This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Medshield Premium Plus.
In-hospital Procedures (2022):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated |
non-Network Specialists: |
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network Specialists: |
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non-Network GPs: |
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network GPs: |
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Hospital Choice: |
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Day Hospitals: |
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Penalty for using other hospital: |
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Other Co-payments: |
- Endoscopic Procedures: R1,000
- Functional Nasal Surgery: R1,000
- Hernia Repair (except in infants): R3,000
- Laparoscopic procedures: R2,000
- Arthroscopic procedures: R2,000
- Wisdom Teeth in day clinic: R900
- Wisdom Teeth and Apicectomy: R2,000
- Nissen fundoplication: R5,000
- Hysterectomy: R5,000
- Back and neck surgery: R4,000
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Specialised Radiology: |
- R23,460 per family, in and out-of hospital, with 10% co-payment, unless PMB
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Scopes: |
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Supplementary Services: (Physio, etc) |
- Physio: R2,800 per person, then from day-to-day benefits
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Transplants: |
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Dialysis: |
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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.
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Alternatives to hospitals: |
- Physical rehab, sub-acute facilities, nursing, hospice: R103,700 per family
- Terminal care: R43,500 per family
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Casualty: |
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Other: |
Following procedures only covered if done in 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
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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
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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.
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Out-of-hospital Procedures (2022):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
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- 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.
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- From day-to-day benefit
- When day-to-day benfit is finished, 2 more vists per person
- Nurse consult: Unlimited
- Nurse-led videomed consult: Unlimited
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- R23,460 per family, in and out-of hospital, with 10% co-payment
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Scopes: |
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- 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
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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.
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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)
Assume scheme pays all these costs, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
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Chronic: |
- Additional 44 condtitions
- R15,630 per person and R31,250 per family
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- From day-to-day benefit, maximum R250 per script
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- IUD and alternatives: 1 device, every 4 years
- R190 per female per month, from acute medicine benefit
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- 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
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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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