliances

In and out of hospital

  • Benefit per beneficiary per 3-year cycle:
    • Artificial eyes - R15 000
    • Speech and hearing aids - R15 000
    • Wheelchairs - R8 200
    • Artificial limbs - R8 200
  • Medical appliances, hyperbaric oxygen treatment, insulin pumps (per 5-year cycle), glucometer (per 5-year cycle) - R1 750 per year
  • Wigs (for alopecia totalis or cancer patients) - R1 750 per beneficiary
    per 3-year period
  • CPAP apparatus - R9 250 per beneficiary per 24-month cycle


This is only a summary of the available benefits. Please consult the registered Medihelp Rules for more information and details of services that are excluded from benefits. In case of a dispute, the Rules of Medihelp will apply (subject to approval by the Council for Medical Schemes).

  • Certain added insured benefits are not available if you have been registered for a chronic/PMB condition as it is no longer considered as preventive care and may be linked to a specific age/gender/item code/clinical validity criteria. Benefits are paid at 100% of the MT.
  • Doctor’s consultation paid from available day-to-day benefits.
  • Subject to pre-authorisation and/or protocols
  • Generic medicine = 100% of MMAP | Original medicine - no generic available = 80% of MT | Choose original medicine - generic is available = 70% of MMAP

BMI-Body mass index | COPD-Chronic obstructive pulmonary disease | CPAP-Continuous positive airway pressure | CT-Computerised tomography | DSP-Designated service provider | EVARS-Endovascular aortic replacement surgery | FOBT-Faecal occult blood test | GP-General practitioner | HPV-Human papilloma virus | MHRP-Medihelp Referrence Price | MMAP-Maximum Medical Aid Price | MRI-Magnetic resonance imaging | MT-Medihelp tariff paid by Medihelp for benefits which can include a contracted tariff or the single exit price | PET-Positron emission tomography | PMB-Prescribed minimum benefits | PPN-Preferred Provider Negotiators

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