Plus Comprehensive in 2021
Medihelp’s top-of-the-range product offers the most extensive cover for medical emergencies, private hospitalisation and preventive care, as well as substantial provision for acute and chronic medicine, radiology, pathology and other day-to-day medical expenses to ensure that you and your family’s healthcare needs are always well taken care of.
View a summary of Plus’s monthly contributions and benefits
Principal member | ![]() | R9 714 | |
Dependant | ![]() | R9 714 | |
Child dependant < 26 years | ![]() | R2 424 | |
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
|
Supporting wellness
| Men's health
|
Enhanced maternity benefits Registration on HealthPrint’s Maternity and Baby programme will activate these additional benefits:
| Child benefits
|
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
|
Psychiatric treatment In and out of hospital R44 700 per beneficiary per year (maximum R61 000 per family per year) | Oncology In and out of hospital 100% of the MT – unlimited |
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 100% of the MT – unlimited |
Palliative care 100% of the MT R28 000 per family per year |
Insured day-to-day benefits GP and specialist consultations, physiotherapy, clinical psychology, psychiatric nursing and supplementary health services – R3 700 per beneficiary per year, pooled per family | Acute medicine R6 440 per beneficiary per year, pooled per family |
Chronic medicine (non-PMB) R18 800 per beneficiary per year | |
PMB chronic medicine | |
Optometry PPN network applies Spectacles or contact lenses per beneficiary per 24-months cycle
| Dentistry DRC network applies
|
Pathology Unlimited | Radiology Unlimited |
External prostheses and medical appliances In and out of hospital
|
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.
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