Medshield Premium Plus medical aid plan: 2020

View all plans in this scheme.
Always consult with your broker before making final decisions regarding your healthcare cover.

Premium Plus
2020 Costs:
Total Cost pm:

Main member:

R5,943

Adult:

R5,448

Child:

R1137
Savings: R14,268 R13,080 R2,724
Self Payment Gap:
R3,232 R3,020 R576
Above Threshold: 4,800 3,500 2,400



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IN HOSPITAL PROCEDURES:
Premium Plus
Scheme Benefits: Notes and Links:
non-Network Specialists: 2020 benefits coming soon
network Specialists: 2020 benefits coming soon
non-Network GPs: 2020 benefits coming soon
network GPs: 2020 benefits coming soon
Hospital Choice: 2020 benefits coming soon
Penalty for using other hospital: 2020 benefits coming soon
  • n/a
Specialised Radiology: 2020 benefits coming soon
Supplementary Services: (Physio, etc) 2020 benefits coming soon
  • The Blue Plan gap cover will increase this to 500% scheme rate
Transplants: 2020 benefits coming soon
Co-payments: 2020 benefits coming soon
Alternatives to hospitals: 2020 benefits coming soon
Casualty: 2020 benefits coming soon
  • Both the Blue Plan and Red Plan gap cover will pay up to R10,000 per person for unpaid casualty costs in event of emergency
Other: 2020 benefits coming soon
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R165,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R165,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)



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All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Premium Plus
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Self Payment Gap:
R3,232 R3,020 R576
General info:
  • Consider getting Primary Health Care (PHC) (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
GP consultations: 2020 benefits coming soon
  • See Primary Health Care benefit above
Childcare: 2020 benefits coming soon
Specialists consultations: 2020 benefits coming soon
  • See Primary Health Care benefit above
Pathology: 2020 benefits coming soon
  • See Primary Health Care benefit above
General radiology: 2020 benefits coming soon
  • See Primary Health Care benefit above
Specialised radiology: 2020 benefits coming soon
Supplementary Services: (Physio, etc) 2020 benefits coming soon



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MATERNITY BENEFITS:
Premium Plus
Scheme Benefits Notes and Links:
Hospital stay: 2020 benefits coming soon
  • The Blue Plan gap cover will increase this to 500% scheme rate
Consultations: 2020 benefits coming soon
Scans: 2020 benefits coming soon



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CANCER (ONCOLOGY):
Premium Plus
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital): 2020 benefits coming soon



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DENTISTRY:
Premium Plus
Scheme Benefits Notes and Links:
Standard Dentistry: 2020 benefits coming soon
  • Consider getting Primary Health Care (medical insurance) that will cover you for a lot of out of hospital claims, including standard dentistry like scaling, polishing, fillings, extractions, root canals and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
Specialised Dentistry: 2020 benefits coming soon
In-Hospital Dentistry: 2020 benefits coming soon
Orthodontics: 2020 benefits coming soon
Maxillo Facial Surgery: 2020 benefits coming soon



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MEDICATION:
Premium Plus
Scheme Benefits: Notes and Links:
Chronic: 2020 benefits coming soon
Acute (presrcibed) medication: 2020 benefits coming soon
  • Consider getting Primary Health Care (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
Over-the-counter: 2020 benefits coming soon
Birth Control: 2020 benefits coming soon
On Discharge: 2020 benefits coming soon
Biological: 2020 benefits coming soon



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OPTOMETRY:
Premium Plus
Scheme Benefits: Notes and Links:
Optometry: 2020 benefits coming soon
  • Consider getting Primary Health Care (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here



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MENTAL HEALTH:
Premium Plus
Scheme Benefits Notes and Links:
In-hospital: 2020 benefits coming soon
Out-of-hospital: 2020 benefits coming soon
Trauma: 2020 benefits coming soon



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OTHER BENEFITS:
Premium Plus
Scheme Benefits Notes and Links:
General Appliances: 2020 benefits coming soon
1.1. Hearing Aids: 2020 benefits coming soon
1.2. Wheelchairs: 2020 benefits coming soon
Dialysis: 2020 benefits coming soon
International Insurance: 2020 benefits coming soon
Other: 2020 benefits coming soon



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WELLNESS/PREVENTATIVE BENEFITS:
Premium Plus
Scheme Benefits: Notes and Links:
Flu vaccination: 2020 benefits coming soon
Pneumonia vaccines: 2020 benefits coming soon
Biometric Screening: 2020 benefits coming soon
Child Immunisation: 2020 benefits coming soon
Pap Smear: 2020 benefits coming soon
Mammogram: 2020 benefits coming soon
PAS Test: 2020 benefits coming soon
HIV Test: 2020 benefits coming soon
Other: 2020 benefits coming soon



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PROSTHETICS:
Premium Plus
Scheme Benefits: Notes and Links:
Overal Limit: 2020 benefits coming soon
Sub-limits: 2020 benefits coming soon



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    Important!
  • Unless specified, assume that all benefits are paid 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