• Benefits, in-hospital, Medimed Plan, out-hospital, Scheme Plans

Medimed Alpha:
in-and-out of hospital benefits (2025)

Contents:

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Medimed Alpha. 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 Providers. Where stipulated, you must use 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 (2026)

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

Medimed:Alpha (2025)
Main member: Adult member: Child member:
Total Cost pm:
  • R1,820
  • R1,820
  • R620
Savings:
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Children Rates:
  • Pay for all children
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In-hospital Procedures (2025):

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

Medimed: Alpha
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:
  • PMBs: 100% scheme rate
  • non-PMBs: 75% scheme rate
 Gap Cover:
Can push payout up to 700% scheme rate
(Plans coming soon)
Hospital Choice:
  • Any hospital
Penalty for using other hospital:
  • n/a
 Gap Cover:
Can cover the penalty in full
(Plans coming soon)
Co-payments:
  • non-PMB conditions have 25%-40% co-payment for services
  • Conservative neck and back treatment: R3,000 co-payment
  • Arthroscopy, FESS, endometrial ablation, laparoscopy and hysterectomy: R5,000
  • Nissan, spinal surgery and joint replacements: R10,000
Note:
  • 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, especially if you don't use a DSP for a PMB or when buying medicine.
 Gap Cover:
Can cover most co-payments
(Plans coming soon)
Specialised Radiology:
  • R10,000 per person and R15,000 per family
  • Paid at 75% scheme rate
  • In or out of hospital
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Scopes: Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Supplementary Services: (Physio, etc)
  • PMBs only
Transplants:
  • PMBs only
Dialysis:
  • PMBs only
Exclusions:
  • NB: See scheme's rules for all exclusions. All schemes have plenty!
 Gap Cover:
Coming soon
Alternatives to hospitals:
  • Step-down facilities: R15,000 per person
  • Compassionate care: R20,000 per person
Casualty/ER:
  • PMBs only
 Gap Cover:
Can cover ER claims
(Plans coming soon)
Other:
  • Pathology: Paid at 75% of scheme rate
  • Radiology: Paid at 75% of scheme rate
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)

Medimed: Alpha
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.
Other Day-to-Day Funds:
PMBs out of hospital:
  • All schemes 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.
  • PMB benefits must never be paid from your savings account.
  • 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.
GP consultations:
  • R3,500 per person and R8,000 per family
  • Paid at 75% scheme rate
  • Shared with GPs and Specialists benefit
Childcare: . Gap Cover:
Can pay for child ER visits
(Plans coming soon)
Specialist consultations:
  • R3,500 per person and R8,000 per family
  • Paid at 75% scheme rate
  • Shared with GPs and Specialists benefit
Pathology:
  • Paid at 75% scheme rate
General radiology:
  • 75% scheme rate
Specialised radiology:
  • R10,000 per person and R15,000 per family
  • Paid at 75% scheme rate
  • In or out of hospital
 Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)
Scopes: Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)
Supplementary Services: (Physio, etc)
  • R2,000 per person and R4,000 per family
  • Paid at 60% scheme rate
General Appliances:
  • R4,000 per family
  • Paid at 60% scheme rate
1.1. Hearing Aids:
  • See above
1.2. Wheelchairs:
  • See above
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)

Medimed: Alpha
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.
Other Day-to-Day Funds:
Chronic:
  • Extended chronic conditions: R3,000 per person and R6,000 per family
Acute (prescribed) medication:
  • R2,000 per person and R6,000 per family
  • Paid at 60% scheme rate
Over-the-counter:
  • R120 per script and R1,200 per family
  • From Acute Medicine benefit
  • Paid at 60% scheme rate
Birth Control:
  • No benefit
On Discharge: .
Biological:
  • PMBs only
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.

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