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Necesse Product Block

Necesse Student in 2020


Necesse is the ideal healthcare solution for full-time students, and provides quality cover through an extensive network of private hospitals and healthcare providers for medical expenses incurred in and out of hospital.


From R597 per month


Core benefits


Chronic illness/PMB
  • 100% of the cost for 270 PMB and 26 chronic conditions (DSPs, formularies, networks, protocols and pre-authorisation apply)
  • Unlimited cover for trauma that necessitates hospitalisation

Emergency transport

Netcare 911
Transport by road or air within South Africa
100% of the MT
Unlimited


Hospitalisation

100% of the MT
Unlimited
131 quality private network hospitals


Specialised radiology

In and out of hospital
Services requested by a specialist on referral by a network GP

  • MRI and CT imaging (subject to pre-authorisation) and angiography
    100% of the MT
    R16 500 per family per year
Emergency unit services and non-network consultations

80% of the MT
Per student = R1 100

  • Outpatient emergency unit services, non-network doctors’ visits, medicine and services rendered by a non-network medical doctor and radiology requested by a non-network medical doctor
100% of the MT
  • Pathology at Lancet and PathCare

Standard radiology, pathology (Lancet/PathCare only) and medical technologist services

In hospital
100% of the MT
R30 500 per family per year


Appendectomy

Conventional or laparoscopic procedure – unlimited

Physiotherapy and occupational therapy

In hospital
R9 850 per family per year
Physiotherapy on request of the attending medical doctor


Alternative care to hospitalisation

R22 300 per year for sub-acute care and private nursing services as an alternative to hospitalisation


Clinical technologist services

In hospital
R22 300 per family per year


Organ transplants

PMB
100% of the cost
Cornea implants – R28 800 per implant per year

Added insured benefits

These benefits are provided in addition to other insured benefits, may be subject to available day-to-day benefits and must be requested by a Necesse network GP unless otherwise indicated.


Health tests & immunisations
  • One blood glucose and one cholesterol test
  • HIV testing, counselling and support by a Necesse network GP
  • A tetanus vaccine
  • A flu vaccination by a Necesse network GP or at a network pharmacy (payable from over-the-counter medicine benefit)
  • A pap smear

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


Consultations
  • 9 network GP consultations per student per year
  • R3 200 per student per year for specialist care (subject to referral by a Necesse network GP and pre-authorisation)

Other medical services
  • R2 050 per student per year for physiotherapy and occupational therapy out of hospital, if requested by a network GP
  • 100% of the Medihelp tariff for black and white
    X-rays and soft-tissue ultrasound scans (subject to specific radiology codes)
  • 100% for blood tests (subject to a list of pathology codes and tests), done by Lancet/PathCare on request of a network GP
Medicine
  • Acute medicine dispensed by a dispensing network GP
  • A list of approved medicine items obtained from a network pharmacy and prescribed by a network GP or network dentist
  • Self-medication obtained from a network pharmacy
    • R100 per event
    • R290 per student per year

Optometry

PPN network of optometrists

Available per student in a 24-month cycle:

  • 1 composite examination
  • Spectacles or contact lenses
    • Spectacles: R550 for a frame/lens enhancements and 1 pair of standard clear Aquity lenses or bifocal lenses
    • R730 for contact lenses
Dental benefits

DRC network of dentists

  • 1 routine check-up
  • 1 scale and polish treatment per student per year
  • 4 fillings per student, 1 filling per tooth in 365 days
  • Tooth extractions (pre-authorisations required for more than 4 extractions)
  • Root canal treatment in the dentist’s chair for 2 teeth per student per year
  • Laughing gas (in the dentist’s chair)
  • X-rays
    • 4 intra-oral X-rays per student per year
    • 1 extra-oral X-ray per student in a 3-year period

Additional information

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).

Benefits may be subject to pre-authorisation and protocols. Benefits are paid at 100% of the MT. The Necesse network GP must be the starting point for all services and must refer Necesse patients for radiology, pathology and treatment by specialists.


Abbreviations:

AOL-Overall annual limit | CDL-Chronic Diseases List | CT-Computerised tomography | CPAP-Continuous positive airway pressure | DRC-Dental Risk Company | DSP-Designated service provider | EMS-Emergency medical services | EVARS-Endovascular aortic replacement surgery | GP-General practitioner | MRI-Magnetic resonance imaging | MMAP-Maximum Medical Aid Price | 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

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