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

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

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

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Monthly Costs:

MedPlus 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R12,792
  • R12,792
  • R3,192
  • 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
  • R4,300
  • R4,300
  • R4,300
Children Rates:
  • Child rates up to age 26.
  • 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:♦️
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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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: MedPlus
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:
Specialised Radiology:
  • Angiography, MRI and CT scan: Unlimited
  • PET scans: R26,200 per case
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
  • PMBs only
  • Cornea implants: R34,200 per implant
  • Bone marrow/stem cell transplant: R376,900
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: R32,200 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: MedPlus
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
  • R4,300
  • R4,300
  • R4,300
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:
  • R4,300 per person
  • Full family benefit available to any member
  • Shared with GP, specialists, physio, psychology, psychiatric nursing, supplementary services
Childcare:
  • Paediatrician/GP/ENT: 2 consults, 0-2yrs
  • Immunisations: Covered, up to 7yrs
  • Flu shot: Covered
Specialists consultations:
  • R4,300 per person
  • Full family benefit available to any member
  • Shared with GP, specialists, physio, psychology, psychiatric nursing, supplementary services
Pathology:
  • Unlimited
General radiology:
  • Unlimited
Specialised radiology:
  • Angiography, MRI and CT scan: Unlimited
  • PET scans: R26,200 per case
Supplementary Services: (Physio, etc)
  • R3,900 per person
  • Full family benefit available to any member
  • Shared with GP, specialists, physio, psychology, psychiatric nursing, supplementary services
General Appliances:
  • CPAP: R11,400 per person every 2 years
  • Medical Appliances: R2,200 per family
  • Wigs: R2,200 per person
1.1. Hearing Aids:
  • R18,900 per person, every 3 years
1.2. Wheelchairs:
  • R10,200 per person, every 3 years
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: MedPlus
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
  • R4,300
  • R4,300
  • R4,300
Chronic:
  • Non-PMB chronic medicine: R22,000 per person
Acute (presrcibed) medication:
  • R7,850 per person
  • Full family benefit available to any member
Over-the-counter:
  • R450 per family. Paid by scheme once you do a health screening.
Birth Control:
  • Oral, injectable: R178 per month up to R2,300 per year
  • IUD: R2,700 every 60 months
On Discharge:
  • From day-to-day benefit
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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