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

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Medihelp MedPlus. 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: MedPlus
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:	Any hospital Day procedure: Any Day hospital
Penalty for using other hospital:	Use of non-Day hospital for certain procedures: 35% penalty	Gap Cover: Can cover the penalty in full (Plans coming soon)
Co-payments:	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: Unlimited, in or out of hospital PET scans: R27,500 per case	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Scopes:		Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	100% scheme rate
Transplants:	PMBs only Cornea implants: R35,900 per implant
Dialysis:	Scheme rate, in and out of hospital
Exclusions:	NB: See scheme's rules for all exclusions. All schemes have plenty!	Gap Cover: Coming soon
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: R33,800 per family
Casualty/ER:	From day to day benefit	Gap Cover: Can cover ER claims (Plans coming soon)
Other:	Speech therapy, OT and physio, post hospital care: R2,300 per person and R3,000 per family Wound care: R16,000 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: MedPlus
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. Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account R4,500 R4,500 R4,500 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:	R4,500 per person, pooled per family From day to day benefit Shared with GPs, specialists, physio, psychology, psychiatric nursing, supplementary services
Childcare:	Conservative dentistry, for under 18yrs Paediatrician/GP/ENT: 2 consults, 0-2yrs Immunisations: Covered, up to 7yrs Flu shot: Covered	Gap Cover: Can pay for child ER visits (Plans coming soon)
Specialists consultations:	R4,500 per person, pooled per family From day to day benefit Shared with GPs, specialists, physio, psychology, psychiatric nursing, supplementary services
Pathology:	Unlimited
General radiology:	Unlimited
Specialised radiology:	Angiography, MRI and CT scan: Unlimited, in or out of hospital PET scans: R27,500 per case	Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Scopes:		Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	R4,500 per person, pooled per family From day to day benefit Shared with GPs, specialists, physio, psychology, psychiatric nursing, supplementary services
General Appliances:	Appliances and hyperbaric oxygen : R2,300 per family Stoma components: Unlimited, paid by scheme CPAP apparatus: R11,900 per person, every 2 years, paid by scheme
1.1. Hearing Aids:	R19,800 per person, every 3 years Paid by scheme
1.2. Wheelchairs:	R10,700 per person, every 3 years Paid by scheme
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: MedPlus
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. Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account R4,500 R4,500 R4,500 Other Day-to-Day Funds:
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. non-PMB chronic medicine: R23,100 per person From day to day benefit
Acute (prescribed) medication:	R8,200 per person From day to day benefit
Over-the-counter:	Care extender benefit: R510 for over the counter meds once you complete a health screening Otherwise, From day to day benefit
Birth Control:	Oral, injectable/implantable: R180 per month up to R2,400 per year IUD: R2,800 every 5 years
On Discharge:	R720 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