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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Main member

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Children aged 18-25

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

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Added insured benefits

Women’s and men’s health tests

Contraceptive benefits

Maternity and baby benefits

Cover for health tests, vaccinations, and screenings

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)

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

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

Product Summary (PDF)

Monthly contributions

Main member		R7 368 (R738 savings contribution included per month and R8 856 per year)
Dependant		R6 900 (R690 savings contribution included per month and R8 280 per year)
Child dependant < 26 years		R1 998 (R198 savings contribution included per month and R2 376 per year)
Children pay child dependant rates until they turn 26

Added insured benefits

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.

Core benefits

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

Day-to-day benefits

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

Care extender (activate additional day-to-day benefits)

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.

MedElite

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