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

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for MedMove. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

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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 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
• 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.

In-hospital Procedures (2025):

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

Medihelp: MedMove
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	100% scheme rate	Gap Cover: Can push payout up to 700% scheme rate (Plans coming soon)
Hospital Choice:	Network hospital Day procedure: Network Day hospital
Penalty for using other hospital:	Use of non-network: 35% penalty Use of non-Day hospital for certain procedures: R12,500 penalty	Gap Cover: Can cover the penalty in full (Plans coming soon)
Co-payments:	Hospital admission: R1,750 co-payment (not for PMBs) Endoscopic procedures , in day hospital: R4,900 co-payment Specialized radiology: R2,850 co-payment Prostatectomy: R11,700 co-payment Note: A co-payment is a fee your medical aid can insist you pay, regardless of how much the doctor/charges. It's not the same as an "excess" payment (which is when a doctor charges more than the medical aid rate). If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here There might be other co-payments if you don't use a DSP, especially if you are being treated for a PMB or when buying medicine.	Gap Cover: Can cover most co-payments (Plans coming soon)
Specialised Radiology:	Angiography, MRI and CT scan: R13,600 per family with R2,850 co-payment. No co-payment if scan is part of PMB protocol	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Scopes:	Endoscopic Procedures: R4,900 copayment	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	.
Transplants:	PMBs only
Dialysis:	PMBs only
Exclusions:	NB: See scheme's rules for all exclusions. All schemes have plenty!	Gap Cover: Coming soon
Alternatives to hospitals:	Palliative care: R20,700 per family
Casualty/ER:	All medical emergencies are paid by scheme, in or out of hospital Non-emergencies must be paid for out of pocket	Gap Cover: Can cover ER claims (Plans coming soon)
Other:	Post hospital care for speech therapy, OT and physio: R2,300 per person and R3,300 per family
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Out-of-hospital Procedures (2025):

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

Medihelp: MedMove
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
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. Other Day-to-Day Funds:
PMBs out of hospital:	All schemes 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 PMB benefits must never be paid from your savings account 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.
GP consultations:	Virtual GP consults: R130 co-payment Network Nourse consults: Unlimited Network GP consults: R130 co-payment
Childcare:		Gap Cover: Can pay for child ER visits (Plans coming soon)
Specialists consultations:	Network Specialists: R1,000 per family
Pathology:	R1,700 per family Shared with pathology, standard radiology and acute medicine
General radiology:	R1,700 per family Shared with pathology, standard radiology and acute medicine
Specialised radiology:	PMBs only	Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Scopes:	Endoscopic Procedures: R4,900 copayment	Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	Physio: 2 consults per family with R130 co-payment
General Appliances:	No benefit
1.1. Hearing Aids:	No benefit
1.2. Wheelchairs:	No benefit
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Medication Benefit (2025):

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

Medihelp: MedMove
Assume scheme pays all these costs, unless otherwise stated
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. Other Day-to-Day Funds:
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here.
Acute (prescribed) medication:	R1,700 per family Shared with pathology, standard radiology and acute medicine
Over-the-counter:	R510 per family
Birth Control:	Oral/injectable/implantable: R110 per month IUD: R1,900 every 5 years
On Discharge:	R390 per admission
Biological:	PMBs only
View 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.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider