Unify 2017

Unify - 2017

from R1 944 per month

 

If you’re looking for comprehensive private hospital cover with a high 25% savings account for your everyday healthcare needs, Unify is the right choice for you. The option also provides insured cover for screening tests. Children pay child dependant rates until they are 26 years old.

Monthly contribution

Member Subscription
Principal memberR1 944
(R486 savings contribution included per month and R5 832 per year)
DependantR1 602
(R402 savings contribution included per month and R4 824 per year)
Child dependant <26 yearsR588
(R150 savings contribution included per month and R1 800 per year)
 

Preventive care

Our preventive care benefits are designed to enable you to identify potential health problems, and enhance your day-to-day benefits.

HEALTH TESTS* (One combo test per beneficiary per year)
  • 1 combo test (blood glucose, cholesterol, BMI and blood pressure measurement) or individual blood glucose and/or cholesterol tests (available at Clicks and Dis-Chem pharmacy clinics)
  • HIV - voluntary counselling and testing (available at Clicks and Dis-Chem pharmacy clinics)

BACK TREATMENT PROGRAMME
One Document-Based Care (DBC) back treatment programme per beneficiary per year at a DBC facility (subject to protocols and pre-authorisation)

HEALTHPRINT WELLNESS PROGRAMME 

HealthPrint is an online wellness programme that supports you with relevant health information through every life stage.  You can also: 

  • View, update and share your health information and results of your health assessment via the site
  • Add your activity tracker and view your performance
  • Join Medihelp MultiSport, receive sports gear at a discounted price and participate as part of the Medihelp team in supported events
  • Join lifestage-specific programmes such as the pregnancy and baby programme and receive added value.

Medihelp's wellness programme

 * These benefits are not available if you have been registered for a chronic/PMB condition as it is no longer considered as preventive care.

Core benefits

 Description Benefit
Essential cover

DIAGNOSIS, TREATMENT AND CARE COSTS OF 270 PMB AND 26 CHRONIC CONDITIONS ON THE CHRONIC DISEASES LIST (CDL)
Subject to protocols, pre-authorisation and DSPs

100% of the cost
Unlimited
Trauma

BENEFITS FOR TRAUMA THAT NECESSITATES HOSPITALISATION IN THE CASE OF:

  • Motor vehicle accidents
  • Stab wounds
  • Gunshot wounds
  • Head trauma
  • Burns
  • Near drowning

Subject to authorisation, PMB protocols and case management

100% of the cost
Unlimited

POST-EXPOSURE PROPHYLAXIS

EMSEMERGENCY TRANSPORT SERVICES
(Netcare 911)

RSA, Lesotho, Swaziland, Mozambique, Namibia and Botswana
Subject to pre-authorisation and protocols
In beneficiary’s country of residence
  • Transport by road
  • Transport by air
100% of the MT
Unlimited
Outside beneficiary’s country of residence
  • Transport by road
100% of the MT
R1 800 per case
Outside beneficiary’s country of residence
  • Transport by air
100% of the MT
R11 800 per case
24-HOUR HELPLINE AND TRAUMA COUNSELLING (Netcare 911)Phone 082 911
HOSPITALISATION (state and private hospitals and day clinics)
Subject to pre-authorisation, protocols and case management
  • Intensive care and high-care wards
  • Ward accommodation
  • Theatre fees
  • Treatment and ward medicine
  • Consultations, surgery and anaesthesia
100% of the MT
Unlimited
POST-HOSPITAL CARE
Professional services required for up to 30 days after discharge following a Medihelp authorised private hospital admission
  • Speech therapy
  • Occupational therapy
  • Physiotherapy



100% of the MT
M = R1 650 per year
M+ = R2 200 per year
CONFINEMENT (childbirth)
Subject to pre-authorisation, protocols and case management
100% of the MT
Unlimited
HOME DELIVERY
Subject to pre-authorisation
  • Professional nursing fees
  • Equipment
  • Material and medicine
100% of the MT
R11 350 per event
STANDARD RADIOLOGY, PATHOLOGY AND MEDICAL TECHNOLOGIST SERVICES
In hospital
Subject to clinical protocols
100% of the MT
Unlimited
SPECIALISED RADIOLOGY
In and out of hospital
On request of a specialist and subject to clinical protocols
  • MRI and CT imaging (subject to pre-authorisation)
  • Angiography


100% of the MT
Unlimited
Member pays the first R1 500 per examination                        

ORGAN TRANSPLANTS
Subject to pre-authorisation and clinical protocols
PMB only

100% of the cost

Unlimited

PHYSIOTHERAPY, OCCUPATIONAL AND SPEECH THERAPY, DIETICIAN SERVICES, AUDIOMETRY, PODIATRY, MASSAGE, ORTHOPTIC, CHIROPRACTIC, HOMEOPATHIC, HERBAL AND NATUROPATHIC, OSTEOPATHIC AND BIOKINETIC SERVICES
In hospital
100% of the MT
Unlimited
OXYGEN
Subject to pre-authorisation and clinical protocols
In and out of hospital
100% of the MT
Unlimited
Hyperbaric oxygen treatment
In hospital
R550 per family per year
NEUROSTIMULATORS
Subject to pre-authorisation and clinical protocols
  • Device and components
100% of the MT
R95 750 per beneficiary per year
RENAL DIALYSIS
PMB only
In and out of hospital
Subject to pre-authorisation and clinical protocols

100% of the cost

Unlimited

APPLICABLE PRESCRIPTION MEDICINE DISPENSED AND CHARGED BY THE HOSPITAL ON DISCHARGE FROM THE HOSPITAL (TTO)
(PMB chronic medicine not included )
100% of the MT
Savings account
PSYCHIATRIC TREATMENT OF A MENTAL HEALTH CONDITION
Subject to pre-authorisation, services rendered in an approved hospital/facility and prescribed by a medical doctor
  • Professional services rendered in and out of hospital by a psychiatrist
  • General ward accommodation
  • Medicine supplied during the period of the treatment in the facility
  • Outpatient consultations
100% of the MT
R21 000 per beneficiary per year (maximum R28 750 per family per year)
ONCOLOGY*
Subject to pre-authorisation and registration on the Medihelp Oncology Management Programme. Protocols and DSP (ICON) apply
  • Radiotherapy
  • Brachytherapy
  • Chemotherapy and associated adjuvant medicine (medicine subject to the MORP)
  • Bone marrow/stem cell transplants (subject to protocols)
100% of the cost
DSP: ICON
HOSPICE SERVICES AND SUB-ACUTE CARE FACILITIES AS AN ALTERNATIVE TO HOSPITALISATION
Subject to pre-authorisation, and services rendered in an approved facility and prescribed by a medical doctor
100% of the MT
Unlimited
PRIVATE NURSING AS AN ALTERNATIVE TO HOSPITALISATION
Subject to pre-authorisation (excluding general day-to-day care)
100% of the MT
Unlimited

APPENDECTOMY
Subject to pre-authorisation

  • Conventional procedure

100% of the MT
Unlimited

  • Laparoscopic procedure

100% of the MT
Hospitalisation:
R15 000 per beneficiary

PROSTATECTOMY
Subject to pre-authorisation 

  • Conventional or laparoscopic procedure

100% of the MT
Unlimited

  • Robotic assisted laparoscopic procedure

100% of the MT

Hospitalisation:

R95 000 per beneficiary

CDL-Chronic Diseases List
CT-Computerised tomography
DSP-Designated service provider
EMS-Emergency medical services
ICON-Independent Clinical Oncology Network
MORP-Medihelp Oncology Reference Price
MRI-Magnetic resonance imaging
PMB -Prescribed minimum benefits 
TTO -To take out (medicine) 
MT-Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price
M-Member
 
* 98% of all oncology cases qualify for prescribed minimum benefits (PMB), which Medihelp will cover at 100% of the cost in terms of the Act, provided that oncology is rendered by oncologists within the Independent Clinical Oncology Network (ICON) according to their protocols. Oncology received outside ICON or that deviates from the protocols is subject to deductibles. 

Internally implanted prostheses

DescriptionBenefit
INTERNALLY IMPLANTED PROSTHESES
All hospital admissions and prostheses are subject to pre-authorisation, protocols and case management
100% of the MT
  • EVARS prosthesis
R111 800 per beneficiary per year
  • Vascular/cardiac prosthesis
R47 900 per beneficiary per year
  • Health-essential functional prosthesis
    • Hip, knee and shoulder replacements*
      In case of acute injury where replacement is the only clinically appropriate treatment modality
      Protocols apply
R53 050 per beneficiary per year
Hospitalisation:
100% of the MT

Prosthesis:
Health-essential functional prosthesis benefits apply (Non-PMB)
    • Intra-ocular lenses
Sub-limit subject to health-essential functional prosthesis benefit:
2 lenses per beneficiary per year
R3 600 per lens
  • Prosthesis with reconstructive or restorative surgery
    In and out of hospital
R8 300 per family per year
DSP-Designated service provider
EVARS-Endovascular aortic replacement surgery
PMB -Prescribed minimum benefits 
MT-Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price
 
*Benefit not applicable to wear and tear

Day-to-day benefits

DescriptionBenefit
DAY-TO-DAY SERVICES
  • GP consultations
  • Specialists
  • Emergency units
  • Physiotherapy
  • Clinical psychology
  • Standard radiology & pathology
  • Psychiatric nursing
  • Dentistry
  • External prostheses, medical, surgical and orthopaedic appliances
  • Optometry
  • Hyperbaric oxygen treatment (out of hospital)
  • Acute and chronic medicine
Savings account
  • Stoma components
  • Incontinence products/ supplies

100% of the MT
Unlimited

PMB chronic medicine
Subject to pre-authorisation and registration on Medihelp’s PMB medicine management programme
100% of the MHRP
GP-General practitioner
PMB-Prescribed minimum benefits
MHRP-Medihelp Reference Price

Deductibles

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

PROCEDURE-SPECIFIC DEDUCTIBLES
There are a limited number of low-incidence procedures that require a procedure-specific payment.

Neck and back fusions
The member pays the first R9 000 per admission and the balance is paid at 100% of the MT. 

Endoscopic procedures
There are only four endoscopic procedures where a member is required to contribute to the cost.

DescriptionBenefit
  • Gastroscopy
  • Colonoscopy
  • Arthroscopy
  • Sigmoidoscopy
In hospitalCovered at 100% of the MT
Member pays the first R3 400 per admission

Specialised radiology
Services rendered in and out of hospital must be requested by a specialist.  Benefits are subject to clinical protocols and the deductible below: 

DescriptionBenefit
  • MRI and CT imaging (subject to pre-authorisation)
  • Angiography
Covered at 100% of the MT
Member pays the first R1 500 per examination 

PRE-AUTHORISATION IS IMPORTANT
100% of the Medihelp tariff will apply if planned hospital admissions (protocols and case management apply) are pre-authorised. Should these services not be pre-authorised, an 80% benefit apply.

Emergency services
Emergency transport services (Netcare 911) by road and by air in and outside the member’s country of residence must be pre-authorised to qualify for the applicable benefit. If it is not pre-authorised, a 50% benefit will apply, except in the case of emergency medical conditions.

MT-Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price. The various tariffs are defined in the Rules of Medihelp.
CT-Computerised tomography
MRI-Magnetic resonance imaging

Important notes:

  • If a beneficiary joins during the course of a financial year, the medical aid benefits are calculated pro rata according to the remaining number of months per year.
  • This is a summary of the available benefits. In the event of a dispute the registered Rules of Medihelp will apply, subject to approval by the Registrar of Medical Schemes. Phone Medihelp on 086 0100 678 if you have any enquiries about the Rules of Medihelp Medical Scheme.

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