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Medihelp Comprehensive: in-and-out of hospital benefits (2021)

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This page shows the In-hospital, Out-of-hospital and Medicine benefits for Medihelp Elite Comprehensive.

Pricing:

Elite Comprehensive
Main member: Adult member: Child member:
Total Cost pm: R5,610 R5,244 R1,524
Pay for all
Savings: R6768 R6264 R1800
Children Rates:
  • Under 26yrs
  • Pay for all
Note:
  • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list.
  • All treatments and procedures are subject to authorisation and protocols
  • All benefits are listed as an indication only. Please verify with your broker and scheme
View other benefits:
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
Compare any two plans, side by side | View all the Medihelp plans, with costs and brief summary

In-hospital Procedures:

Elite Comprehensive
non-Network Specialists:
  • 100% scheme rate
network Specialists:
  • 100% scheme rate
non-Network GPs:
  • 100% scheme rate
network GPs:
  • 100% scheme rate
Hospital Choice:
  • Choose from any hospital
    Penalty for using other hospital:
    • n/a
    Specialised Radiology:
    • MRI/CT Scans: R1,500 co-payment
    Supplementary Services: (Physio, etc)
    • 100% scheme rate
    Transplants:
    • Covered
    Dialysis:
    • Covered
    Day Hospitals:
    • Ophthalmological, endoscopic, ear, nose and throat procedures, removal of skin lesions and circumcisions: Must use a network day surgery
    Co-payments:
    • Spinal column surgery:R8,100
    • Gastroscopy, colonoscopy, arthroscopy and sigmoidoscopy:R2,200
    • Wisdom teeth or extensive dental treatment for children under 7yrs: R935
    • Specialised radiology:R1,500, in hospital and R1,200 out of hospital
    • Ophthalmological, endoscopic and ENT procedues, removal of skin lesions, circumcisions; outside of day surgery: 65% of benefit
    Alternatives to hospitals:
    • Private nursing in lieu of hospitalisation: 100% scheme rate
    • Hospice and sub acute: 100% scheme rate
    • Palliative care: R26,000 per family
    Casualty: When will this be updated?
    Other:
    • Cornea implant: R29 900 per implant per year
    • Radiography, in and out of hospital: R1,100 per family
    • Post-hospital care: Speech and occupational therapy and physiotherapy for up to 30 days after discharge: R1,870 per person and R2,600 per family
    Note:
    • PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
    • DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
    • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
    • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones here, but you must consult with your scheme to get the full list.
    View other benefits:
    Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

    You can also:
    Compare any two plans, side by side | View all the Medihelp plans, with costs and brief summary

    All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.



    Out-of-hospital Procedures:

    Elite Comprehensive
    Summary of day-to-day benefits:
    Main Member: Adult: Child:
    Savings /yr: R6768 R6264 R1800
    PMBs out of hospital:
    • All medical aids must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
    • This can include consults with specialists, blood or other tests, radiology and medicine
    • The benefit is paid by the scheme, and not out of your savings account
    • If you have no day-to-day funds, you still have cover for PMBs
    • Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
    • See our Guide to PMBs for more information.
    General info:
    GP consultations:
    • Paid from day-to-day benefit, subject to sublimits below. From savings first.:
      • M =R3,000
      • M+1 =R4,000
      • M+2 =R5,000
      • M3+ =R6,000
    • Shared with GP, specialists, physiotherapy, psychologist and supplementary health providers benefits
    Childcare:
    • Child flu vaccination at network pharmacy clinics
    • Babies under 2 years receive 2 additional visits to a GP, paediatrician or ear, nose and throat specialist
    • Full schedule of standard child immunisations covered up to 7 years at network pharmacy clinics
    Specialists consultations:
    • Paid from day-to-day benefit, subject to sublimits below. From savings first.:
      • M =R3,000
      • M+1 =R4,000
      • M+2 =R5,000
      • M3+ =R6,000
    • Shared with GP, specialists, physiotherapy, psychologist and supplementary health providers benefits
    Pathology:
    • From savings account first
    • Then, R2,900 per family, subject to overall day-to-day limit
    General radiology:
    • From savings account first
    • Then, R2,900 per family, subject to overall day-to-day limit
    Specialised radiology:
    • MRI/CT Scans: R1,200 co-payment
    Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit, subject to sublimits below. From savings first.:
      • M =R3,000
      • M+1 =R4,000
      • M+2 =R5,000
      • M3+ =R6,000
    • Shared with GP, specialists, physiotherapy, psychologist and supplementary health providers benefits
    General Appliances:
    • Medical Appliances, Hyperbaric oxygen: R1,550 per family, every 3 years
    • CPAP apparatus: R10,000 per person, every 2 years
    1.1. Hearing Aids:
    • R8,200 per person, every 3 years
    1.2. Wheelchairs:
    • R6,500 per person, every 3 years
    Note:
    • PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
    • DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
    • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
    View other benefits:
    Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

    You can also:
    Compare any two plans, side by side | View all the Medihelp plans, with costs and brief summary

    All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.



    Medication cover:

    Elite Comprehensive
    Summary of day-to-day benefits:
    Main Member: Adult: Child:
    Savings /yr: R6768 R6264 R1800
    Chronic: non-PMB chronic medicine:
    • M =R4,700
    • M+1 =R7,100
    • M+2 =R9,500
    • M3+ =R10,105
    Acute (presrcibed) medication:
    • Paid from day-to-day benefit, subject to sublimits below. From savings first.:
      • M =R4,000
      • M+1 =R6,000
      • M+2 =R6,000
      • M3+ =R7,000
    Over-the-counter:
    • Homeopathic, naturopathic and osteopathic: First from savings, then from 25% of acute medicine benefit
    Birth Control:
    • R150 per month and R1,800 per year
    • IUD: R2,400, every 5 years
    On Discharge:
    • Strong>R500 per admission
    Biological: When will this be updated?
    Note:
    • Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
    • Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
    • PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
    • DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
    • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
    View other benefits:
    Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

    You can also:
    Compare any two plans, side by side | View all the Medihelp plans, with costs and brief summary

    All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

    Important!

    • Unless specified, assume that all benefits 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


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