Medihelp Plus Comprehensive: in-and-out of hospital benefits (2021)

Share on facebook
Share on twitter
Share on linkedin
Share on email

Table of Contents

This page shows the In-hospital, Out-of-hospital and Medicine benefits for Medihelp Plus Comprehensive.

Pricing:

Plus Comprehensive
Main member: Adult member: Child member:
Total Cost pm: R9,714 R9,714 R2,424
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims, though. See below, and see benefits.
Children:
View all benefits: Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics
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

You can also:

In-hospital Procedures:

Plus Comprehensive
non-Network Specialists:
  • 100% scheme rate
network Specialists:
  • 100% scheme rate
non-Network GPs:
  • 100% scheme rate
network GPs:
  • 100% scheme rate
Hospital Choice:
  • Choose from any hospital
    Penalty for using other hospital:
    • n/a
    Specialised Radiology:
    • MRI/CT Scans: unlimited
    • PET scans: R23,000 per case
    Supplementary Services: (Physio, etc)
    • 100% scheme rate
    Transplants:
    • PMBs only
    Dialysis:
    • Covered
    Day Hospitals:
    • Ophthalmological, endoscopic, ear, nose and throat procedures, removal of skin lesions and circumcisions: Must use a network day surgery
    Co-payments:
    • n/a
    Alternatives to hospitals:
    • Private nursing in lieu of hospitalisation: 100% scheme rate
    • Hospice and sub acute: 100% scheme rate
    • Palliative care: R28,000 per family
    Casualty: When will this be updated?
    Other:
    • Cornea implant: R29 900 per implant per year
    • Post-hospital care: Speech and occupational therapy and physiotherapy for up to 30 days after discharge: R1,870 per person and R2,600 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
    • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones here, but you must consult with your scheme to get the full list.

    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.

    Looking for this plan's other benefits?

    Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics


    Out-of-hospital Procedures:

    Plus Comprehensive
    Summary of day-to-day benefits:
    Main Member: Adult: Child:
    Savings /yr: No savings option on this plan
    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:
    • R3,700 per family
    • Shared with GP, specialists, physiotherapy, psychologist and supplementary health providers benefits
    Childcare:
    • Child flu vaccination at network pharmacy clinics
    • Babies under 2 years receive 2 additional visits to a GP, paediatrician or ear, nose and throat specialist
    • Full schedule of standard child immunisations covered up to 7 years at network pharmacy clinics
    Specialists consultations:
    • R3,700 per family
    • Shared with GP, specialists, physiotherapy, psychologist and supplementary health providers benefits
    Pathology:
    • Unlimited
    General radiology:
    • Unlimited
    Specialised radiology:
    • MRI/CT Scans: unlimited
    • PET scans: R23,000 per case
    Supplementary Services: (Physio, etc)
    • R3,700 per family
    • Shared with GP, specialists, physiotherapy, psychologist and supplementary health providers benefits
    General Appliances:
    • Medical Appliances, Hyperbaric oxygen: R1,850 per family, every 3 years
    • CPAP apparatus: R10,000 per person, every 2 years
    1.1. Hearing Aids:
    • R16,400 per person, every 3 years
    1.2. Wheelchairs:
    • R8,900 per person, every 3 years
    Note:
    • 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

    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.

    Looking for this plan's other benefits?

    Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics


    Medication cover:

    Plus Comprehensive
    Summary of day-to-day benefits:
    Main Member: Adult: Child:
    Savings /yr: No savings option on this plan
    Chronic:
    • non-PMB medicine: R18,800 per person
    Acute (presrcibed) medication:
    • non-PMB medicine: R6,440 per person
    Over-the-counter: .
    Birth Control: .
    On Discharge: .
    Biological: When will this be updated?
    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

    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.

    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

    There’s more help here:

    Hi! I'm Eve Dmochowska, rehealth's founder.

    Thanks for reading this far! I hope it was useful.

    rehealth is a small, self-funded startup, growing the mission to help South Africans make informed healthcare choices. An informed patient is a healthier patient!

    If you found this helpful, please share it using buttons below:-)

    And if you are in the business of healthcare and see opportunities here, please give me a shout. hello@rehealth.co.za

    Share on facebook
    Share on twitter
    Share on linkedin
    Share on email