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Savings plans for 2019

This is a summary of Medihelp's savings plans. On this affordable option older children pay child dependant rates until they are 26 years old.

The monthly contribution does not take any employer subsidy into account.

Unify product block
Unify

This option has a 25% medical savings account that earns interest on unused funds, which accumulate and are carried over to the next year. Coupled with generous hospital benefits, this is a smart investment for people seeking control over their healthcare expenses.

 Principal memberPrincipal member R2 304
  (R576 savings contribution included per month and R6 912 per year)
  Dependant Dependant R1 896
  (R474 savings contribution included per month and R5 688 per year)
 Child dependant <26 years Child dependant R696
 (R174 savings contribution included per month and R2 088 per year)

Core benefits


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

Unify 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

Unify Hospitalisation - 2019
Hospitalisation

100% of the MT
Any private hospital


Unify 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
Unify Psychiatric treatment - 2019
Psychiatric treatment

R23 200 per beneficiary per year
(maximum R31 800 per family per year)


Unify Oncology - 2019
Oncology

In and out of hospital

  • PMB - 100% of the MT
  • Non-PMB - R220 000 per family per year

Unify 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

Unify Organ transplants - 2019
Organ transplants

100% of the cost

  • Cornea implants - R27 400 per implant per year

Unify Other core benefits - 2019
Other core benefits

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

Unify 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


Unify Prostheses benefits - 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: no benefits)
    • 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 (in and out of hospital) - R9 150 per family per year

Added insured benefits

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


Unify 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
  • Flu vaccination
Unify 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


Unify Insured day-to-day benefits - 2019
Day-to-day benefits

25% Savings account

  • GP consultations
  • Specialists
  • Emergency units
  • Physiotherapy
  • Clinical psychology
  • Standard radiology & pathology
  • Psychiatric nursing
  • External prostheses and medical appliances
  • Supplementary health services
  • Hyperbaric oxygen treatment (out of hospital)
  • Acute and chronic medicine
Unify dentistry - 2019
Dental

Subject to DSP's managed care protocols

  • Conservative and specialised dental services - savings account
  • Dental procedures under conscious sedation in the dentist’s chair (sedation cost) for the removal of impacted teeth only (dentist’s account - item codes apply)
    100% of the MT

Unify Medicine - 2019
Medicine

PMB chronic medicine
100% of the MHRP


Unify Insured optometry benefits- 2019
Optometry

Savings account

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 – R9 950 per admission
  • Endoscopic procedures – gastroscopy, colonoscopy, arthroscopy and sigmoidoscopy
    • In a day clinic – R2 650
    • In hospital - R3 700
  • Specialised radiology – R1 600 per examination
  • Dental procedures under general anaesthesia during hospitalisation
    • Removal of impacted teeth (item codes apply on dentist’s account)
      R3 000 per admission
Pre-authorisation is important

The following services and procedures are paid at 100% of the Medihelp tariff or benefit amount 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)
  • Midwife and private nursing services

Should these services not be pre-authorised, an 80% benefit will apply or in case of midwife and private nursing services, it will be paid from the savings account.

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. Benefits are paid at 100% of the MT. Doctor’s consultation paid from available savings account. Subject to pre-authorisation and/or protocols.

BMI-Body mass index | COPD-Chronic obstructive pulmonary disease | 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 | 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

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