Medihelp Unify medical aid plan: 2019

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

Unify
2019 Costs:
Total Cost pm:

Main member:

R2,304

Adult:

R1,896

Child: Pay for all

R696
Savings: R6,912 R5,688 R2,088
NEED HELP?
We can help you manage or change this plan.
Click here to start.

IN HOSPITAL PROCEDURES:
Unify
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 any hospital
Specialised Radiology:
  • You or your gap pay R1,550 co-payment
  • In and out of hospital
Supplementary Services: (Physio, etc)
  • Up to 100% scheme rate
  • Professional services for up to 30 days after discharge following hospital admission: speech therapy, occupational therapy and physiotherapy. R1,750 per person and R2,400 per family
Transplants:
  • PMBs only
  • Cornea implants: R27,400
Co-payments:
    Back and neck fusion: R9,950 co-payment
  • Gastroscopy and Colonoscopy:
    • in doctor's rooms: no co-payment, paid from day-to-day benefit
    • in day hospital: R2,650 co-payment
    • in-hospital: R3,700 co-payment
  • Specialised radiology (MRIs and CT Scans): R1,600 co-payment
  • In-hospital dentistry: R3,000 co-payment
  • Co-payments paid by you or your gap cover
Alternatives to hospitals:
  • Hospice and sub-acute facilities: paid by scheme, subject to authorisation
  • Private nursing: paid by scheme, subject to authorisation
Casualty:
  • From day-to-day benefits
Other:
  • Robotic assisted laparoscopic procedure for prostatectomy: R100,400 per person
  • Neurostimulators: R105,400 per person
  • Hyperbaric oxygen in-hospital: R600 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):
Unify
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: R6,912 R5,688 R2,088
General info: 2019 Benefits coming November 9, 2018
GP consultations:
    From day-to-day benefit , unless PMB.
Childcare: 2019 Benefits coming November 9, 2018
Specialists consultations:
    From day-to-day benefit , unless PMB.
Pathology:
    From day-to-day benefit , unless PMB.
General radiology:
    From day-to-day benefit , unless PMB.
Specialised radiology:
  • R1,600 co-payment, in or out of hospital, unless PMB
Supplementary Services: (Physio, etc)
  • Also, speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge following hospital admission. Limited to R1,750 per person and R2,400 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:
Unify
Scheme Benefits Notes and Links:
Hospital stay:
  • Hospital delivery: 100% scheme rate
  • Home delivery: R12,400
Consultations:
  • From day-to-day benefits
Scans:
  • From day-to-day benefits
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):
Unify
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • R220,000 per family per year for non-PMB cases
  • PMBs covered in full
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:
Unify
Scheme Benefits Notes and Links:
Standard Dentistry:
  • Standard dentistry: from day-to-day benefits
Specialised Dentistry:
  • Specialised dentistry: from day-to-day benefits
In-Hospital Dentistry:
  • Maxilo-facial surgery: No benefit, unless PMB
Orthodontics:
  • From day-to-day benefits
Maxillo Facial Surgery:
  • No benefit, unless PMB
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:
Unify
Scheme Benefits: Notes and Links:
Chronic:
  • Conditions covered:27 CDL conditions
  • Co-payment for use of non-formulary:
Acute (presrcibed) medication:
  • From day-to-day benefit
Over-the-counter:
  • From day-to-day benefits
Birth Control:
  • From day-to-day benefits
On Discharge:
  • From day-to-day benefits
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:
Unify
Scheme Benefits: Notes and Links:
Optometry:
Limit:From day-to-day benefit
Consult:n/a
Frames:n/a
Single lensesn/a
Bifocals:n/a
Multifocalsn/a
Contactsn/a
Refractive Surgery:n/a
Notes:n/a
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:
Unify
Scheme Benefits Notes and Links:
In-hospital: 2019 Benefits coming November 9, 2018
Out-of-hospital:
  • From day-to-day benefits
/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:
Unify
Scheme Benefits Notes and Links:
General Appliances:
  • Medical Appliances, CPAP apparatus and hyperbaric oxygen: paid from day-to-day savings
  • Stoma products and urine bags: paid by scheme
  • No benefit
1.1. Hearing Aids:
  • From day-to-day benefits
1.2. Wheelchairs:
  • From day-to-day benefits
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:
  • Transport by road outside RSA: R1,950 per event
  • Transport by air outside RSA: R13,000 per event
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:
Unify
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • No benefit
Back Rehabilitation Programme:
  • Covered
Biometric Screening:
  • Covered
Child Immunisation:
  • No benefit
Pap Smear:
  • No benefit
Mammogram:
  • No benefit
PAS Test:
  • No benefit
HIV Test:
  • Covered
Other: 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.

.
.
PROSTHETICS:
Unify
Scheme Benefits: Notes and Links:
Overal Limit: Most non-PMB sublimits are increased by gap cover, if authorised by medical aid
  • EVARS prosthesis: R124,000
  • Vascular/cardiac prosthesis: R53,100
  • Health-essential functional prosthesis: R58,800. This includes non-PMB hip, knee and shoulder replacements, with no benefit for wear and tear
  • Intra-ocular lenses: R3,950 per lens, 2 lenses per beneficiary per year and subject to health-essential functional prosthesis benefit (above)
  • Prosthesis with reconstructive or restorative surgery, (in and out of hospital) or external breast prostheses, (in and out of hospital): R9,150 per family per year
  • External prosthesis: from day-to-day benefit
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