Medihelp MedElite:
cancer, maternity and mental health (2025)

This page has information on: Costs, Maternity, Oncology, Mental Health for Medihelp MedElite

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Terminology:

• 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 Providers. Where stipulated, you must use 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.
• All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

Monthly Costs (2026)

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

Cancer/ Oncology benefits (2025):

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

Medihelp: MedElite
Assume scheme pays all these costs, unless otherwise stated
Overall cancer coverage (in and out of hospital):	R480,000 per family Note: Most cancers are PMBs, and treatment is paid in full by scheme. More info here Most schemes require use of specific providers (DSPs) for oncology treatment.	Gap Cover: Can cover the penalty in full (Plans coming soon)

Maternity benefits (2025):

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

Medihelp: MedElite
Assume scheme pays all these costs, unless otherwise stated
Hospital stay:	100% scheme rate Home birth: R16,300 per event Usually covered for 2 nights for natural birth, and 3 nights for C-sections. All newborns receive immediate full medical aid cover at birth, even if parents are on a waiting period.	Gap Cover: Can cover most shortfalls (Plans coming soon)
Consultations:	Antenatal: 10 consults with GP, gynaecologist or midwife Postnatal: 2 consults with dietician, lactation specialist, antenatal classes
Scans:	2 x 2D scans
Note:	If you are pregnant and don't have medical aid, your pregnancy will most likely be excluded for new cover, but your baby will be covered from birth. Read more about pregnancy cover if you don't have medical aid.

Mental Health benefits (2025):

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

Medihelp: MedElite
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:	Main Member: Adult: Child: Savings: R10,728 R10,008 R2,418 Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account Main= R15,200 Main+1= R17,700 Main+2= R20,200 Main+3= R22,700 Other Day-to-Day Funds:
FYI:	Mental Health PMB conditions are covered for in and out of hospital treatment, even on "hospital" plans. For a full list see here. Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts. Scheme will pay this in full, if you use a DSP.
In-hospital:	PMBs: 21 days admission Alcoholism/Drug Addiction: 21 days admission Otherwise, R44,200 per person and R61,300 per family, including PMBs	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Out-of-hospital:	PMBs: 10+ consults Otherwise, From day to day benefit Shared with GPs, specialists, physio, psychology, psychiatric nursing, supplementary services After savings are depleted, the extra fund covers this benefit to these limits: Main: R3,700 Main + 1: R4,800 Main +2: R6,000 Main +3+: R7,200
Other:	.

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.