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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
Plus

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


Elite 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

Elite Emergency transport - 2019
Emergency transport (Netcare 911)

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

Outside country of residence
Transport:

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

Elite Hospitalisation - 2019
Hospitalisation

100% of the MT
Any private hospital


Elite Specialised radiology- 2019
Specialised radiology

In and out of hospital

  • MRI and CT imaging
    • 100% of the MT
    • Unlimited (see deductibles)
  • Angiography
    • 100% of the MT
    • Unlimited
Elite Psychiatric treatment - 2019
Psychiatric treatment

R33 600 per beneficiary per year
(maximum R46 600 per family per year)


Elite Oncology - 2019
Oncology

In and out of hospital

  • PMB -100% of the MT
  • Non-PMB - R300 000 per family per year

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

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

Elite Organ transplants - 2019
Organ transplants

100% of the cost

  • Cornea implants - R27 400 per implant per year

Elite Other core benefits - 2019
Other core benefits

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

Elite Post hospital - 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


Elite prosthesis - 2019
Prostheses benefits
  • Health-essential functional prosthesis: R58 800
    • Hip, knee and shoulder replacements (non-PMB):
      • Acute injuries where replacement is the only treatment option
        Hospitalisation: 100% of the MT
        Prosthesis: Health-essential functional prosthesis benefit applies
      • Wear and tear: Subject to DSP if patient qualifies in terms of clinical criteria (only hip and knee replacements)
        If not, a R18 600 benefit applies for the hospital account and prosthesis components (combined) per admission
  • 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


Elite 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

Elite Enhanced maternity benefits - 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
  • Two 2D ultrasound scans per family
  • Flu vaccination during your pregnancy at Clicks/Dis-Chem pharmacy clinics

Elite 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
Elite Routine screening and immunisation benefits - 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, and three between 15-26 years.

Elite 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

Elite Additional screenings and immunisation for over 50s - 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 by a 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
Elite 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


Elite Insured day-to-day benefits - 2019
Insured day-to-day benefits

Member = R2 650 per year
Member +1 = R4 500 per year
Member +2 = R5 550 per year
Member +3+ = R6 700 per year

GP and specialist consultations, physiotherapy, clinical psychology and supplementary health services.

Pathology

R2 650 per family per year

Radiology

R2 650 per family per year

Elite Medicine - 2019
Medicine

Acute medicine
Member = R4 050 per year
Member +1 = R6 850 per year
Member +2 = R8 400 per year
Member +3+ = R9 000 per year

Chronic medicine (non-PMB)
Member = R4 300 per year
Member +1 = R6 500 per year
Member +2 = R8 700 per year
Member +3+ = R9 300 per year

PMB chronic medicine
100% of the MHRP


Elite Optometry- 2019
Optometry

PPN network applies

Spectacles or contact lenses per beneficiary per 24-month cycle

  • R1 000 for a frame
  • R1 635 for contact lenses
Elite Medical, surgical, and orthopeadic appliances - 2019
External prostheses and medical appliances

In and out of hospital

  • Benefit per beneficiary per 3-year cycle:
    • Artificial eyes - R7 500
    • Speech and hearing aids - R7 500
    • Wheelchairs - R6 000
    • Artificial limbs - R6 000
  • Medical appliances, hyperbaric oxygen treatment, insulin pumps (per 5-year cycle), glucometer (per 5-year cycle) - R1 450 per year
  • CPAP apparatus - R9 250 per beneficiary per 24-month cycle

Plus Insured dental benefits- 2019
Insured dental benefits
  • Conservative services (including routine check-ups, fillings, X-rays and oral hygiene)
  • Specialised services (including crowns, bridges and orthodontic treatments)

Deductibles

Visiting network service providers, following the correct pre-authorisation process and negotiating tariffs with your doctor are just some of the ways you can manage or reduce out-of-pocket medical expenses.


Procedure-specific deductibles

Payable by the member

  • Back and neck fusion – R7 400 per admission
  • Endoscopic procedures – gastroscopy, colonoscopy, arthroscopy and sigmoidoscopy
    • In a day clinic – R2 000
    • In hospital – R3 050
  • Specialised radiology – R1 100 per examination
  • Dental procedures under general anaesthesia during hospitalisation
    • Removal of impacted teeth and extensive dental treatment for children <5 years – R820 per admission
Pre-authorisation is important

The following services and procedures are paid at 100% of the Medihelp tariff if pre-authorised:

  • All planned hospital admissions (protocols and case management apply)
  • Oxygen for out-of-hospital use (protocols and case management apply)
  • Dental procedures under conscious sedation (sedation cost) in the dentist’s chair (managed care protocols apply)
  • Specialised dental services
    • Crowns and bridges
    • Periodontal treatment (conservative non-surgical therapy only)
      Subject to pre-authorisation and treatment plan

Should these services not be pre-authorised, an 80% benefit will apply.

Emergency transport services (Netcare 911)

In and outside the country of residence (air and road transport) should be pre-authorised to qualify for the applicable benefit. If not pre-authorised, 50% of the benefit applies except in the case of emergency medical conditions.

Oncology

Subject to pre-authorisation and registration on the Medihelp Oncology Programme, use of the designated service provider and treatment protocols to avoid deductibles. The Medihelp Oncology Reference Price applies to oncology medicine.


Important:

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 Reference 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 | PMB-Prescribed minimum benefits | PPN-Preferred Provider Negotiators

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