Medshield MediPlus Compact:
in-and-out of hospital benefits (2025)

What's on this page:

  1. Monthly Costs (2025)
  2. In-hospital Procedures (2022):
  3. Out-of-hospital Procedures (2022):
  4. Medication Benefit (2022):
This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Medshield MediPlus Compact.

Monthly Costs (2025)

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

MediValue 2025 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R4,533
  • R3,234
  • R1020
  • 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.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R11,000
  • Main+1= R15,000
  • Main+2= R17,000
  • Main+3= R18,500
  • Main+4+= R20,000
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:
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 Medshield plans, with costs and brief summary.

Find all other open medical aid plans here.
.

In-hospital Procedures (2022):

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

Medshield: MediValue
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
non-Network Specialists:
  • Covered
Scheme rate is set by Medshield
network Specialists:
  • Covered
non-Network GPs:
  • Covered
network GPs:
  • Covered
Hospital Choice:
  • Prime Hospital network
Day Hospitals: .
Penalty for using other hospital:
  • 25% penalty
 You don't pay a penalty if admission was unavoidable due an emergency
Other Co-payments:
  • Endoscopic Procedures: R2,000 . No co-payment if done in doctor's rooms.
  • Functional Nasal Surgery: R2,000
  • Hernia Repair (except in infants):R3,000
  • Laparoscopic procedures: R4,000
  • Arthroscopic procedures: R4,000
  • Nissen fundoplication: R5,000
  • Hysterectomy: R5,000
  • Wisdom Teeth: R4,000
* There might be other co-payments if you don't use scheme-chosen provider for some services.

* Treatment required for PMB level care is always paid by scheme, with no co-payment, if you follow the protocols.
That means that these co-payments might not apply in your case! More info here
Specialised Radiology:
  • R9,400 per family, in and out-of-hospital
  • 8% co-payment, unless PMB
 No limits or co-payments for PMB level care and/or for emergency
Scopes: No limits or co-payments for PMB level care and/or for emergency
Supplementary Services: (Physio, etc)
  • Physio: R2,800 per person, then from day-to-day benefits
 No limits or co-payments for PMB level care and/or for emergency
Transplants:
  • PMBs only
Dialysis:
  • PMBs only
Exclusions: Exclusions:
  • Note: All schemes have extensive exclusions. We've tried to list the major ones here, but please consult your scheme or broker to get the full list.
 * Treatment required for PMB level of care is always paid by scheme, if you follow the protocols. It cannot be excluded. More info here.

Alternatives to hospitals:
  • Physical rehab, sub-acute facilities, nursing, hospice: R31,250 per family
  • Terminal care: R13,000 per family
Casualty:
  • fromday-to-day limit
Other:
    Following procedures only covered out of above limit if done in network 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:
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 Medshield plans, with costs and brief summary.

Find all other open medical aid plans here.
.

Out-of-hospital Procedures (2022):

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

Medshield: MediValue
Assume scheme pays all these costs, at 100% scheme rate, 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.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R11,000
  • Main+1= R15,000
  • Main+2= R17,000
  • Main+3= R18,500
  • Main+4+= R20,000
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:
  • Nominated GP: day-to-day benefit/strong>
  • 2 consults per person once day-to-day benefit is finished
  • Nurse consult: Unlimited
  • Nurse-led videomed consult: Unlimited
 Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Childcare:
  • Vaccines: up to 12 yrs
Specialists consultations:
  • 2 per family, thereafter from day-to-day benefit
 Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
  • R9,800 per family, in and out-of hospital, with 10% co-payment
 Scans required for PMB level care are paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Scopes: No limits or co-payments for PMB level care and/or for emergency
Supplementary Services: (Physio, etc)
  • From day-to-day limit
General Appliances:
  • R2,800 per family
1.1. Hearing Aids:
  • From appliance limit
1.2. Wheelchairs:
  • From appliance limit
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:
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 Medshield plans, with costs and brief summary.

Find all other open medical aid plans here.
.

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 (2022):

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

Medshield: MediValue
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.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R11,000
  • Main+1= R15,000
  • Main+2= R17,000
  • Main+3= R18,500
  • Main+4+= R20,000
Chronic: . You might be required to use specific pharmacies and be limited to specific medicines
Acute (presrcibed) medication:
  • From day-to-day limit
Over-the-counter:
  • From day-to-day limit, and R250 per script
Birth Control:
  • IUD and alternatives: 1 device, every 4 years
  • R190 per female per month, from acute medicine benefit
On Discharge:
  • R875 per admission
Biological:
  • PMBs only
Treatment that is required (by law) for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here.)
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:
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 Medshield plans, with costs and brief summary.

Find all other open medical aid plans here.
.

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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