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

Medimed Standard C:
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 Standard C. 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:Standard C (2025)
Main member: Adult member: Child member:
Total Cost pm:
  • R2,980
  • R2,980
  • R660
Savings:
  • R8,940
  • R8,940
  • R1,980
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R6,000
  • Main+1= R12,000
Children Rates:
  • Pay for all children
Income band:

In-hospital Procedures (2025):

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

Medimed: Standard C
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:
  • 100% 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: . 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:
  • R15,000 per person and R20,000 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)
  • R3,000 per person
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:
  • 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: Standard C
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child:
Savings:
  • R8,940
  • R8,940
  • R1,980
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R6,000
  • Main+1= R12,000
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:
  • From day-to-day benefit
Childcare:
  • From day-to-day benefit
Gap Cover:
Can pay for child ER visits
(Plans coming soon)
Specialist consultations:
  • From day-to-day benefit
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
  • R15,000 per person and R20,000 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:
  • In and out of hospital: R3,000 per person and R6,000 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

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: Standard C
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child:
Savings:
  • R8,940
  • R8,940
  • R1,980
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R6,000
  • Main+1= R12,000
Other Day-to-Day Funds:
Chronic:
  • Extended chronic conditions: R2,000 per person and R4,000 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:
  • 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.

More Information