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

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

Medshield: MediPlus
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	Paid in full	Gap Cover: Can push payout up to 700% scheme rate (Plans coming soon)
Hospital Choice:	Prime 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: R1,500 co-payment Wisdom teeth extraction, day clinic: R800 co-payment Functional Nasal surgery: R1,500 co-payment Laparoscopic, Arthroscopic procedures: R3,500 co-payment Wisdom Teeth, Apicoectomy: R3,500 co-payment Hernia repair: R3,000 co-payment Back and neck surgery: R5,000 co-payment Nissen Fundoplication R5,000 co-payment Hysterectomy: R5,000 co-payment 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.	Gap Cover: Can cover most co-payments (Plans coming soon)
Specialised Radiology:	CT scans, MUGA, MRI, Radio Isotope studies: R16,000 per family, in and out-of-hospital PET scans: 1 scan per family, for oncology	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: R3,300 per person
Transplants:	R183,000 per family Corneal Grafts: : up to R51,900
Dialysis:	R227,000 per family
Exclusions:	NB: See scheme's rules for all exclusions. All schemes have plenty!	Gap Cover: Coming soon
Alternatives to hospitals:	Physical rehab, sub-acute facilities, nursing, hospice: R78,500 per family Terminal care: R55,000 per family
Casualty/ER:	2 facility fees per family Thereafter, 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)

Medshield: MediPlus
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. 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 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 When day to day benefit is depleted, 2 more visits per person Emergency and chronic: Unlimited, once day to day benefit is finished Nurse consult: Unlimited Nurse-led videomed consult: 1 consult
Childcare:	Paediatric: 2 consults, under age of 2 Immunisation: Covered up to 12 yrs	Gap Cover: Can pay for child ER visits (Plans coming soon)
Specialists consultations:	2 per family paid by scheme, thereafter from day-to-day benefit
Pathology:	From day to day benefits
General radiology:	From day to day benefits
Specialised radiology:	CT scans, MUGA, MRI, Radio Isotope studies: R33,100 per family, in and out-of-hospital PET scans: 1 scan per family, for oncology	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)	From day to day benefit
General Appliances:	In and out of hospital: R11,500 per family Stoma Products: Unlimited, if pre-authorized
1.1. Hearing Aids:	From appliance limit
1.2. Wheelchairs:	From appliance limit
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)

Medshield: MediPlus
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. 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 Other Day-to-Day Funds:
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. R8,350 per person and R16,700 per family
Acute (prescribed) medication:	From day-to-day benefit
Over-the-counter:	From day-to-day benefit R1,000 per script
Birth Control:	IUD and alternatives: 1 device, every 2-5 years Pills: R225 per female per month
On Discharge:	R700 per admission
Biological:	Specialised oncology drugs: R145,500 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 Medshield plans, with costs and brief summary. Find all other open medical aid plans here.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider