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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.

Medical aid comprehensive plan

View a summary of Plus’s monthly contributions and benefits

Principal memberPrincipal memberR9 714
DependantDependantR9 714
Child dependant < 26 yearsChild dependantR2 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:
  • A combo test (blood glucose, cholesterol, BMI & blood pressure measurement)/ individual test (blood glucose or cholesterol)
  • HIV testing, counselling & support
  • A tetanus vaccine
  • A flu vaccination
  • Two HPV vaccinations for girls and boys between 10-14 years or three between 15-26 years
Women's health
  • A mammogram requested by a medical doctor per 2-year cycle (women 40-75 years)
  • A Pap smear requested by a medical doctor per 3-year cycle (women over 21 years)
  • Contraceptives:
    • Oral/ injectable/ implantable contraceptives (women up to 50 years) –
      R150 per beneficiary per month, up to R1 800 per year
    • Intra-uterine device every 60 months –
      R2 400 per beneficiary
Supporting wellness
  • Back treatment as an alternative to surgery at a Document Based Care facility for eligible patients, and the treatment is also a prerequisite for spinal surgery
  • Chronic Care programme
  • One dietician consultation if a BMI measurement indicates a BMI higher than 30
  • Early Detection programme
  • Bipolar programme (from 1 April 2021)
Men's health
  • A prostate test (PSA level) requested by a medical doctor (men 40 years and older)
Enhanced maternity benefits
Registration on HealthPrint’s Maternity and Baby programme will activate these additional benefits:
  • 10 antenatal and post-natal consultations with a midwife/ GP/ gynaecologist
  • 2 antenatal and post-natal consultations at a dietician/ breastfeeding specialist/ antenatal classes
  • Two 2D ultrasound scans
  • 9 months' antenatal iron supplements
  • 9 months' antenatal folic acid supplements
Child benefits
  • Babies under 2 years receive 2 additional visits to a GP, paediatrician or ear, nose and throat specialist
  • Standard child immunisations for children up to 7 years at network pharmacy clinics
Over 50s
  • One bone mineral density test requested by a medical doctor (women >50 years)
  • A Pneumovax vaccine in a 5-year cycle per person older than 55 years (if registered for asthma or COPD)
  • An FOBT test for people over 50 years
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
100% of the MT

Any hospital
Day surgery network: 134 day surgeries for certain procedures

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
  • 100% of the cost for 270 PMB and 26 chronic conditions (DSPs, specialist network, protocols and pre-authorisation apply)
  • Unlimited cover for trauma that necessitates hospitalisation
Specialised radiology
In and out of hospital
  • MRI, CT imaging and angiography
    100% of the MT – unlimited
  • PET imaging (non-PMB) – 100% of the MT
    R23 000 per case
    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)
    • In hospital – 100% of the MT
    • Home delivery – R13 500 per event
    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
    • Health-essential functional prosthesis: R64 300
      • Intra-ocular lenses – R4 300 per lens, 2 lenses per beneficiary per year, health essential functional prosthesis benefit applies
    • EVARS prosthesis – R135 600
    • Vascular/cardiac prosthesis – R58 000
    • Prosthesis with reconstructive or restorative surgery and external breast prostheses (in and out of hospital) – R9 900 per family per year
    • Implantable hearing devices (including device and components) – R280 000 per year
    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
      100% of the MHRP

      Optometry
      PPN network applies
      Spectacles or contact lenses per beneficiary per 24-months cycle
      • R1 000 for a frame/ lens enhancements
      • R1 680 for contact lenses
      Dentistry
      DRC network applies
      • Conservative services (including routine check-ups, fillings, X-rays and oral hygiene)
      • Specialised services (including crowns, bridges and orthodontic treatment)
      Pathology
      Unlimited
      Radiology
      Unlimited
      External prostheses and medical appliances
      In and out of hospital
      • Benefit per beneficiary per 3-year cycle:
        • Artificial eyes – R16 400
        • Speech and hearing aids – R16 400
        • Wheelchairs – R8 900
        • Artificial limbs – R8 900
      • CPAP apparatus – R10 000 per beneficiary per 2-year cycle
      • Medical appliances and hyperbaric oxygen treatment - R1 850 per beneficiary per year


      Important:
      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

        Day surgery network

        Specialist network

        If you are interested in a medical aid, complete the form below and an accredited adviser will get in touch with you:

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


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