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MedElite


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

From {{small.model.Total}} per month

Quick price overview: include dependants

Adult

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Child

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*You only pay for two children younger than 18 years, until they are 26 years old
MedElite

Added insured benefits

Women’s & men’s health tests

Contraceptives

Maternity & baby benefits

Screenings & immunisations

MedElite

Core benefits

Specialised radiology

Emergency transport services | Post-hospital | Trauma cover

Hospital benefits (no overall annual limit)

Any hospitals

270 PMB conditions Diagnosis, treatment & 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 = R12 600 | M+1 = R14 600
M+2 = R16 700 | M+3+ = R18 800
Insured day-to-day benefit amounts
GPs, specialists & supplementary services
M = R3 200 | M+1 = R4 200
M+2 = R5 300 | M+3+ = R6 300

MedElite

Day-to-day benefits

Acute medicine
M = R4 200 | M+1 = R5 300
M+2 = R6 300 | M+3+ = R7 300
Pathology − R3 030
Radiology − R3 030
Chronic medicine
Dentistry | Optometry
Care extender benefit

Principal memberPrincipal memberR5 832
(R582 savings contribution included per month and R6 984 per year)
DependantDependantR5 454
(R546 savings contribution included per month and R6 552 per year)
Child dependant < 26 yearsChild dependantR1 584
(R156 savings contribution included per month and R1 872 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
  • 10 antenatal and post-natal consultations at a midwife/ GP/  gynaecologist
  • 2 antenatal and post-natal consultations at a dietician/ lactation specialist/ antenatal classes
  • Two 2D ultrasound scans
  • 9 months’ antenatal iron supplements
  • 9 months’ antenatal folic acid supplements
Babies <2 years
2 consultations at a paediatrician/ GP/ ear, nose and throat specialist
Child immunisation
Standard immunisation up to 7 years
Health screening tests
  • One combo health screening (blood glucose, cholesterol, BMI & blood pressure measurement)*
    or
    an individual test (blood glucose or cholesterol)
  • HIV testing, counselling & support
Preventive care benefits
  • A tetanus vaccine
  • A flu vaccine
  • A mammogram* every 2 years
  • A Pap smear* every 3 years
  • A prostate test*
  • A Pneumovax vaccine
  • A Faecal occult blood test (FOBT)* 
  • A bone mineral density test* every 2 years
  • 2 HPV vaccinations for girls and boys between 10-14 years or three between 15-26 years
Contraceptives
  • Oral/injectable/implantable contraceptives – R160 per month, up to R1 900 per year
  • Intra-uterine device – R2 500 every 60 months
Supporting wellness
  • Back treatment at a Document Based Care facility (a prerequisite for spinal column surgery)
  • Chronic Care programme
  • One dietician consultation if BMI is >30

*Care extender benefits are extra benefits activated when a beneficiary make use of certain added insured benefits.

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

Hospitalisation
No overall annual limit
Any private hospital
Refractive surgery
R20 800 per family per event (18-50 years)
Trauma that necessitates hospitalisation
Unlimited
Childbirth
  • In hospital – unlimited
  • Home delivery – R14 100 per event
Specialised radiology
Angiography, MRI and CT imaging – unlimited
Post-hospital care for speech therapy, occupational therapy and physiotherapy
R2 000 per member and R2 800 per family
Emergency transport (Netcare 911)
  • In country of residence
    Unlimited (RSA, Lesotho, Eswatini, Mozambique, Zimbabwe, Namibia & Botswana)
  • Outside country of residence
    R2 210 for road transport and R14 700 for air transport
Treatment of life-threatening conditions
Unlimited
Includes 270 PMB and 26 Chronic Diseases List (CDL) conditions
PMB medicine
Unlimited
Cancer treatment
  • PMB – unlimited
  • Non-PMB – R433 000 per family
Mental health (psychiatric treatment)
R38 200 per person to a maximum of R53 100 per family
Health-essential functional prostheses
  • Intra-ocular lenses – R4 480 per lens, 2 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 & tear - subject to DSP if patient qualifies in terms of clinical criteria, or else a R21 200 benefit applies to the hospital account and prosthesis components (combined) per admission
Other prostheses
  • EVARS prosthesis – R141 200 per person
  • Vascular/cardiac prosthesis – R60 400 per person
  • Prosthesis with reconstructive or restorative surgery and external breast prostheses – R10 300 per family
  • Implantable hearing devices (including device and components) – R281 000 per person
Organ transplants
PMB – unlimited
Cornea implants – R31 100 per implant
Palliative care
R27 100 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 = R6 984 per year
Member +1 = R13 536 per year
Member +2 = R15 408 per year

Unused savings are carried over to the next year and earn 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 = R12 600
Member +1 = R14 600
Member +2 = R16 700
Member +3+ = R18 800
GP and specialist visits, virtual consultations, physiotherapy, clinical psychology, psychiatric nursing and supplementary health services
Member = R3 200
Member +1 = R4 200
Member +2 = R5 300
Member +3+ = R6 300
Subject to annual day-to-day benefit
Medicine
Acute medicine
Member = R4 200
Member +1 = R5 300
Member +2 = R6 300
Member +3+ = R7 300
Subject to annual day-to-day benefit
Non-PMB chronic medicine
Member = R4 900
Member +1 = R7 400
Member +2 = R9 900
Member +3+ = R10 600
Other day-to-day benefits
External prostheses and medical appliances
Per person per 3-year cycle
  • Artificial eyes – R8 500
  • Speech and hearing aids – R8 500
  • Wheelchairs – R6 750
  • Artificial limbs – R6 750

CPAP apparatus – R10 400 per person per 2-year cycle
Medical appliances and hyperbaric oxygen treatment – R1 600 per person

Optometry (PPN network)
Per person per 24-month cycle
  • Eye test
  • R1 000 for a frame/lens enhancements
  • R1 680 for contact lenses
  • Replacement of lost/broken spectacles
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 030 per family
Subject to annual day-to-day benefit
Pathology
R3 030 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

R450 for self-medication
Activates for the family once the first claim for a combo health screening (blood glucose, cholesterol, BMI & 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.