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

What's on this page:

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

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.

Monthly Costs (2025)

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

Medihelp:MedVital Elect (2025 prices)
Main member: Adult member: Child member:
Total Cost pm:
  • R2,244
  • R1,632
  • R942
  • Only pay for 2 children under 18yrs
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= R1,500
  • Main+1= R2,900
Children Rates:
  • Up to age 26yrs
  • Only pay for 2 children under 18yrs

In-hospital Procedures (2025):

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

Medihelp: MedVital Elect
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:
  • 100% scheme rate
Hospital Choice:
  • Network hospital
  • Day procedure: Network Day hospital
Penalty for using other hospital:
  • non-network hospital : 35% penalty
  • Use of non-Day hospital: 35% penalty
Co-payments:
  • Spinal Column surgery: R18,300 co-payment
  • Endoscopic procedures, in day hospital (all scopes): R5,100 - R7,550 co-payment
  • Dental procedures: R4,100 co-payment
  • Specialized radiology: R2,500 co-payment
  • Prostatectomy: R8,000 co-payment
  • Hysterectomy and Endometrial Ablation: R8,000 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.
Specialised Radiology:
  • MRI and CT scan: R15,000 per family with a R2,500 co-payment, in or out of hospital
Scopes:
  • Endoscopic Procedures: R5,100 copayment
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!
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: R23,900 per family
Casualty/ER:
  • All medical emergencies are paid by scheme, in or out of hospital
  • For non-emergencies, paid for from day-to-day benefit
Other:
  • Speech therapy, OT and physio, post hospital care: R2,300 per person and R3,000 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: MedVital Elect
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
  • Main= R1,500
  • Main+1= R2,900
PMBs out of hospital:
GP consultations:
  • From day-to-day benefit
Childcare:
  • Paediatrician/GP/ENT: 2 consults, 0-2yrs
  • Immunisations: Covered, up to 7yrs
  • Flu shot: Covered
Specialists consultations:
  • From day-to-day benefit
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
  • MRI and CT scan: R15,000 per family with a R2,300 co-payment, in or out of hospital
Scopes:
  • Endoscopic Procedures: R5,100 copayment
Supplementary Services: (Physio, etc)
  • PMBs only
General Appliances:
  • Stoma components: Unlimited
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

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 (2025):

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

Medihelp: MedVital Elect
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
  • Main= R1,500
  • Main+1= R2,900
Chronic:
Acute (prescribed) medication:
  • From day-to-day benefit
Over-the-counter:
  • Care extender benefit: R510 for over the counter meds once you complete a health screening
Birth Control:
  • Oral, injectable/implantable: R150 per month up to R2,100 per year
  • IUD: R2,350 every 5 years
On Discharge:
  • R420 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

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.


What does a “PMBs only” restriction mean?
In this case, the scheme will only pay for diagnosis, treatment and management of a claim for one of 270 pre-defined conditions (PMBs). Read more, and see full list of PMB conditions. 

What does “From Risk” mean?
The scheme will pay for this claim from its own funds, not from your savings or other day-to-day benefits. 

What is a DSP?
A Designated Service Provider. The scheme has a network of providers, and will often only pay claims in full if you use a DSP. If you choose another provider, you might have a co-payment, or even no cover.