Medihelp Necesse C medical aid plan: 2019

View all plans in this scheme.
Always consult with your broker before making final decisions regarding your healthcare cover.

Necesse C
2019 Costs:
Total Cost pm:

Main member:

R2,280

Adult:

R1,784

Child: Pay for all under 21yrs

R990
Savings (per year):
  • No savings option on this plan
Income band:
NEED HELP?
We can help you manage or change this plan.
Click here to start.

IN HOSPITAL PROCEDURES:
Necesse C
Scheme Benefits: Notes and Links:
Specialists:
  • Up to 100% scheme rate
  • You or gap cover pay the balance, if any
Gap Cover
  • Gap cover is available for this plan. Budget about R350 for a fully comprehensive gap cover that will increase the scheme rate to 500% and pay most co-payments and increase sublimits.
Hospital Choice:
  • Choose a Network Hospital
Specialised Radiology:
  • R15,000 per family
  • In and out of hospital
Supplementary Services: (Physio, etc)
  • Physiotherapy and occupational therapy: R9,350 per family
Transplants:
  • PMBs only
  • Cornea implants: R27,400 per implant
Co-payments:
  • N/A
Alternatives to hospitals:
  • Private nursing and sub-acute care: R21,200 per family, subject to authorisation.
Casualty:
  • Unlimited for PMBs, otherwise 80% of scheme rate up to R1,050 per person and R2,150 per family
  • Radiology 65% scheme rate and forms part of above limit
  • Pathology 100% rate, separate from above limit
  • Excludes facility fee
Other:
  • Robotic assisted laparoscopic procedure: R105,400 per person
  • Pathology, standard radiology and clinical technologist services: R29,000 per family
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

.
.
.
.
OUT OF HOSPITAL BENEFITS (non-PMB):
Necesse C
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
General info: 2019 Benefits coming November 9, 2018
GP consultations:
  • Network GP: 9 consults per person
  • . Thereafter PMBs only.
Childcare: 2019 Benefits coming November 9, 2018
Specialists consultations:
  • Specialist care (consult and treatment or intervention): R2,950 per person and R3,050 per family
  • This benefit covers specialist consultations, surgical and non-surgical procedures, endoscopic procedures, radiology interventions, pathology, acute medicine
Pathology:
  • Paid by scheme
General radiology:
  • Paid by scheme
Specialised radiology:
  • R15,700 per family, in and out of hospital
Supplementary Services: (Physio, etc)
    Physiotherapy and Occupational therapy: R1,950 per person and R3,050 per family
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
MATERNITY BENEFITS:
Necesse C
Scheme Benefits Notes and Links:
Hospital stay:
  • Hospital delivery: 100% scheme rate
  • Elective C-section: R25,000
  • Home delivery: R12,400
Consultations:
  • GP: 9 consults, shared with GP benefit.
  • Midwife service, pre and post natalcare: Unlimited
Scans:
  • No additional benefit
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
CANCER (ONCOLOGY):
Necesse C
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • PMBs only
  • Designated Service Provider: ICON
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
DENTISTRY:
Necesse C
Scheme Benefits Notes and Links:
Standard Dentistry:
  • Standard Dentistry: paid by scheme.
  • Includes:
    • 1 annual checkup
    • X-rays, 4 per person per year. (Extra-oral 1 every 3 years)
    • 1 annual scale or polish treatments per person
    • 4 fillings per person per year
    • Extractions and root canals
    • Fluoride treatment (5-13yrs) and Fissure sealants (under 16yrs)
    • Plastic dentures, 1 set per family every 2 years
Specialised Dentistry:
  • Plastic dentures: 1 set per family every 2 years
In-Hospital Dentistry:
  • Maxilo-facial surgery: No benefit, unless PMB
  • In-hospital: PMBs only for children under 5yrs
  • Orthodontics:
    • No benefit
    Maxillo Facial Surgery:
    • PMBs only
    What next?
    We will email you a quote for this and two other comparable plans. No phone calls.

    Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

    .
    .
    MEDICATION:
    Necesse C
    Scheme Benefits: Notes and Links:
    Chronic:
    • Conditions covered:27 CDL conditions
    • Co-payment for use of non-formulary:
    Acute (presrcibed) medication:
    • If dispensed by GP: 100% of scheme rate
    • If dispensed by pharmacy: 100% of MMAP (maximum medical aid price)
    Over-the-counter:
    • R100 per event, R280 per person per year
    Birth Control: 2019 Benefits coming November 9, 2018
    On Discharge:
    • R340 per admission
    Biological:
    • No benefit, unless PMB level of care
    What next?
    We will email you a quote for this and two other comparable plans. No phone calls.

    Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

    .
    .
    OPTOMETRY:
    Necesse C
    Scheme Benefits: Notes and Links:
    Optometry:
    Limit:Paid by scheme, every 2 years
    Consult:1 per person
    Frames:R550 per person
    Single lenses1 set per person
    Bifocals:
    Multifocals
    ContactsR730 per person
    Refractive Surgery:
    Notes:From network provider
    What next?
    We will email you a quote for this and two other comparable plans. No phone calls.

    Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

    .
    .
    MENTAL HEALTH:
    Necesse C
    Scheme Benefits Notes and Links:
    In-hospital: 2019 Benefits coming November 9, 2018
    Out-of-hospital:
    • PMBs only
    /td>
    Trauma:
    • Netcare 911 phoneline
    What next?
    We will email you a quote for this and two other comparable plans. No phone calls.

    Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

    .
    .
    OTHER BENEFITS:
    Necesse C
    Scheme Benefits Notes and Links:
    General Appliances:
    • PMB cases: back, leg, arm and neck supports, crutches, orthopaedic footwear, elastic stockings, peakflow meters, nebulisers: 100% scheem rate
    • CPAP: R9,250 per person every 24 months
    • No benefit
    1.1. Hearing Aids:
    • No benefit, unless PMB
    1.2. Wheelchairs:
    • R4,500 per family, every 3 years
    Dialysis:
    • PMBs only
    HIV:
    • Post exposure prophylaxis in the event of sexual assault or accidental exposure to HIV
    • Paid by scheme
    • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
    Emergency Transport:
    • Netcare 911
    International Insurance: 2019 Benefits coming November 9, 2018
    Other:
    • Oxygen out-of-hospital: paid by scheme
    What next?
    We will email you a quote for this and two other comparable plans. No phone calls.

    Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

    .
    .
    WELLNESS/PREVENTATIVE BENEFITS:
    Necesse C
    Scheme Benefits: Notes and Links:
    Flu vaccination:
    • Covered, from over-the-counter medicine benefit
    Pneumonia vaccines:
    • No benefit, unless PMB
    Back Rehabilitation Programme:
    • Covered
    Biometric Screening:
    • Covered
    Child Immunisation:
    • No benefit, unless PMB
    Pap Smear:
    • Covered
    Mammogram:
    • Covered, 40yrs+
    PAS Test:
    • Covered, 40yrs+
    HIV Test:
    • Covered
    Other:
    • Bone density, 50yrs+
    • Tetanus vaccine or flu vaccine option
    What next?
    We will email you a quote for this and two other comparable plans. No phone calls.

    Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

    .
    .
    PROSTHETICS:
    Necesse C
    Scheme Benefits: Notes and Links:
    Overal Limit:
    • Evars prosthesis, vascular/cardiac prosthesis, health-essential prosthesis: R21,900 per person
    • Intra-ocular lenses, prosthesis with reconstructive or restorative surgery, external breast prosthesis: PMBs only
    Sub-limits: 2019 Benefits coming November 9, 2018
    What next?
    We will email you a quote for this and two other comparable plans. No phone calls.

    Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.


      Important!
    • Unless specified, assume that all benefits are paid 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