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Cover for everyday medical expenses

Your everyday medical expenses such as consultations and medicine are covered from day-to-day benefits that differ per plan.

How does your cover for these services work?

The cover you will enjoy for day-to-day medical expenses depends on your plan, so make sure to choose a plan based on your specific healthcare needs and preferences. Benefits include:

  • Consultations at GPs and specialists
  • Self-medication (medicine that you can buy without a doctor’s prescription)
  • Acute and chronic medicine prescribed by your doctor
  • Dental services
  • Eye tests, contact lenses and spectacles
  • Blood tests
  • Physiotherapy
  • Dietician visits
  • X-rays and scans
  • Medical appliances

Here is how Medihelp covers these expenses:

Members who prefer having fixed amounts available for specific healthcare services should choose a plan that offers fixed benefits. Some of these benefits are available as pooled amounts that you or any of your registered beneficiaries can use.

A savings account gives you the freedom to use your available funds for medical services or co-payments. You have the entire year’s savings funds available immediately at the beginning of the year. Any unclaimed funds in your savings account are automatically carried forward to the next year, allowing you to build a nest egg for future medical expenses.

Some plans offer a combination of fixed benefits and a savings account, giving you the best of both worlds. You can then enjoy the flexibility of a savings account and the assurance of fixed benefits for certain services should you deplete your savings account.

All Medihelp’s plans also include a separate basket of added insured benefits such as generous cover for preventive health screenings, extra benefits for children, and special benefits for pregnancy and babies. Click here to read more.

What is the care extender?
All the Medihelp plans except the entry-level plan offer a care extender to provide even more cover. You will receive one additional GP consultation for the family once you or one of your registered family members undergoes a specific preventive care health test and claims the test from your preventive care benefits. You will also get an additional R450 for the family to use for non-prescribed medicine once you or one of your beneficiaries undergoes the combo health screening and claims this from your preventive care benefits.

READ MORE ABOUT PREVENTIVE CARE AND HEALTH SCREENING BENEFITS

How the different plans offer day-to-day benefits

MedVital
This plan offers a benefit for GP and specialist consultations, physiotherapy, acute medicine and self-medication, and visits to emergency units. A single member has R1 250 available and a family has R2 500 for the year. Other benefits include the care extender, cover for contraceptives, health tests and more.
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MedAdd
MedAdd includes a 15% savings account, available at the beginning of the year, for day-to-day services. MedAdd also offers separate dental and eye care benefits, contraceptive cover and outstanding maternity and baby benefits. Once the savings account is depleted, a fixed benefit of R1 250 for a member and R2 500 for a family will unlock.
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MedSaver
This savings plan offers a generous 25% savings account for out-of-hospital medical expenses. Savings funds not used, accumulate and are transferred to the next year. A separate basket of maternity, baby, screening and preventive vaccination benefits as well as other benefits are included, and the plan also has the additional care extender benefit.
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MedElect
MedElect’s quality networks ensure that families enjoy comprehensive cover for medical services such as doctors’ consultations, medicine, dental and eye care, and other benefits such as the care extender. Out-of-network benefits are available for those times when members are unable to visit their local network doctors. MedElect members have access to the same extensive added insured benefits as Medihelp’s other plans, including maternity and baby benefits, health tests and preventive care benefits.
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MedPrime
MedPrime is enriched with a 10% savings account, and once the savings account is depleted, day-to-day benefits of R6 000 per person and R11 000 per family are activated for GPs, specialists and medicine. MedPrime also offers separate benefits for dental and eye care, the care extender, maternity and other benefits.
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MedElite
This plan offers a 10% savings account for day-to-day medical expenses, with unused funds accumulating and carried forward to the next year. Once the savings account is depleted, a benefit of R12 000 per member and R14 000 per family becomes available for doctors’ visits and other medical services. MedElite also offers separate benefits for acute medicine, dental and eye care. Non-PMB chronic medicines are covered from a benefit of R4 700 per member and R7 100 per family. The care extender is also available to members of this plan.
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