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

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

• View all the Medimed plans, with costs and brief summary.
• View all open medical aid plans.
• Compare any two plans side by side, instantly.

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.

In-hospital Procedures (2025):

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

Medimed: Essential C
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	DSPs: 100% scheme rate non-DSPs: 80% scheme rate	Gap Cover: Can push payout up to 700% scheme rate (Plans coming soon)
Hospital Choice:	Network
Penalty for using other hospital:	Non-network: 80% scheme rate	Gap Cover: Can cover the penalty in full (Plans coming soon)
Co-payments:	. 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.	Gap Cover: Can cover most co-payments (Plans coming soon)
Specialised Radiology:	R10,000 per person and R15,000 per family 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)	R2,000 per person
Transplants:	R50,000 per family Shared with dialysis, organ transplant and oncology benefits
Dialysis:	R50,000 per family Shared with dialysis, organ transplant and oncology benefits
Exclusions:	NB: See scheme's rules for all exclusions. All schemes have plenty!	Gap Cover: Coming soon
Alternatives to hospitals:	Step-down facilities: R6,000 per person Compassionate care: R20,000 per person
Casualty/ER:	R500 per family Then, from day-to-day benefit	Gap Cover: Can cover ER claims (Plans coming soon)
Other:	.
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: Essential C
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child: Savings: R2,976 R2,976 R780 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:	Nominated GP: Unlimited, paid by scheme non-Nominated GP: 6 consults per person, from day to day benefit
Childcare:	.	Gap Cover: Can pay for child ER visits (Plans coming soon)
Specialists consultations:	R3,000 per person and R6,000 per family Paid by scheme
Pathology:	Unlimited, if referred by GP Paid by scheme
General radiology:	Unlimited, if referred by GP Paid by scheme
Specialised radiology:	R10,000 per person and R15,000 per family 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)	From day-to-day benefit
General Appliances:	From day to day benefit
1.1. Hearing Aids:	See above
1.2. Wheelchairs:	See above
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Medication Benefit (2025):

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

Medimed: Essential C
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child: Savings: R2,976 R2,976 R780 Other Day-to-Day Funds:
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. .
Acute (prescribed) medication:	Unlimited, if prescribed by selected GP from formulary
Over-the-counter:	R120 per script and R450 per family From day-to-day benefit
Birth Control:	From day to day benefit
On Discharge:	.
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 Medimed plans, with costs and brief summary. Find all other open medical aid plans here.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider