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Student plan for 2019

This is a summary of the income-based Necesse network benefit option.

necesse product block
Necesse student

For only R529 p/m

(If your income is less than R600 per month and you provide us with proof of registration as a full-time student from the tertiary institution.)

You are covered for

  • Added insured benefits for immunisations and health tests
  • Doctor’s visits (national Necesse GP network)
  • Specialist care (on referral)
  • X-rays & blood tests
  • Prescribed medicine
  • Optometry
  • Dentistry
  • Hospital cover at 123 private network hospitals
  • Emergency & trauma cover

Why Medihelp


Peace of mind

While you study, you can rest assured that we’ve got you covered:

  • Medihelp has more than a century’s experience in the medical schemes industry
  • We’re one of the five largest open medical schemes in the country

Adding value to your Medihelp experience
  • HealthPrint is Medihelp’s free online wellness programme which provides relevant health support and value –
    • Special offer on Planet Fitness gym membership (and for a gym buddy)
    • You can run and cycle for FREE at Medihelp-sponsored events
    • Join Medihelp’s Multisport club for runners and cyclists
    • Link your fitness tracker
    • View your health test results
  • An emergency app that ensures you can be located in an emergency
Always there for you

Get in touch with us and use our digital platforms to easily navigate your healthcare cover:

  • Use the Live Chat feature on Medihelp’s website to receive instant online support from our customer care consultants
  • Get answers to Medihelp questions with our Quick Answers functionality on the website
  • Download the member app to –
    • View and share your digital membership card
    • Find network providers near you
    • View your available benefits
  • Use the secured website to get hassle-free e-authorisation for hospitalisation

You can also –

  • Phone Medihelp’s Customer Care centre
  • Email us at equiries@medihelp.co.za

Core benefits


necesse essential
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

necesse emergency
Emergency transport (Netcare 911)

Transport by road or air within the borders of South Africa
100% of the MT
Unlimited


necesse hospital
Hospitalisation

100% of the MT
Unlimited
Over 123 quality private network hospitals


necesse radiology
Specialised radiology

In and out of hospital
Services requested by a specialist on referral by a network GP

  • MRI and CT imaging (subject to pre-authorisation) and angiography
    • 100% of the MT
    • R15 700 per year
necesse emergency unit
Emergency unit services and non-network consultations
  • Per student = R1 050
    • Outpatient emergency unit services, non-network doctors’ visits and medicine and services rendered by a non-network medical doctor - 80% of the MT
    • Radiology – 65% of the MT
  • Pathology – DSPs apply (Lancet/PathCare)

necesse standard radiology
Standard radiology, pathology (Lancet/PathCare only) and medical technologist services

In hospital
100% of the MT
R29 000 per family per year


Appendectomy

Conventional or laparoscopic procedure – unlimited

necesse post-hospital
Physiotherapy and occupational therapy

In hospital
R9 350 per family per year
(Physiotherapy must be referred by the attending medical doctor)


necesse post-hospital
Alternative care to hospitalisation

R21 200 per year for sub-acute care and private nursing services as an alternative to hospitalisation


Clinical technologist services

In hospital
R21 200 per family per year


necesse organ transplant
Organ transplants

100% of the cost

  • Cornea implants - R27 400 per implant per year

Added insured benefits

These benefits are provided in addition to other insured benefits, may be subject to available day-to-day benefits and must be requested by a Necesse network GP unless otherwise indicated.


necesse immunisation
Health tests & immunisations
  • One blood glucose and one cholesterol test
  • HIV testing, counselling and support by a Necesse network GP
  • A tetanus vaccine
  • A flu vaccination by a Necesse network GP or at a network pharmacy (payable from over-the-counter medicine benefit)
  • A pap smear

Day-to-day benefits


necesse day-to-day
Consultations
  • 9 network GP consultations per student per year
  • R3 050 per student per year for specialist care (subject to referral by a Necesse network GP and pre-authorisation)

Other medical services
  • R1 950 per student per year for physiotherapy and occupational therapy out of hospital, if requested by a network GP
  • 100% of the Medihelp tariff for black and white X-rays and soft-tissue ultrasound scans (subject to specific radiology codes)
  • 100% for blood tests (subject to a list of pathology codes and tests), done by Lancet/PathCare on request of a network GP
necesse medicine
Medicine
  • Acute medicine dispensed by a dispensing network GP
  • A list of approved medicine items obtained from a network pharmacy and prescribed by a network GP or network dentist
  • Self-medication obtained from a network pharmacy
    - R100 per event
    - R280 per student per year

necesse optometry
Optometry

PPN network of optometrists

Available per student in a 24-month cycle:

  • 1 composite examination
  • Spectacles or contact lenses
    - Spectacles: R550 for a frame and 1 pair of standard clear Aquity lenses or bifocal lenses
    - R730 for contact lenses
necesse dentistry
Dental benefits

DRC network of dentists

  • Routine check-ups
  • 1 scale and polish treatment per student per year
  • 4 fillings per student, 1 filling per tooth in 365 days
  • Tooth extractions
  • Root canal treatment in the dentist’s chair for 2 teeth per student per year
  • Laughing gas (in the dentist’s chair)
  • X-rays
    • 4 intra-oral X-rays per student per year
    • 1 extra-oral X-ray per student in a 3-year period

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).

Benefits may be subject to pre-authorisation and protocols. Benefits are paid at 100% of the MT. The Necesse network GP must be the starting point for all services and must refer Necesse patients for radiology, pathology and treatment by specialists.

CT – Computerised tomography | CPAP – Continuous positive airway pressure | DRC – Dental Risk Company | DSP – Designated service provider | EVARS – Endovascular aortic replacement surgery | GP – General practitioner | MRI – Magnetic resonance imaging | MHRP – Medihelp Reference Price | MMAP – Maximum Medical Aid Price | 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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