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.
View a summary of Elite’s monthly contributions and benefits
Principal member | ![]() | R5 610 (R564 savings contribution included per month and R6 768 per year) | |
Dependant | ![]() | R5 244 (R522 savings contribution included per month and R6 264 per year) | |
Child dependant < 26 years | ![]() | 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 these benefits.
Routine screening and immunisation Available at network pharmacy clinics per person:
| Women's health
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Supporting wellness
| Men's health
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Enhanced maternity benefits Registration on HealthPrint’s Maternity and Baby programme will activate these additional benefits:
| Child benefits
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Over 50s
| 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 Any hospital | 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
| Specialised radiology
In and out of hospital
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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
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Confinement (childbirth)
| 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
| 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
| 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 | External prostheses and medical appliances In and out of hospital
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Optometry PPN network applies Spectacles or contact lenses per beneficiary per 24-months cycle
| Dentistry DRC network applies
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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 |
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
- Endoscopic procedures – gastroscopy, colonoscopy, arthroscopy and sigmoidoscopy: In a day clinic/ hospital – R2 200 (services should be rendered in a day surgery 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
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