Medihelp MedElect:
in-and-out of hospital benefits (2025)

What's on this page:

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

Monthly Costs (2025)

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

MedElect 2025 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R3,126
  • R2,448
  • R1,014
  • Pay for all children
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R6,400
  • Main+1= R9,500
  • Main+2= R11,600
  • Main+3= R12,700
  • Main+4+= R7,750
Children Rates:
  • Up to age 26yrs
  • Pay for all children
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:
In-hospital | 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.

Find all other open medical aid plans here.
.

In-hospital Procedures (2024):

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

Medihelp: MedElect
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
non-Network Specialists:
  • 100% scheme rate
Scheme rate is set by Medihelp
network Specialists:
  • 100% scheme rate
non-Network GPs:
  • 100% scheme rate
network GPs:
  • 100% scheme rate
Hospital Choice:
  • Long stay: Network hospital
  • Day procedure: Network 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--network: 35% penalty
  • Use of non-Day hospital for certain procedures: 35% penalty
 You don't pay a penalty if admission was unavoidable due an emergency
Other Co-payments:
  • Spinal Column surgery: R16,300 co-payment
  • Endoscopic procedures, in day hospital (all scopes): R5,000 co-payment
  • Endoscopic procedures, in rooms (all scopes): no co-payment
  • Dental procedures: R2,140 co-payment
  • Specialized radiology: R2,900-R3,450 co-payment
  • Prostatectomy: R7,550 co-payment
  • Hysterectomy and Endometrial Ablation: R7,550 co-payment
  • Facet joint injections: R3,400 co-payment
  • Functional Nasal repair: R3,400 co-payment
  • Umbilical hernia repair: R3,400 co-payment
  • Varicose vein surgery: R3,400 co-payment
 * There might be other co-payments if you don't use scheme-chosen provider for some services.

* Treatment required for PMB level care is always paid by scheme, with no co-payment, if you follow the protocols.
That means that these co-payments might not apply in your case! More info here
Specialised Radiology:
  • MRI and CT scan: R3,450 co-payment, in and out of hospital. (R2,900 co-payment if out of hospital)
  • Angiography: Unlimited, in and out of hospital
 No limits or co-payments for PMB level care and/or for emergency
Scopes: No limits or co-payments for PMB level care and/or for emergency
Supplementary Services: (Physio, etc)
  • PMBs only
  • Physio and OT: R2,200 per person and R3,450 per family, in and out of hospital
 No limits or co-payments for PMB level care and/or for emergency
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: Exclusions:
  • Note: All schemes have extensive exclusions. We've tried to list the major ones here, but please consult your scheme or broker to get the full list.
 * Treatment required for PMB level of care is always paid by scheme, if you follow the protocols. It cannot be excluded. More info here.

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: R20,700 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:
In-hospital | 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.

Find all other open medical aid plans here.
.

Out-of-hospital Procedures (2024):

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

Medihelp: MedElect
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R6,400
  • Main+1= R9,500
  • Main+2= R11,600
  • Main+3= R12,700
  • Main+4+= R7,750
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, Network GP consults:
    • Paid by scheme
    • M: R2,200
    • M+1: R4,050
    • M+2: R4,750
    • M+3: R5,100
    • M+4+: R5,700
Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Childcare:
  • Paediatrician/GP/ENT: 2 consults, 0-2yrs
  • Immunisations: Covered, up to 7yrs
  • Flu shot: Covered
Specialists consultations:
  • From day-to-day benefit
 Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
  • MRI and CT scan: R3,450 co-payment, in and out of hospital. (R2,900 co-payment if out of hospital)
  • Angiography: Unlimited, in and out of hospital
 Scans required for PMB level care are paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Scopes: No limits or co-payments for PMB level care and/or for emergency
Supplementary Services: (Physio, etc)
  • Speech therapy, dietician services, audiometry, podiatry, massage, orthoptic, chiropractic, homeopathic, herbal and naturopathic, osteopathic, and biokinetic services: No benefit
  • Physio and OT: R2,400 per person and R3,750 per family
  • Paid by scheme
General Appliances:
  • R1,100 per family
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • From Medical Appliances 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:
In-hospital | 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.

Find all other open medical aid plans here.
.

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 Benefit (2024):

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

Medihelp: MedElect
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R6,400
  • Main+1= R9,500
  • Main+2= R11,600
  • Main+3= R12,700
  • Main+4+= R7,750
Chronic: You might be required to use specific pharmacies and be limited to specific medicines
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
  • Otherwise, R580 per person and R1,700 per family
  • From day-to-day benefit
Birth Control:
  • Oral, injectable: R150 per month up to R2,000 per year
  • IUD: R2,300 every 60 months
On Discharge:
  • R400 per admission
Biological:
  • PMBs only
Treatment that is required (by law) for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here.)
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:
In-hospital | 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.

Find all other open medical aid plans here.
.

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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