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

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Medshield Premium Plus. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

• View all the Medshield plans, with costs and brief summary.
• View all open medical aid plans.
• Compare any two plans side by side, instantly.

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: Premium Plus
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	Paid in full
Hospital Choice:	Any hospital
Penalty for using other hospital:	n/a
Co-payments:	In-hospital or Day Clinic: Endoscopic Procedures: R1,000 co-payment Wisdom teeth extraction, day clinic: R800 co-payment Functional Nasal surgery: R1,000 co-payment Laparoscopic, Arthroscopic procedures: R2,000 co-payment Wisdom Teeth, Apicoectomy: R2,000 co-payment Hernia repair: R3,000 co-payment Back and neck surgery: R4,000 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.
Specialised Radiology:	CT scans, MUGA, MRI, Radio Isotope studies: R33,100 per family, in and out-of-hospital PET scans: 2 scans per family, for oncology
Scopes:	No co-payment if done in rooms
Supplementary Services: (Physio, etc)	Physio: R3,000 per person, then from day-to-day benefit
Transplants:	Covered Corneal Grafts: : up to R51,900
Dialysis:	Covered
Exclusions:	NB: See scheme's rules for all exclusions. All schemes have plenty!
Alternatives to hospitals:	Physical rehab, sub-acute facilities, nursing, hospice: R166,000 per family Terminal care: R60,000 per family
Casualty/ER:	2 facility fees per family Thereafter, from day-to-day benefit
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: Premium Plus
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child: Savings: R21,084 R19,308 R4,032 Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit) R2,766 R2,742 R418 "Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid the self payment gap. 7,000 5,000 3,500
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 savings is depleted, 2 more visits per person Emergency and chronic: Unlimited, once savings is finished Nurse consult: Unlimited Nurse-led videomed consult: Unlimited
Childcare:	Paediatric: 2 consults, under age of 2 Immunisation: Covered up to 12 yrs
Specialists consultations:	From day-to-day benefit 30% co-payment if non-DSP is used
Pathology:	From day to day benefits Not paid from Above Threshold Benefit
General radiology:	From day to day benefits Not paid from Above Threshold Benefit
Specialised radiology:	CT scans, MUGA, MRI, Radio Isotope studies: R33,100 per family, in and out-of-hospital PET scans: 2 scans per family, for oncology
Scopes:	No co-payment if done in rooms
Supplementary Services: (Physio, etc)	From day to day benefit
General Appliances:	In and out of hospital: R17,500 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: Premium Plus
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child: Savings: R21,084 R19,308 R4,032 Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit) R2,766 R2,742 R418 "Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid the self payment gap. 7,000 5,000 3,500
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. Additional 54 conditions R18,400 per person and R36,800 per family
Acute (prescribed) medication:	From day-to-day benefit Not paid from Above Threshold benefit
Over-the-counter:	From day-to-day benefit R1,000 per family if paid from Above Threshold
Birth Control:	IUD and alternatives: 1 device, every 2-5 years Pills: R225 per female per month
On Discharge:	R1,000 per admission
Biological:	Specialised oncology drugs: R437,250 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