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

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

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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: Max A
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	100% scheme rate
Hospital Choice:	Any hospital
Penalty for using other hospital:	n/a
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.
Specialised Radiology:	R20,000 per person and R30,000 per family In or out of hospital
Scopes:
Supplementary Services: (Physio, etc)	R4,000 per person
Transplants:	PMBs only
Dialysis:	PMBs only
Exclusions:	NB: See scheme's rules for all exclusions. All schemes have plenty!
Alternatives to hospitals:	Step-down facilities: R20,000 per person Compassionate care: R30,000 per person
Casualty/ER:	From day-to-day benefit
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: Max A
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child: Savings: R12,600 R12,600 R2,310 Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account Main= R7,500 Main+1= R15,000
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:	From day-to-day benefit
Childcare:	From day-to-day benefit
Specialists consultations:	From day-to-day benefit
Pathology:	From day-to-day benefit
General radiology:	From day-to-day benefit
Specialised radiology:	R20,000 per person and R30,000 per family In or out of hospital
Scopes:
Supplementary Services: (Physio, etc)	From day-to-day benefit
General Appliances:	In and out of hospital: R4,000 per person and R8,000 per family 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: Max A
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child: Savings: R12,600 R12,600 R2,310 Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account Main= R7,500 Main+1= R15,000
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. Extended chronic conditions: R3,500 per person and R7,000 per family
Acute (prescribed) medication:	From day-to-day benefit
Over-the-counter:	R200 per script and R1,800 per family From day-to-day benefit
Birth Control:	From day-to-day benefit
On Discharge:	.
Biological:	R200,000 per family
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