MedElite

MedElite

This all-inclusive plan is ideal for families and individuals with extensive healthcare needs.

from
R7 368 per month
in 2024
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Children aged 18-25

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Children up to age 25 Children up to age 20 Children up to age 17*

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Looking for a new medical aid?

Choosing a new medical aid is made easier by speaking to an accredited adviser about the plan that will suit your healthcare needs and pocket best. Whether you’re studying, moving up the corporate ladder or planning a family, we will help you make an informed decision.

To request pre-authorisation, view your benefits, and for other member services please log in to the Member Zone.


MedElite

Added insured benefits

Women’s and men’s health tests

Contraceptive benefits

Maternity and baby benefits

Cover for health tests, vaccinations, and screenings

MedElite

Core benefits

Specialised radiology benefit

Emergency transport services | Post-hospital benefit | Trauma cover

Hospital benefits (no overall annual limit)

Any hospitals

271 PMB conditions – diagnosis, treatment, and care | 26 chronic illnesses (CDL)

MedElite

Day-to-day benefits

10% savings account
Annual day-to-day benefits after depletion of savings account funds
M = R13 900
M +1 = R16 100
M +2 = R18 400
M +3+ = R20 700
Insured day-to-day benefit amounts
GPs, specialists, and supplementary services
M = R3 550
M+1 = R4 600
M+2 = R5 750
M+3+ = R6 900

MedElite

Day-to-day benefits

Acute medicine
M = R4 600
M+1 = R5 750
M+2 = R6 900
M+3+ = R8 050
Pathology − R3 300
Radiology − R3 300
Non-PMB chronic medicine
M = R5 450
M+1 = R8 150
M+2 = R10 900
M+3+ = R11 700
Dentistry | Optometry
Care extender benefit
Non-PMB chronic medicine

Main memberMain member

R7 368
(R738 savings contribution included per month and R8 856 per year)

DependantDependant

R6 900
(R690 savings contribution included per month and R8 280 per year)

Child dependant < 26 yearsChild dependant

R1 998
(R198 savings contribution included per month and R2 376 per year)

Children pay child dependant rates until they turn 26

These benefits are provided in addition to your insured day-to-day benefits and are activated when you register on HealthPrint, Medihelp’s free wellness programme for members, on the Member Zone. Your health screening results from Dis-Chem or Clicks will automatically upload to your health record on HealthPrint.

Maternity benefits
  • Ten antenatal and postnatal consultations at a midwife/ GP/ gynaecologist
  • Two antenatal and postnatal consultations at a dietician/ lactation specialist/ antenatal classes
  • Two 2D ultrasound scans
  • Nine months’ antenatal iron supplements
  • Nine months’ antenatal folic acid supplements
Babies <2 years
Two consultations at a paediatrician/ GP/ ear, nose, and throat specialist
Child immunisation
Standard immunisation up to seven years
Health screening tests
  • One combo health screening (blood glucose, cholesterol, BMI, and blood pressure measurement)*
    or
    an individual test (blood glucose or cholesterol)
  • HIV testing, counselling, and support
Preventive care benefits
  • A tetanus vaccine
  • A flu vaccine
  • A mammogram* every two years
  • A Pap smear* every three years
  • A prostate test*
  • A pneumococcal vaccine
  • An FOBT test* 
  • A bone mineral density test* every two years
  • Two HPV vaccinations for girls and boys between 10-14 years or three between 15-26 years
Contraceptives
  • Oral/ injectable/ implantable contraceptives – R178 per month, up to R2 300 per year
  • Intra-uterine device – R2 700 every 60 months
Supporting wellness
  • Back treatment at a Documentation Based Care facility (a prerequisite for spinal column surgery)
  • One dietician consultation if BMI is >30

*Making use of these benefits activate the care extender benefit.

In-hospital treatment and life-essential services (insured benefits)

Hospitalisation
No overall annual limit
Any private hospital. Day procedure facilities apply for certain day procedures
Refractive surgery
R22 800 per family per event (beneficiaries 18 to 50 years)
Trauma that necessitates hospitalisation
Unlimited
Childbirth
  • In hospital – unlimited
  • Home delivery – R15 600 per event
Specialised radiology
Angiography, MRI, and CT imaging – unlimited
Post-hospital care for speech therapy, occupational therapy, and physiotherapy
R2 200 per member and R3 150 per family
Emergency transport (Netcare 911)
  • In country of residence
    Unlimited (RSA, Lesotho, Eswatini, Mozambique, Zimbabwe, Namibia, and Botswana)
  • Outside country of residence
    R2 400 for road transport and R16 100 for air transport
Treatment of life-threatening conditions
Unlimited
Includes 271 PMB and 26 Chronic Disease List (CDL) conditions
PMB medicine
Unlimited
Cancer treatment
  • PMB – unlimited
  • Non-PMB – R476 700 per family
Mental health (psychiatric treatment)
R42 100 per person to a maximum of R58 400 per family
Health-essential functional prostheses
R73 800 per person
  • Intra-ocular lenses – R4 900 per lens, two lenses per person
  • Hip, knee, and shoulder replacement – non-PMB cases are limited to replacements caused by an acute injury
  • Hip, knee, and shoulder replacements due to wear and tear – a R23 400 benefit applies to the hospital account and prosthesis components (combined) per admission. Hip and knee replacements are subject a DSP if the patient qualifies in terms of clinical criteria
Other prostheses
  • EVARS prosthesis – R155 600 per person
  • Vascular/ cardiac prosthesis – R66 500 per person
  • Prosthesis with reconstructive or restorative surgery and external breast prostheses – R11 300 per family
  • Implantable hearing devices (including device and components) – R309 700 per person
Organ transplants
PMB – unlimited
Cornea implants – R34 200 per implant
Palliative care
R29 900 per family
Other core benefits
Including renal dialysis, prostatectomy, oxygen, hospice, subacute care, and private nursing services as an alternative to hospitalisation

 

Savings account
10% savings available at the beginning of the year (see monthly contributions)

Example of available savings:

Member = R8 856 per year
Member + dependant = R17 136 per year
Member + dependant + child = R19 512 per year

Unused savings are carried over to the next year and accumulate interest. Once your savings are depleted, insured day-to-day benefits become available

Insured day-to-day benefits (available after depletion of your savings)
Overall annual day-to-day benefit
Member = R13 900
Member + 1 = R16 100
Member + 2 = R18 400
Member + 3 + = R20 700
GP and specialist visits, virtual consultations, physiotherapy, clinical psychology, psychiatric nursing, and supplementary health services
Member = R3 550
Member + 1 = R4 600
Member + 2 = R5 750
Member + 3 + = R6 900
Subject to annual day-to-day benefit
Medicine
Acute medicine
Member = R4 600
Member + 1 = R5 750
Member + 2 = R6 900
Member + 3 + = R8 050
Subject to annual day-to-day benefit
Non-PMB chronic medicine
Member = R5 450
Member + 1 = R8 150
Member + 2 = R10 900
Member + 3 + = R11 700
Other day-to-day benefits
External prostheses and medical appliances
Per person per three-year cycle
  • Artificial eyes – R9 300
  • Speech and hearing aids – R9 300
  • Wheelchairs – R7 400
  • Artificial limbs – R7 400

CPAP apparatus – R11 400 per person per two-year cycle
Medical appliances and hyperbaric oxygen treatment – R1 750 per person

Optometry (PPN network)
Per person per 24-month cycle
  • Eye test
  • R1 080 for a frame/ lens enhancements
  • R1 780 for contact lenses
Conservative dentistry (DRC network)
Routine check-ups, fillings, X-rays, and oral hygiene
Specialised dentistry (DRC network)
Crowns, bridges, and orthodontic treatment
Standard radiology
R3 300 per family
Subject to annual day-to-day benefit
Pathology (Ampath, Lancet, and PathCare Vermaak)
R3 300 per family
Subject to annual day-to-day benefit

One additional GP consultation
Activates for the family once the first claim for either a Pap smear, mammogram, prostate test, faecal occult blood test (FOBT) or bone mineral density test is paid from your added insured benefits

R490 for self-medication
Activates for the family once the first claim for a combo health screening (blood glucose, cholesterol, BMI, and blood pressure measurement) is paid from your added insured benefits

 

This is only a summary of the available benefits and co-payments may apply to certain benefits. Please consult the registered Rules of Medihelp and your plan’s brochure for more details. 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 the patient has registered the medical condition for PMB or chronic medicine benefits, as the treatment is no longer considered as preventive care.
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