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

What's on this page:

  1. Monthly Costs (2025)
  2. In-hospital Procedures (2022):
  3. Out-of-hospital Procedures (2022):
  4. Medication Benefit (2022):
This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Medshield Premium Plus.

Monthly Costs (2025)

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

MediBonus 2025 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R8,784
  • R8,046
  • R1,680
  • Only pay for 3 children (excl students)
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
Children Rates:
  • Under 21yrs, or students under 28 yrs
  • Only pay for 3 children (excl students)
Note:
  • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list.
  • All treatments and procedures are subject to authorisation and protocols
  • All benefits are listed as an indication only. Please verify with your broker and scheme
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.
.

In-hospital Procedures (2022):

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

Medshield: MediBonus
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
non-Network Specialists:
  • 200% scheme rate
Scheme rate is set by Medshield
network Specialists:
  • 200% scheme rate
non-Network GPs:
  • 200% scheme rate
network GPs:
  • 200% scheme rate
Hospital Choice:
  • Any hospital
Day Hospitals: .
Penalty for using other hospital:
  • n/a
 You don't pay a penalty if admission was unavoidable due an emergency
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
* There might be other co-payments if you don't use scheme-chosen provider for some services.

* Treatment required for PMB level care is always paid by scheme, with no co-payment, if you follow the protocols.
That means that these co-payments might not apply in your case! More info here
Specialised Radiology:
  • R23,460 per family, in and out-of hospital, with 10% co-payment, unless PMB
 No limits or co-payments for PMB level care and/or for emergency
Scopes: No limits or co-payments for PMB level care and/or for emergency
Supplementary Services: (Physio, etc)
  • Physio: R2,800 per person, then from day-to-day benefits
 No limits or co-payments for PMB level care and/or for emergency
Transplants:
  • Covered
Dialysis:
  • Covered
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.
 * Treatment required for PMB level of care is always paid by scheme, if you follow the protocols. It cannot be excluded. More info here.

Alternatives to hospitals:
  • Physical rehab, sub-acute facilities, nursing, hospice: R103,700 per family
  • Terminal care: R43,500 per family
Casualty:
  • From day-to-day benefit
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
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
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.
.

Out-of-hospital Procedures (2022):

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

Medshield: MediBonus
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Summary of day-to-day benefits:
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 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.
General info:
GP consultations:
  • 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
 Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Childcare:
  • Vaccines: up to 12 yrs
Specialists consultations:
  • From day-to-day benefit
 Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
  • R23,460 per family, in and out-of hospital, with 10% co-payment
 Scans required for PMB level care are paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Scopes: No limits or co-payments for PMB level care and/or for emergency
Supplementary Services: (Physio, etc)
  • From day-to-day benefit
General Appliances:
  • R16,550 per family
1.1. Hearing Aids:
  • From appliance limit
1.2. Wheelchairs:
  • From appliance limit
Note:
  • 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
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.

Medication Benefit (2022):

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

Medshield: MediBonus
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
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:
  • Additional 44 condtitions
  • R15,630 per person and R31,250 per family
 You might be required to use specific pharmacies and be limited to specific medicines
Acute (presrcibed) medication:
  • From day-to-day benefit
Over-the-counter:
  • From day-to-day benefit, maximum R250 per script
Birth Control:
  • IUD and alternatives: 1 device, every 4 years
  • R190 per female per month, from acute medicine benefit
On Discharge:
  • R875 per admission
Biological:
  • R211,870 per family
 Treatment that is required (by law) for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here.)
Note:
  • 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
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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