Medshield MediCore medical aid plan: 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

COSTS and OVERVIEW:
MediCore
Quick Overview
Main: Adult: Child:
Total Cost pm: R R R

Gap (optional):
  • Varies. See below for specific recommendation for this plan.
In brief: See full benefits below

IN HOSPITAL PROCEDURES:
MediCore
Scheme Benefits: Gap Benefits:
Specialists: 2018 benefits coming soon. 2017 benefits:
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice: 2018 benefits coming soon. 2017 benefits:
  • Network
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • 1 scan per family, with 10% co-payment
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Physiotherapy: Unlimited
Transplants: 2018 benefits coming soon. 2017 benefits:
Co-payments: 2018 benefits coming soon. 2017 benefits:
  • Hernia repair: R3,000
  • Diagnostic laparoscopy: R2,000
  • Reflux: R5,000
  • Hysterectomy: R5,000
  • Functional nasal surgery: R5,000
  • Back surgery: R5,000
  • Scopes: R1,500, in hospital
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals: 2018 benefits coming soon. 2017 benefits:
  • Physical rehabilitation, sub-acute facilities, nursing services, hospice: R30,000 per family
Casualty: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Other: 2018 benefits coming soon. 2017 benefits:
  • Sleep Studies: Unlimited diagnostic polysomnograms
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)

No phone calls!
Our quote will include the right gap cover for this plan

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
MediCore
Scheme Benefits Gap benefits
Main: Adult: Child:
General info:
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
  • Scopes: most paid by scheme if done in rooms
  • Otherwise, no benefit
Childcare:
  • No extra benefit available
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
  • Scopes: most paid by scheme if done in rooms
  • Otherwise, no benefit
Pathology: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
General radiology: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB

No phone calls!
Our quote will include the right gap cover for this plan

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MATERNITY BENEFITS:
MediCore
Scheme Benefits Gap benefits
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • 200% scheme rate
Consultations: 2018 benefits coming soon. 2017 benefits:
  • 6 consults, paid by scheme
  • 4 post-natal consults with midwife, paid by scheme
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2 x 2D scans

No phone calls!
Our quote will include the right gap cover for this plan

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CANCER (ONCOLOGY):
MediCore
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • PMBs only
  • 6 visits per family from social worker, for psychological support during treatment
  • Breast reconstruction: R80,000 per family

No phone calls!
Our quote will include the right gap cover for this plan

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DENTISTRY:
MediCore
Scheme Benefits Gap benefits
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry:unlimited, including in-hospital for under 6yr olds. Paid by scheme.
  • Specialised dentistry: no benefit
Orthodontics: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Maxillo Facial Surgery: 2018 benefits coming soon. 2017 benefits:
  • R10,000 per family, at200% scheme rate

No phone calls!
Our quote will include the right gap cover for this plan

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MEDICATION:
MediCore
Scheme Benefits Gap benefits
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMBs chronic: paid by scheme
Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • R140 per monthly script
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • R300 per admission
Biological:

No phone calls!
Our quote will include the right gap cover for this plan

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OPTOMETRY:
MediCore
Scheme Benefits Gap benefits
Optometry: 2018 benefits coming soon. 2017 benefits:
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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MENTAL HEALTH:
MediCore
Scheme Benefits Gap benefits
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • R30,000 per family, in the hospital network
Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Trauma:

No phone calls!
Our quote will include the right gap cover for this plan

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OTHER BENEFITS:
MediCore
Scheme Benefits Gap benefits
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • Stoma products: Unlimited
  • CPAP apparatus:PMBs only
  • Oxygen therapy equipment:
  • PMBs only
  • Ventilators:PMBs only
  • No benefit
1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
1.2. Wheelchairs: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
Dialysis: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
HIV: 2018 benefits coming soon. 2017 benefits:
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
  • No benefit
Emergency Transport: 2018 benefits are coming soon!
  • No benefit
International Insurance: 2018 benefits are coming soon!
  • No benefit
Other: 2018 benefits are coming soon!

No phone calls!
Our quote will include the right gap cover for this plan

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WELLNESS/PREVENTATIVE BENEFITS:
MediCore
Scheme Benefits Gap benefits
Flu vaccination: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Pneumonia vaccines: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • 60yrs+
  • No benefit
Back Rehabilitation Programme: 2018 benefits are coming soon!
  • No benefit
Biometric Screening: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Child Immunisation: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Pap Smear: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Mammogram: 2018 benefits coming soon. 2017 benefits:
  • Covered for 40yrs+, every 2 years.
  • No benefit
PAS Test: 2018 benefits are coming soon!
  • No benefit
HIV Test: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Other: 2018 benefits coming soon. 2017 benefits:
  • Bone densitometry: 50yrs+, every 3 years
  • TB test
  • Adult vaccinations: R320 per family
  • HPV vaccination
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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PROSTHETICS:
MediCore
Scheme Benefits Gap benefits
Overal Limit:
Sub-limits:

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Our quote will include the right gap cover for this plan


    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised