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Elite Comprehensive in 2021

This all-inclusive product offers comprehensive benefits for hospitalisation and a 10% savings plan as well as rich, insured chronic medicine and other insured day-to-day benefits which are further amplified by added insured benefits. This is the ideal option if you are looking for complete peace of mind.

Medical aid full cover 2021

View a summary of Elite’s monthly contributions and benefits

Principal member Principal member R5 610
(R564 savings contribution included per month and
R6 768 per year)
Dependant Dependant R5 244
(R522 savings contribution included per month and
R6 264 per year)
Child dependant < 26 years Child dependant R1 524
(R150 savings contribution included per month and
R1 800 per year)
The monthly contribution does not take any employer subsidy into account.

These benefits are provided in addition to other insured benefits and are available annually, unless otherwise indicated. Protocols and specific item codes may apply. Network information is available on the provider search page. Register for HealthPrint, Medihelp’s free online health and wellness programme, to activate benefits as indicated

Routine screening and immunisation
Available at network pharmacy clinics per person:
  • A combo test (blood glucose, cholesterol, BMI & blood pressure measurement)/ individual test (blood glucose or cholesterol)
  • HIV testing, counselling & support
  • A tetanus vaccine
  • A flu vaccination
  • Two HPV vaccinations for girls and boys between 10-14 years or three between 15-26 years
Women's health
  • A mammogram requested by a medical doctor per 2-year cycle (women 40-75 years)
  • A Pap smear requested by a medical doctor per 3-year cycle (women over 21 years)
  • Contraceptives:
    • Oral/ injectable/ implantable contraceptives (women up to 50 years) –
      R150 per beneficiary per month, up to R1 800 per year
    • Intra-uterine device every 60 months –
      R2 400 per beneficiary
Supporting wellness
  • Back treatment as an alternative to surgery at a Document Based Care facility for eligible patients, and the treatment is also a prerequisite for spinal surgery
  • Chronic Care programme
  • One dietician consultation if a BMI measurement indicates a BMI higher than 30
  • Early Detection programme
  • Bipolar programme
 Men's health
  • A prostate test (PSA level) requested by a medical doctor (men 40 years and older)
Enhanced maternity benefits
Registration on HealthPrint’s Maternity and Baby programme will activate these additional benefits:
  • 10 antenatal and post-natal consultations with a midwife/ GP/ gynaecologist
  • 2 antenatal and post-natal consultations at a dietician/ breastfeeding specialist/ antenatal classes
  • Two 2D ultrasound scans
  • 9 months' antenatal iron supplements
  • 9 months' antenatal folic acid supplements
 Child benefits
  • Babies under 2 years receive 2 additional visits to a GP, paediatrician or ear, nose and throat specialist
  • Standard child immunisations for children up to 7 years at network pharmacy clinics
Over 50s
  • One bone mineral density test requested by a medical doctor (women >50 years)
  • A Pneumovax vaccine in a 5-year cycle per person older than 55 years (if registered for asthma or COPD)
  • An FOBT test for people over 50 years
 HealthPrint

Medihelp members get free access to this online health and wellness programme designed to add value based on their health profile through programmes such as the Maternity and Baby programme.

 

Hospitalisation
100% of the MT

Any hospital
Day procedure network: 240 day procedure facilities for certain procedures

Emergency transport
Netcare 911
In country of residence
RSA, Lesotho, Eswatini, Mozambique, Namibia & Botswana – unlimited
Outside country of residence
Transport by road R2 130 and by air R14 200 per case
Chronic illness/ PMB
  • 100% of the cost for 270 PMB and 26 chronic conditions (DSPs, specialist network, protocols and pre-authorisation apply)
  • Unlimited cover for trauma that necessitates hospitalisation
 Specialised radiology
In and out of hospital
  • MRI and CT imaging
    100% of the MT – unlimited (see additional information - deductibles) 
  • Angiography
    100% of the MT – unlimited
    Psychiatric treatment
    In and out of hospital
    R36 700 per beneficiary per year (maximum R51 000 per family per year)
    		 Oncology
    In and out of hospital
    • PMB – 100% of the MT
    • Non-PMB – R415 600 per family per year
    Confinement (childbirth)
    • In hospital – 100% of the MT
    • Home delivery – R13 500 per event
    		 Organ transplants
    PMB only – 100% of the cost
    Cornea implants – R29 900 per implant per year
    Other core benefits
    Renal dialysis, prostatectomy, oxygen, hospice, sub-acute care and private nursing services as an alternative to hospitalisation     		Post-hospital care
    R1 870 per member and R2 600 per family per year for speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge
    Prostheses benefits
    • Health-essential functional prosthesis: R64 300
      • 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 R20 300 benefit applies for the hospital account and prosthesis components (combined) per admission
      • Intra-ocular lenses – R4 300 per lens, 2 lenses per beneficiary per year, health essential functional prosthesis benefit applies
    • EVARS prosthesis – R135 600
    • Vascular/ cardiac prosthesis – R58 000
    • Prosthesis with reconstructive or restorative surgery and external breast prostheses (in and out of hospital) – R9 900 per family per year
    • Implantable hearing devices (including device and components) – R270 000 per year
    		Refractive surgery
    Hospitalisation: 100% of the MT
    R20 000 per family per year  
    (beneficiaries 18-50 years)
    Palliative care
    100% of the MT
    R26 000 per family per year

     

    10% savings account
    Once your savings have run out, the overall day-to-day limit and insured day-to-day benefits apply
    • A credit facility equalling 12 months’ savings contributions is available at the start of each financial year
    • Unclaimed savings accumulate interest and will be added to your savings for the next year
    		Acute medicine
    Paid from savings first
    Member = R4 000 per year
    Member +1 = R5 000 per year
    Member +2 = R6 000 per year
    Member +3+ = R7 000 per year
    Subject to overall day-to-day limit
    Overall annual day-to-day limit

    Member = R12 000 per year

    Member +1 = R14 000 per year

    Member +2 = R16 000 per year

    Member +3+ = R18 000 per year

    Chronic medicine (non-PMB)

    Member = R4 700 per year

    Member +1 = R7 100 per year

    Member +2 = R9 500 per year

    Member +3+ = R10 105 per year

    PMB chronic medicine

    100% of the MHRP

    Insured day-to-day benefits
    Paid from savings first
    GP and specialist consultations, physiotherapy, clinical psychology, psychiatric nursing and supplementary health services
    Member = R3 000 per year
    Member +1 = R4 000 per year
    Member +2 = R5 000 per year
    Member +3+ = R6 000 per year
    Subject to overall day-to-day limit

    		External prostheses and medical appliances
    In and out of hospital
    • Benefit per beneficiary per 3-year cycle:
      • Artificial eyes – R8 200
      • Speech and hearing aids – R8 200
      • Wheelchairs – R6 500
      • Artificial limbs – R6 500
    • CPAP apparatus – R10 000 per beneficiary per 2-year cycle
    • Medical appliances and hyperbaric oxygen treatment - R1 550 per beneficiary per year
    Optometry
    PPN network applies
    Spectacles or contact lenses per beneficiary per 24-months cycle
    • R1 000 for a frame/ lens enhancements
    • R1 680 for contact lenses
    		 Dentistry
    DRC network applies
    • Conservative services (including routine check-ups, fillings, X-rays and oral hygiene)
    • Specialised services (including crowns, bridges and orthodontic treatment)
    Pathology
    Paid from savings first
    R2 900 per family per year
    Subject to overall day-to-day limit     		Radiology
    Paid from savings first
    R2 900 per family per year
    Subject to overall day-to-day limit

     

    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 the treatment is no longer considered as preventive care.
      Some benefits may be linked to a specific age/ gender/ item code. Benefits are paid at 100% of the MT.
    • Doctors' consultations are paid from the available savings/ day-to-day benefits.
    • Benefits may be subject to pre-authorisation and/ or protocols.
    • Medihelp pays generic medicine at 100% of the MMAP, original medicine with no generic at 80% of the MT, and original medicine with a generic at 70% of the MMAP.
    Procedure-specific deductibles
    • Spinal column surgery – R8 100 per admission (non-surgical back treatment at a DBC clinic is a prerequisite)
    • Endoscopic procedures – gastroscopy, colonoscopy, arthroscopy and sigmoidoscopy: In a day clinic/ hospital  – R2 200 (services should be rendered in a day procedure network to avoid a further 35% deductible)
    • Specialised radiology – R1 500 per examination in hospital and R1 200 out of hospital
    • Dental procedures under general anaesthesia during hospitalisation
      Removal of impacted teeth (3rd molars – only specific item codes are paid on the dentist's account) and extensive dental treatment for children <7 years – R935 per admission (a further 35% deductible per admission applies if procedures are obtained in facilities other than the day procedure network)
    Abbreviations
    BMI-Body mass index | CDL-Chronic Diseases List | COPD-Chronic obstructive pulmonary disease | CPAP-Continuous positive airway pressure | CT-Computerised tomography | DRC-Dental Risk Company | DSP-Designated service provider | EMS-Emergency  medical services | EVARS-Endovascular aortic replacement surgery | FOBT-Faecal occult blood test | GP-General practitioner | HPV-Human papilloma virus | OAL-Overall annual limit | 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

    Day procedure network

    View 2021 list

    Specialist network

    More info

    Savings account explanation

    Download

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