Medshield MediCore:
in-and-out of hospital benefits (2024)

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

We also have information on: Dentistry, Optometry, Wellness and Preventative, Other, Maternity, Cancer, Mental Health and Prosthetics benefits.

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Monthly Costs:

MediCore 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R3,474
  • R2,940
  • R801
  • Only pay for 3 children (excl students)
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.
Children Rates:
  • Under 21yrs, or students under 28 yrs
  • Only pay for 3 children (excl students)
Note:
  • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list.
  • All treatments and procedures are subject to authorisation and protocols
  • All benefits are listed as an indication only. Please verify with your broker and scheme
♦️View all the other benefits for this plan:♦️
Inhospital | 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 Medshield plans, with costs and brief summary
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In-hospital Procedures for 2022:

(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
non-Network Specialists:
  • 200% scheme rate
network Specialists:
  • 200% scheme rate
non-Network GPs:
  • Covered
network GPs:
  • 200% scheme rate
Hospital Choice:
  • Network hospital
Day Hospitals: .
Penalty for using other hospital:
  • 25% co-payment
Other Co-payments:
  • Endoscopic Procedures: R2,000
  • Functional Nasal Surgery: R5,000
  • Hernia Repair (except in infants): R3,000
  • Laparoscopic procedures: R4,000
  • Arthroscopic procedures: R4,000
  • Nissen fundoplication: R5,000
  • Hysterectomy: R5,000
  • Back and neck surgery: R8,000
Specialised Radiology:
  • R10,050 per family, in and out of hospital
  • 10% co-payment, unless PMB
Supplementary Services: (Physio, etc)
  • Physio: R2,800 per person, then from day-to-day benefits
Transplants:
  • PMBs only
Dialysis:
  • PMBs only
Exclusions:
Alternatives to hospitals:
  • Physical rehab, sub-acute facilities, nursing, hospice: R42,710 per family
  • Terminal care: R39,240 per family
Casualty:
  • PMBs only
Other:
    Following procedures only covered if done in doctor's rooms:
  • Breast fine needle biopsy
  • Vasectomy
  • Excision Pterygium with or without graft Excision ganglion wrist
  • Excision of non-malignant lesions less than 2cm
  • Prostate needle biopsy
  • Circumcision
  • Excision wedge ingrown toenail skin of nail fold Drainage skin
  • abscess/curbuncle/whitlow/cyst
Note:
  • 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
♦️View all the other benefits for this plan:♦️
Inhospital | 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 Medshield plans, with costs and brief summary
.
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.

Out-of-hospital Procedures for 2022:

(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
Summary of day-to-day benefits:
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.
PMBs out of hospital:
  • All medical aids 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
  • The benefit is paid by the scheme, and not out of your savings account
  • If you have no day-to-day funds, you still have cover for PMBs
  • 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.
General info:
GP consultations:
  • Network GP visit: 2 per person
  • Nurse consult: Unlimited
  • Nurse-led videomed consult: Unlimited
Childcare:
  • Immunisation: up to 12 yrs
Specialists consultations:
  • PMBs only
Pathology:
  • PMBs only
General radiology:
  • PMBs only
Specialised radiology:
  • R10,050 per family, in and out of hospital
  • 10% co-payment
Supplementary Services: (Physio, etc)
  • PMBs only
General Appliances:
  • PMBs only
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
Note:
  • PMBs: Prescribed Minimum Benefits. To read more about PMBs click here
  • 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
♦️View all the other benefits for this plan:♦️
Inhospital | 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 Medshield plans, with costs and brief summary
.

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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Medication Benefit for 2022:

(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
Summary of day-to-day benefits:
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.
Chronic: .
Acute (presrcibed) medication:
  • No benefit
Over-the-counter:
  • No benefit
Birth Control:
  • R190 per female per month, from acute medicine benefit
On Discharge:
  • R875 per admission
Biological:
  • PMBs only
Note:
  • Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
  • Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
  • PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
  • 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
♦️View all the other benefits for this plan:♦️
Inhospital | 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 Medshield plans, with costs and brief summary
.

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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