MedPlus

MedPlus

Medihelp’s top-of-the-range plan offers the most extensive cover for medical emergencies, private hospitalisation, and preventative care. It also makes substantial provision for acute and chronic medicine, radiology, pathology, and other day-to-day medical expenses.

from
R12 792 per month
in 2024
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Children aged 18-25

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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.


MedPlus

Added insured benefits

Women’s and men’s health tests

Contraceptive benefits

Maternity and baby benefits

Cover for health tests, vaccinations, and screenings

MedPlus

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 and 26 chronic illnesses (CDL)

MedPlus

Day-to-day benefits

GPs, specialists, and supplementary services

Pooled benefits

Acute medicine benefits

Chronic medicine benefits

Standard radiology benefits

Dentistry | Optometry

Pathology benefits

Care extender benefit

Main memberMain memberR12 792
DependantDependantR12 792
Child dependant < 26 yearsChild dependantR3 192
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
Unlimited
Trauma that necessitates hospitalisation
Unlimited
Childbirth
  • In hospital – unlimited
  • Home delivery – R15 600 per event
Specialised radiology
  • Angiography, MRI, and CT imaging – unlimited
  • PET scans – R26 200 per case
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
Unlimited
Mental health (psychiatric treatment)
R51 400 per person to a maximum of R69 900 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 – PMB and non-PMB
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) – R320 200 per person
Organ transplants
PMB only – unlimited
Cornea implants – R34 200 per implant
Bone marrow/ stem cell transplants – R376 900 per person
Palliative care
R32 200 per family
Other core benefits
Including renal dialysis, prostatectomy, oxygen, hospice, subacute care, and private nursing services as an alternative to hospitalisation
GP and specialist visits, virtual consultations, physiotherapy, clinical psychology, psychiatric nursing, and supplementary health services
R4 300 per person (pooled per family)
Acute medicine
R7 850 per person (pooled per family)
Non-PMB chronic medicine
R22 000 per person
External prostheses and medical appliances
Per person per three-year cycle
  • Artificial eyes – R18 900
  • Speech and hearing aids – R18 900
  • Wheelchairs – R10 200
  • Artificial limbs – R10 200
  • Wigs – R2 200

CPAP apparatus – R11 400 per person per two-year cycle

Medical appliances and hyperbaric oxygen treatment – R2 200 per person

Optometry (PPN netwerk)
Per person per 24-month cycle
  • R1 080 for 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, implants, bridges, and orthodontic treatment
Standard radiology
Unlimited
Radiography
R1 250 per family
Pathology (Ampath, Lancet, and PathCare Vermaak)
Unlimited

 

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 deductibles 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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