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Elite Product Block

Elite Comprehensive in 2020

This all-inclusive product offers rich, insured benefits for hospitalisation, chronic medicine and other day-to-day medical expenses.

Elite A
Elite B
Elite C
Elite D


 Principal memberPrincipal memberR5 304
 DependantDependantR4 956
 Child dependant <26 yearsChild dependantR1 440


Core benefits

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

Emergency transport

Netcare 911

In country of residence
RSA, Lesotho, Swaziland, Mozambique, Namibia & Botswana – unlimited

Outside country of residence
Transport by road R2 050 and by air
R13 700 per case


100% of the MT

Specialised radiology

In and out of hospital

  • MRI and CT imaging – 100% of the MT
    Unlimited (see deductibles)
  • Angiography – 100% of the MT

Psychiatric treatment

R35 400 per beneficiary per year (maximum R49 100 per family per year)


In and out of hospital

  • PMB – 100% of the MT
  • Non-PMB – R400 000 per family per year

Confinement (childbirth)
  • In hospital – 100% of the MT
  • Home delivery – R13 000 per event

Organ transplants

100% of the cost

Cornea implants – R28 800 per implant

Other core benefits

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

Post-hospital care

R1 800 per member and R2 500 per family per year for speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge

Prostheses benefits
  • Health-essential functional prosthesis: R61 900
    • 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 R19 600 benefit applies for the hospital account and prosthesis components (combined) per admission
    • Intra-ocular lenses – R4 150 per lens, 2 lenses per beneficiary per year, health essential functional prosthesis benefit applies
  • EVARS prosthesis – R130 600
  • Vascular/cardiac prosthesis – R55 900
  • Prosthesis with reconstructive or restorative surgery and external breast prostheses (in and out of hospital) – R9 600 per family per year
  • Implantable hearing devices (including device and components) – R105 100 per beneficiary per year

Added insured benefits

Women's health
  • A mammogram for women 40 years and older (per 2-year cycle)
  • A pap smear (per 3-year cycle)

Enhanced maternity benefits
  • Pregnancy and baby programme
  • 12 ante- & postnatal consultations
  • Two 2D ultrasound scans per family

Child benefits
  • Two additional GP or specialist visits (babies under 1 year)
  • Standard child immunisations for children younger than 7 years
Routine screening and immunisation
  • A combo test (blood glucose, cholesterol, BMI & blood pressure measurement)/individual blood glucose or cholesterol test
  • HIV testing
  • A tetanus vaccine
  • A flu vaccination
  • Two HPV vaccinations for girls and boys between 10-14 years or three between 15-26 years


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 a pregnancy and baby programme and discounts at selected partners

Men's health
  • A prostate test (PSA level) for men 40 years and older

Supporting wellness
  • One dietician consultation per registered HealthPrint member if a BMI test result indicates a BMI higher than 30
  • Back treatment at a Document Based Care facility
  • Chronic Care programme

Over 50s
  • One bone mineral density test for women over 50 years
  • A Pneumovax vaccine in a 5-year cycle per person over 55 years
  • An FOBT test for people over 50 years

Day-to-day benefits

Insured day-to-day benefits

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

Member = R2 750 per year
Member +1 = R4 700 per year
Member +2 = R5 800 per year
Member +3+ = R7 050 per year


PPN network applies

Spectacles or contact lenses per beneficiary per 24-month cycle

  • R1 000 for a frame/lens enhancements
  • R1 635 for contact lenses


R2 750 per family per year


R2 750 per family per year


Acute medicine
Member = R4 250 per year
Member +1 = R7 200 per year
Member +2 = R8 850 per year
Member +3+ = R9 450 per year

Chronic medicine (non-PMB)
Member = R4 500 per year
Member +1 = R6 850 per year
Member +2 = R9 150 per year
Member +3+ = R9 800 per year

PMB chronic medicine
100% of the MHRP


DRC network applies

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

External prostheses and medical appliances

In and out of hospital

  • Benefit per beneficiary per 3-year cycle:
    • Artificial eyes – R7 900
    • Speech and hearing aids – R7 900
    • Wheelchairs – R6 300
    • Artificial limbs – R6 300
  • CPAP apparatus – R9 700 per beneficiary per 24-month cycle
  • Medical appliances and hyperbaric oxygen treatment – R1 500 per beneficiary per year

Additional information


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)

  • Spinal column surgery – R7 750 per admission
  • Endoscopic procedures – gastroscopy, colonoscopy, arthroscopy and sigmoidoscopy
    In a day clinic – R2 100, in hospital – R3 200
  • Specialised radiology – R1 150 per examination
  • Dental procedures under general anaesthesia during hospitalisation
    Removal of impacted teeth (3rd molars, item codes apply on dentist’s account) and extensive dental treatment for children < 5 years – R900 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.


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.


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 and may be linked to a specific age/gender/item code. Benefits are paid at 100% of the MT.
  • Doctors’ consultations are 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



AOL-Overall annual limit | BMI-Body mass index | CDL-Chronic Diseases List | 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 | 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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