Medihelp MedAdd: in-and-out of hospital benefits (2024)

This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Medihelp MedAdd.

We also have information on: Dentistry, Optometry, Wellness and Preventative, Other, Maternity, Cancer, Mental Health and Prosthetics benefits.

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Monthly Costs:

MedAdd 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R3,354
  • R2,832
  • R1,134
  • Only pay for 2 children under 18yrs
Savings:
  • R6,048
  • R5,112
  • R2,016
Children Rates:
  • Child rates up to age 26.
  • Only pay for 2 children under 18yrs
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 all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

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In-hospital Procedures for 2024:

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Medihelp: MedAdd
Assume scheme pays all these costs, unless otherwise stated
non-Network Specialists:
  • 100% scheme rate
network Specialists:
  • 100% scheme rate
non-Network GPs:
  • 100% scheme rate
network GPs:
  • 100% scheme rate
Hospital Choice:
  • Long stay: Any hospital
  • Day procedure: Any Day hospital
Day Hospitals:
  • Procedures requiring Day hospital use: Ophthalmological, dental, endoscopic and ear, nose and throat procedures, removal of skin lesions, circumcisions and other case-by-case pre-authorised procedures
Penalty for using other hospital:
  • Use of non-Day hospital for certain procedures: 35% co-payment
Other Co-payments:
  • Spinal Column surgery: R12,000 co-payment
  • Endoscopic procedures, in day hospital (all scopes): R4,700 co-payment
  • Endoscopic procedures, in rooms (all scopes): no co-payment
  • Dental procedures: R3,880 co-payment
  • Specialized radiology: R2,800-R3,350 co-payment
  • Prostatectomy: R6,900 co-payment
  • Hysterectomy and Endometrial Ablation: R6,900 co-payment
Specialised Radiology:
  • MRI and CT scan: R3,350 co-payment, in and out of hospital. (R2,800 co-payment if out of hospital)
  • Angiography: Unlimited, in and out of hospital
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
  • PMBs only
  • Cornea implants: R34,200 per implant
  • Bone marrow/stem cell transplant: No benefit, unless PMB
Dialysis:
  • Scheme rate, in and out of hospital
Exclusions:
Alternatives to hospitals:
  • Hospice as an alternative to hospitalisation: Covered
  • Subacute care as an alternative to hospitalisation: Covered
  • Private Nursing as an alternative to hospitalisation: Covered
  • Palliative care: R25,200 per family
Casualty:
  • PMBs only
Other:
  • Speech therapy, OT and physio, post hospital care: R2,200 per person and R3,150 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
♦️View all the other benefits for this plan:♦️
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
.
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.

Out-of-hospital Procedures for 2024:

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Medihelp: MedAdd
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings:
  • R6,048
  • R5,112
  • R2,016
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:
  • Care extender benefit: One GP consult for family once you complete any one Pap smear, mammogram, prostate test, faecal occult blood test (FOBT) or bone mineral density test
  • Otherwise, from day-to-day benefit
Childcare:
  • Conservative dentistry, for under 18yrs
  • Paediatrician/GP/ENT: 2 consults, 0-2yrs
  • Immunisations: Covered, up to 7yrs
  • Flu shot: Covered
Specialists consultations:
  • From day-to-day benefit
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
  • MRI and CT scan: R3,350 co-payment, in and out of hospital. (R2,800 co-payment if out of hospital)
  • Angiography: Unlimited, in and out of hospital
Supplementary Services: (Physio, etc)
  • Occupational and speech therapy, dietician services, audiometry, podiatry, massage, orthoptic, chiropractic, homeopathic, herbal and naturopathic, osteopathic, and biokinetic services: From day-to-day benefit
General Appliances:
  • Hyperbaric oxygen ttreatment: R840 per family
  • Otherwise, from day-to-day benefit
1.1. Hearing Aids:
  • From day-to-day benefit
1.2. Wheelchairs:
  • From day-to-day benefit
Note:
  • PMBs: Prescribed Minimum Benefits. 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 all the other benefits for this plan:♦️
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.

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Medication Benefit for 2024:

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Medihelp: MedAdd
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings:
  • R6,048
  • R5,112
  • R2,016
Chronic:
Acute (presrcibed) medication:
  • From day-to-day benefit
Over-the-counter:
  • Care extender benefit: R490 for over the counter meds once you complete a health screening
Birth Control:
  • Oral, injectable: R160 per month up to R2,100 per year
  • IUD: R2,500 every 60 months
On Discharge:
  • R400 per admission
Biological:
  • PMBs only
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 all the other benefits for this plan:♦️
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.

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