• Benefits, dentistry, Medshield Plan, optometry, Scheme Plans, wellness

Medshield Premium Plus:
dentistry, optometry and wellness (2025)

Contents:

This page has information on: Costs, Dentistry, Optometry, Wellness and Preventative and Other benefits for Medshield Premium Plus

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:Premium Plus (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R9,489
  • R8,691
  • R1,815
Savings:
  • R28,464
  • R26,076
  • R5,448
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R5,036
  • R5,924
  • R552
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • 7,500
  • 5,500
  • 3,700
Children Rates:
  • Under 21yrs, or students under 28 yrs
  • Only pay for 3 children (excl students)
medicalaid_guide
FREE GUIDE!
How to choose the right Medical Aid plan
Instant download when you subscribe

Dentistry benefits (2025):

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

Medshield: Premium Plus
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child:
Savings:
  • R28,464
  • R26,076
  • R5,448
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R5,036
  • R5,924
  • R552
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • 7,500
  • 5,500
  • 3,700
Other Day-to-Day Funds:
Standard Dentistry:
  • From day-to-day benefit
Specialised Dentistry:
  • R23,000 per family
  • Wisdom Teeth and Apicoectomy: >R2,000 co-payment if done in-hospital and R800 co-payment if done in day clinic.
  • Crowns, Bridges, Inlays, Mounted Study Models, Partial Metal Base DEntures and Periodontics: From day to day benefits .
Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
In-Hospital Dentistry:
  • Under 6yrs: Unlimited
  • Wisdom Teeth and Apicoectomy: >R2,000 co-payment if done in-hospital and R800 co-payment if done in day clinic. Part of Specialised Dentistry limit.
  • Maxillo-Facial and Oral surgery: R23,000 per family
Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Orthodontics:
  • See "Specialised Dentistry"

Optometry benefits (2025):

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

Medshield: Premium Plus
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child:
Savings:
  • R28,464
  • R26,076
  • R5,448
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R5,036
  • R5,924
  • R552
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • 7,500
  • 5,500
  • 3,700
Other Day-to-Day Funds:
Optometry:
  • From day to day benefit, but not from Above Threshold benefit, every 2 years
Note:
  • This section does not apply to ophthalmology benefits, which fall under "in-hospital" benefits. Some of those are PMBs, and are paid for in full by your scheme. You can read more about PMBs here.

Wellness/Preventative benefits (2025):

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

Medshield: Premium Plus
Assume scheme pays all these costs, unless otherwise stated
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • Covered, 60yrs+
Biometric Screening:
  • Covered
Child Immunisation:
  • Covered, up to 12 yrs
Pap Smear:
  • Covered
Mammogram:
  • Covered, 40yrs+ every 2 yrs
PAS Test:
  • Covered
HIV Test:
  • Covered
Other:
  • Adult vaccines: R2,000 per family
  • Bone density: 1 per person, 50yrs+, every 3 yrs
  • TB test: 1 per person
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.

Other benefits for 2025:

Premium Plus
International Insurance: .
Other: .
    Important!
  • Unless specified, assume that all benefits are paid at 100% scheme rate.
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • "Unlimited" benefits are still subject to authorisation, protocols and sublimits.
  • Assume that all benefits need to be pre-authorised.
medicalaid_guide
FREE GUIDE!
How to choose the right Medical Aid plan
Instant download when you subscribe

More Information