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

Medshield MediCore: in-and-out of hospital benefits (2027)

Contents:

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Medshield MediCore. 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

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

Medshield:MediCore (2027)
Main member: Adult member: Child member:
Total Cost pm:
  • R4,701
  • R3,975
  • R1,086
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:
  • Under 24yrs, or students under 28 yrs
  • Only pay for 3 children (excl students)
Medshield:MediCore (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R4,278
  • R3,618
  • R987
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:
  • Under 24yrs, or students under 28 yrs
  • Only pay for 3 children (excl students)
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In-hospital Procedures (2027):

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

Medshield: MediCore
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:
  • 100% - 200% scheme rate
 Gap Cover:
Can push payout up to 700% scheme rate
(Plans coming soon)
Hospital Choice:
  • Compact Hospital Network
Penalty for using other hospital:
  • 30% penalty
 Gap Cover:
Can cover the penalty in full
(Plans coming soon)
Co-payments: In-hospital or day clinic:
  • Endoscopic Procedures: R2,000 co-payment
  • Functional Nasal surgery: R5,000 co-payment
  • Laparoscopic, Arthroscopic procedures: R4,000 co-payment
  • Hernia repair: R3,000 co-payment
  • Nissen Fundoplication R5,000 co-payment
  • Hysterectomy: R5,000 co-payment
  • Back and Neck surgery: R8,000 co-payment
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:
  • CT scans, MUGA, MRI, Radio Isotope studies: R13,000 per family, in-hospital and out-of-hospital, unless PMB
  • PMB level of care: paid by scheme
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Scopes:
  • No co-payment if done in rooms
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Supplementary Services: (Physio, etc)
  • Physio: R3,600 per person
Transplants:
  • PMB only
  • Corneal Grafts (internationally sourced): up to R54,250
  • Corneal Grafts (locally sourced): up to R23,250
Dialysis:
  • PMB only
Exclusions:
  • NB: See scheme's rules for all exclusions. All schemes have plenty!
 Gap Cover:
Coming soon
Alternatives to hospitals:
  • R53,300 per family
  • Treatment only available immediately following an event
  • Includes: Physical rehab, sub-acute facilities, nursing, hospice
  • Hospital-at-home: see above limit
  • Terminal care: R53,300 per family. PMB level of care, subject to above limit
Casualty/ER:
  • PMB only
 Gap Cover:
Can cover ER claims
(Plans coming soon)
Other: .
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

Out-of-hospital Procedures (2027):

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

Medshield: MediCore
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: SmartCare Benefits in SmartCare network:
  • Pharmacy/Clinic private Nurse consult: Unlimited
  • Mental Health consult: Unlimited, if done by nurse
  • Nurse-led virtual GP consults: 1 consult per family
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:
  • Network GP: 2 consults per person
  • Virtual care (GP and Specialists): 3 consults per family
Childcare: . Gap Cover:
Can pay for child ER visits
(Plans coming soon)
Specialist consultations:
  • Virtual care (GP and Specialists): 3 consults per family
Pathology:
  • PMB only
General radiology:
  • PMB only
Specialised radiology:
  • CT scans, MUGA, MRI, Radio Isotope studies: R13,000 per family, in-hospital and out-of-hospital, unless PMB
  • PMB level of care: paid by scheme
 Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)
Scopes:
  • No co-payment if done in rooms
 Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)
Supplementary Services: (Physio, etc)
  • PMB only
General Appliances:
  • PMB only
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
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 (2027):

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

Medshield: MediCore
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: SmartCare Benefits in SmartCare network:
  • Pharmacy/Clinic private Nurse consult: Unlimited
  • Mental Health consult: Unlimited, if done by nurse
  • Nurse-led virtual GP consults: 1 consult per family
Chronic:
  • 20% co-payment for non-formulary or using a non-DSP
Acute (prescribed) medication:
  • No benefit
Over-the-counter:
  • No benefit
Birth Control:
  • Pills: R225 per female per month, from acute medicine benefit
On Discharge:
  • R500 per admission
Biological:
  • PMB 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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