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Unify Product Block

Unify 25% savings plan in 2020


This product has a medical savings account for day-to-day medical expenses that earns interest on unused funds which are carried over to the next year. A special GP consultation benefit for children provides cover when your savings are depleted, while a basket of insured preventive care benefits keeps your health in check. Add to that generous hospital benefits and Unify is a smart choice to make.

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 Principal memberPrincipal memberR2 598
(R7 776 savings available per year)
 DependantDependantR2 136
(R6 408 savings available per year)
 Child dependant <26 yearsChild dependantR780
(R2 304 savings available per year)

Core benefits


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

Emergency transport

Netcare 911

In country of residence
RSA, Lesotho, Swaziland, Mozambique, Namibia & Botswana – unlimited

Outside country of residence
Transport by road R2 050 and
by air R13 700 per case


Hospitalisation

100% of the MT

Any hospital


Specialised radiology

In and out of hospital

  • MRI and CT imaging
    100% of the MT – unlimited (see deductibles)
  • Angiography
    100% of the MT – unlimited
Psychiatric treatment

R24 400 per beneficiary per year (maximum R33 500 per family per year)


Oncology

In and out of hospital

  • PMB – 100% of the MT
  • Non-PMB – R231 800 per family per year

Confinement (childbirth)
  • In hospital – 100% of the MT
  • Home delivery – R13 000 per event

Organ transplants

100% of the cost

Cornea implants – R28 800 per implant


Other core benefits

Renal dialysis, oxygen, prostatectomy, hospice, sub-acute care and private nursing services as an alternative to hospitalisation

Post-hospital care

R1 800 per member and R2 500 per family per year for speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge


Prostheses benefits
  • Health-essential functional prosthesis: R61 900
    • Hip, knee and shoulder replacements (non-PMB):
      • Acute injuries where replacement is the only treatment option –
        Hospitalisation: 100% of the MT
        Prosthesis: Health-essential functional prosthesis benefit applies (wear and tear: no benefits)
    • Intra-ocular lenses – R4 150 per lens, 2 lenses per beneficiary per year, health essential functional prosthesis benefit applies
  • EVARS prosthesis – R130 600
  • Vascular/cardiac prosthesis – R55 900
  • Prosthesis with reconstructive or restorative surgery (in and out of hospital) – R9 600 per family per year

Added insured benefits


Routine screening and immunisation
  • A combo test (blood glucose, cholesterol, BMI & blood pressure measurement)/individual blood glucose or cholesterol test
  • HIV testing
  • A tetanus vaccine
  • A flu vaccination
  • A pap smear (per 3-year cycle)
Supporting wellness
  • One dietician consultation per registered HealthPrint member if a BMI test result indicates a BMI higher than 30
  • Back treatment at a Document Based Care facility
  • Chronic Care programme
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 a pregnancy and baby programme and discounts at selected partners

Day-to-day benefits


Day-to-day benefits

25% savings account

  • Credit facility equalling 12 months’ savings contributions is available at the beginning of each financial year
  • Unclaimed savings funds will accumulate interest and be added to your available savings for the next year
  • Flexible payment option to include or exclude in-hospital co-payments and shortfalls

Optometry

Savings account

Medicine

PMB chronic medicine
100% of the MHRP


Dentistry

DRC network applies

  • Conservative and specialised dental services – savings account
  • 100% of the MT for dental procedures under conscious sedation in the dentist’s chair (sedation cost) for the removal of impacted teeth only (3rd molars)
    Dentist’s account – item codes apply
Child care benefit

R1 000 per family per year

A special benefit for GP consultations for children 2 to <12 years old is activated after depletion of the savings account


External prostheses and medical appliances

In and out of hospital

  • Savings account
  • Hyperbaric oxygen treatment in hospital – R630 per family per year

Additional information

Deductibles

Visiting network service providers, following the correct pre-authorisation process and negotiating tariffs with your doctor are just some of the ways you can manage or reduce out-of-pocket medical expenses.


Procedure-specific deductibles

(Payable by the member)

  • Spinal column surgery – R10 400 per admission
  • Endoscopic procedures – gastroscopy, colonoscopy, arthroscopy and sigmoidoscopy
    In a day clinic – R2 750, in hospital – R3 850
  • Specialised radiology – R1 650 per examination
  • Dental procedures under general anaesthesia during hospitalisation
    Removal of impacted teeth (3rd molars, item codes apply on dentist’s account) and extensive dental treatment for children < 5 years (dentist’s account payable from savings account) – R3 300 per admission
Pre-authorisation is important

The following services and procedures are paid at 100% of the Medihelp tariff or benefit amount if pre-authorised:

  • All planned hospital admissions (protocols and case management apply)
  • Oxygen for out-of-hospital use (protocols and case management apply)
  • Dental procedures under conscious sedation (sedation cost) in the dentist’s chair (managed care protocols apply)
  • Midwife and private nursing services

Should these services not be pre-authorised, an 80% benefit will apply or in case of midwife and private nursing services, it will be paid from the savings account.

Emergency transport services (Netcare 911)

In and outside the country of residence (air and road transport) should be pre-authorised to qualify for the applicable benefit. If not pre-authorised, 50% of the benefit applies except in the case of emergency medical conditions.

Oncology

Subject to pre-authorisation and registration on the Medihelp Oncology Programme, use of the designated service provider and treatment protocols to avoid deductibles. The Medihelp Oncology Reference Price applies to oncology medicine.


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 PMB condition as the treatment is no longer considered as preventive care and may be linked to a specific age/gender/item code. Benefits are paid at 100% of the MT.
  • Doctors’ consultations are paid from available savings plan benefits.
  • Subject to pre-authorisation and/or protocols.

Abbreviation:

AOL-Overall annual limit | BMI-Body mass index | CDL-Chronic Diseases List | CT-Computerised tomography | DRC-Dental Risk Company | DSP-Designated service provider | EMS-Emergency medical services | EVARS-Endovascular aortic replacement surgery | GP-General practitioner | MHRP-Medihelp Reference 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

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