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

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

Contents:

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

Medshield:MediValue (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R3,207
  • R2,802
  • R906
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.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R8,500
  • Main+1= R10,200
  • Main+2= R10,600
  • Main+3= R12,000
  • Main+4+= R13,000
Children Rates:
  • Under 21yrs, or students under 28 yrs
  • Only pay for 3 children (excl students)
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In-hospital Procedures (2025):

(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
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: R2,000 co-payment
  • Wisdom teeth extraction, day clinic: R800 co-payment
  • Functional Nasal surgery: R2,000 co-payment
  • Laparoscopic, Arthroscopic procedures: R4,000 co-payment
  • Wisdom Teeth, Apicoectomy: R4,000 co-payment
  • Hernia repair: R3,000 co-payment
  • Nissen Fundoplication R5,000 co-payment
  • Hysterectomy: R5,000 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: R11,600 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:
  • 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:
  • Physical rehab, sub-acute facilities, nursing, hospice: R36,700 per family
  • Terminal care: R36,700 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: MediValue
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= R8,500
  • Main+1= R10,200
  • Main+2= R10,600
  • Main+3= R12,000
  • Main+4+= R13,000
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:
  • Nominated GP: From day-to-day benefit
  • Emergency and chronic: Unlimited, once day to day benefit is finished
  • Nurse consult: Unlimited
  • Nurse-led videomed consult: Unlimited
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)
Specialist consultations:
  • 2 per family paid by scheme, thereafter from day-to-day benefit
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
  • CT scans, MUGA, MRI, Radio Isotope studies: R11,600 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: R3,300 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

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)

Medshield: MediValue
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= R8,500
  • Main+1= R10,200
  • Main+2= R10,600
  • Main+3= R12,000
  • Main+4+= R13,000
Other Day-to-Day Funds:
Chronic: .
Acute (prescribed) medication:
  • From day-to-day limit
Over-the-counter:
  • R700 per script, from day-to-day limit
Birth Control:
  • IUD and alternatives: 1 device, every 4 years
  • Contraceptives: : R225 per female per month
On Discharge:
  • R875 per admission
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.

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