Medihelp Plus medical aid plan: 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

Plus
2018 Costs:
Total Cost pm:

Main member:

R

Adult:

R

Child:

R
2019 Costs:
Total Cost pm:

Main member:

R
(%)

Adult:

R

Child:

R
In brief (2018):
  • Diagnosis and treatment of the 270 PMBs is always paid by scheme, in and out of hospital, according to protocols.
See full benefits below

IN HOSPITAL PROCEDURES:
Plus
Scheme Benefits: Gap Benefits:
Specialists:
  • 100% scheme rate
  • You or gap cover pay the balance, if any
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • Recommended for this plan: Plan Blue, R295pm per family where no member is older than 64yrs (otherwise, R435pm per family)
Hospital Choice:
  • Choose any hospital
  • No benefit
Specialised Radiology: 2018 benefits coming soon!
  • Gap cover pays co-payments for procedures approved by medical aid
Supplementary Services: (Physio, etc) 2018 benefits coming soon! .
Transplants:
  • Cornea implants: R26,100 per implant
  • Otherwise, unlimited
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • Sublimits increased as necessary
Co-payments:
  • N/A
  • N/A
Alternatives to hospitals:
  • Hospice and sub-acute facilities: paid by scheme, subject to authorisation
  • Private nursing: paid by scheme, subject to authorisation
  • No benefit
Casualty: 2018 benefits coming soon!
  • Pays up to R20,000 per person per year for emergency medical treatment not paid for by medical aid
Other: 2018 benefits coming soon!
  • Pays up to 500% scheme rate for specialists, GPs and other medical professionals, in-hospital only
  • Sublimits increased as necessary
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 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)

No phone calls!
Our quote will include the right gap cover for this plan

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):
Plus
Scheme Benefits Gap benefits
Main: Adult: Child:
General info:
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
GP consultations: 2018 benefits coming soon!
  • No benefit
Childcare:
  • No extra benefit available
Specialists consultations: 2018 benefits coming soon!
  • No benefit
Pathology: 2018 benefits coming soon!
  • No benefit
General radiology: 2018 benefits coming soon!
  • No benefit
Specialised radiology: 2018 benefits coming soon!
  • Co-payment paid, for authorised out of hospital MRI and CT Scans
Supplementary Services: (Physio, etc)
  • Physiotherapy: shared with GP consult benefit Also, speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge following hospital admission. Limited to R1,700 per person and R2,300 per family
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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MATERNITY BENEFITS:
Plus
Scheme Benefits Gap benefits
Hospital stay: 2018 benefits coming soon!
  • Pays up to 500% scheme rate for specialists, GPs and other medical professionals, in-hospital only
Consultations: 2018 benefits coming soon!
  • No benefit
Scans: 2018 benefits coming soon!
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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CANCER (ONCOLOGY):
Plus
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits coming soon!
  • Once you or the medical scheme have spent R200,000 per oncology treatment cycle from a private hospital, your sublimits increase as necessary. More info

No phone calls!
Our quote will include the right gap cover for this plan

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DENTISTRY:
Plus
Scheme Benefits Gap benefits
Dentistry: 2018 benefits coming soon!
  • Pays shortfalls and co-payments for in-hospital dentistry treatment approved by scheme
Orthodontics: 2018 benefits coming soon!
  • No extra benefit available
Maxillo Facial Surgery: 2018 benefits coming soon!
  • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)

No phone calls!
Our quote will include the right gap cover for this plan

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MEDICATION:
Plus
Scheme Benefits Gap benefits
Chronic: 2018 benefits coming soon!
  • No benefit
Acute (presrcibed) medication:
  • No benefit
Over-the-counter:
  • See "Acute Medicine" benefit
  • No benefit
Birth Control:
  • No benefit
On Discharge:
  • No benefit
Biological:

No phone calls!
Our quote will include the right gap cover for this plan

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OPTOMETRY:
Plus
Scheme Benefits Gap benefits
Optometry: 2018 benefits coming soon!
  • Pays shortfalls and co-payments for any non-PMB in-hospital treatment approved by scheme. (PMBs are paid in full by scheme if you use DSP)

No phone calls!
Our quote will include the right gap cover for this plan

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MENTAL HEALTH:
Plus
Scheme Benefits Gap benefits
In-hospital: 2018 benefits coming soon!
  • No benefit
Out-of-hospital: 2018 benefits coming soon!
  • No benefit
Trauma:
  • Netcare 911 phoneline
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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OTHER BENEFITS:
Plus
Scheme Benefits Gap benefits
General Appliances: 2018 benefits coming soon!
  • No benefit
1.1. Hearing Aids: 2018 benefits coming soon!
  • No benefit
1.2. Wheelchairs: 2018 benefits coming soon!
  • No benefit
Dialysis:
  • Unlimited
HIV: 2018 benefits coming soon!
  • No benefit
Emergency Transport:
  • Netcare 911
  • No benefit
International Insurance: 2018 benefits coming soon!
  • No benefit
Other:
  • Oxygen out-of-hospital: Unlimited, at 100% scheme rate
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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WELLNESS/PREVENTATIVE BENEFITS:
Plus
Scheme Benefits Gap benefits
Flu vaccination:
  • Covered
  • No benefit
Pneumonia vaccines:
  • Covered, 55yrs+
  • No benefit
Back Rehabilitation Programme:
  • Covered
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation:
  • Covered
  • No benefit
Pap Smear:
  • Covered
  • No benefit
Mammogram:
  • Covered, 40yrs+
  • No benefit
PAS Test:
  • Covered, 40yrs+
  • No benefit
HIV Test:
  • Covered
  • No benefit
Other:
  • FOBT, 50yrs+
  • Bone density, 50yrs+
  • Tetanus vaccine
  • HPV vaccine, 10-26 yrs
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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PROSTHETICS:
Plus
Scheme Benefits Gap benefits
Overal Limit: Hospitalisation: 100% of the MT
  • Sublimit increased by up to R150,000 per person
  • No benefit for procedures excluded by medical aid
Sub-limits:
  • Sublimit increased by up to R150,000 per person
  • No benefit for procedures excluded by medical aid

No phone calls!
Our quote will include the right gap cover for this plan


    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