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Medical aid student plan

Necesse Student in 2021


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 R636 per month

View a summary of Necesse’s monthly contributions and benefits

These benefits are provided in addition to other insured benefits and are available annually, unless otherwise indicated. Benefits for certain services may be limited to specific item codes and protocols may apply.  A GP network and referrals to a specialist also 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 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) –
      R125 per beneficiary per month, up to R1 500 per year
    • Intra-uterine device every 60 months –
      R2 000 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
  • One dietician consultation if a BMI measurement indicates a BMI higher than 30
  • Bipolar programme (from 1 April 2021)
    Support for individuals with bipolar disorder

 

     

    Hospitalisation

    100% of the MT for hospitalisation in a network hospital  
    (subject to pre-authorisation and protocols)
    Emergency cover
    Unlimited emergency cover in South Africa for transport by road or air, pre-authorised and provided by Netcare 911
    Day surgery procedures
    100% of the MT 
    Day surgery network applies
    Ophthalmological, endoscopic, dental procedures and ear, nose and throat procedures, as well as skin lesion removal and circumcisions
    Emergency unit services and out-of-network visits
    • 80% of the MT
    • R1 150 per student per year
      Outpatient emergency unit services, non-network doctors' visits, including medicine, services and radiology
    • 100% of the MT  
    • Pathology (DSPs Lancet/ PathCare apply)
    Chronic illness/ PMB & trauma
    • 100% cover for 270 PMB and 26 chronic conditions (DSPs, formularies, networks, protocols and pre-authorisation apply)
    • Unlimited cover for trauma that necessitates hospitalisation (motor vehicle accidents and similar trauma)
    • Other PMB services, e.g. oncology, HIV/ Aids, prostheses and renal dialysis 
    Radiology & pathology
    • R31 700 per year for standard radiology, pathology and medical technologist services in hospital
    • R17 100 per year for specialised radiology in and out of hospital. Services must be requested by a specialist on referral by a network GP and benefits are subject to clinical protocols
      • MRI & CT (subject to pre-authorisation) and angiography

    Alternative care to hospitalisation
    R23 100 per year for sub-acute care and private nursing services as an alternative to hospitalisation
    Physiotherapy and occupational therapy
    In hospital, R10 250 per year (services rendered in hospital must be requested by the attending medical doctor)
    Appendectomy
    Conventional or laparoscopic procedure – 100% of the MT
    Organ transplant
    PMB – 100% of the cost
    • Cornea implants – R29 900 per implant per year
    Clinical technologist services
    R23 100 per year (in hospital)
     
    Consultations
    • 9 network GP consultations per student per year
    • R3 300 per student per year for specialist care
    • (subject to referral by a Necesse network GP and pre-authorisation)
    Other medical services
    • R2 100 per student per year for physiotherapy and occupational therapy out of hospital, requested by a network GP
    • 100% of the MT for black and white X-rays and soft-tissue ultrasound scans (only specific radiology codes)
    • 100% of the MT for blood tests (only specific pathology codes and tests) done by Lancet/ PathCare on request of a network GP
    Optometry 
    PPN network of optometrists
    Available per student in a 24-month cycle:
    • 1 composite optometric consultation
    • Spectacles or contact lenses 
    • Spectacles
      • R550 for a frame and/ or lens enhancements
      • 1 pair of standard clear Aquity single vision or bifocal lenses (multifocal lenses are paid at the cost of bifocal lenses)
      Contact lenses
      • R750 per student
    Dentistry 
    DRC network of dentists
    • 1 routine check-up per year
    • 1 scale and polish treatment per year
    • 4 fillings per student, 1 filling per tooth in 365 days
    • Tooth extractions (pre-authorisation required for more than 4 extractions)
    • Root canal treatment for 2 permanent teeth per year
    • Laughing gas (in the dentist's chair)
    • X-rays
      • 4 intra-oral X-rays per year
      • 1 extra-oral X-ray in a 3-year period
    Medicine
    • Acute medicine dispensed by a dispensing network GP
    • A list of approved medicine items prescribed by a network GP or network dentist and obtained from a network pharmacy 
    • Self-medication obtained from a network pharmacy
      - R110 per event to a maximum of R300 per student per year

      Service provider networks
      You must use your option's network hospitals and day surgeries, pharmacies, doctors and specialists when you require medical treatment. By using network providers, you will avoid additional expenses and ensure that the treatment is considered for benefits. To find a network provider, use the provider search function on this website.

      • Spinal column surgery – R15 000 per admission
      • All endoscopic procedures (in hospital/ day clinic) – R4 500 (services should be rendered in a day surgery network to avoid a further 35% deductible)
      • Hospital network: Use network hospitals for all planned hospital admissions
      • Day surgery network: Use the day surgery network when you need to undergo ophthalmological, endoscopic and ear, nose and throat procedures, as well as skin lesion removal, dental procedures and circumcisions
      • Medihelp Preferred Pharmacy Network: Have your prescribed medicine dispensed at a network pharmacy to qualify for benefits
      • GP network: Use a network GP for day-to-day treatment and for referrals to specialists, including for radiology and pathology
      • Specialist network: Use network specialists, as they have been matched to our network hospitals

      Explanation of terms

      An emergency medical condition means any sudden and unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide such treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person's life in serious jeopardy. An emergency medical condition must be certified as such by a medical practitioner. Emergencies qualify for PMB and must therefore also be registered for PMB (see also "PMB").

      Hospital benefits refer to benefits for services rendered by a network hospital during a patient's stay in hospital. Services include ward accommodation and ward medicine, standard radiology, pathology and consultations during hospitalisation. Hospital benefits are subject to pre-authorisation and an 80% benefit will apply to the hospital account if the admission is not pre-authorised. Emergency admissions must be registered on the first workday following the admission. A 65% benefit applies for voluntary admission to a non-network hospital.

      PMB – Prescribed minimum benefits are paid for 26 chronic conditions on the Chronic Diseases List (CDL) and 270 diagnoses with their treatments as published in the regulations under the Medical Schemes Act 131 of 1998. In terms of these Regulations, medical schemes are compelled to grant benefits for the diagnosis, treatment and care costs of any of these conditions as well as emergency medical conditions (that meet the published definition) without imposing any limits, PMB are subject to pre-authorisation, protocols and the utilisation of designated service providers where applicable, e.g. Lancet/ PathCare for pathology tests and a specialist in the Necesse specialist network. PMB services are first funded from the related day-to-day benefits.

      Necesse hospital 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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