Medihelp Plus medical aid plan: 2017 v 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.

COSTS and OVERVIEW:
Plus
2018 costs Gap
In brief: On Plus in 2018: See full benefits below For this plan, our recommended Gap Cover:
  • increases payout for in-hospital claims to 500% scheme rate
  • pays for ER treatment,
  • covers the 20% co-payment for cancer claims and
  • covers other in-hospital co-payments
See more benefits below, or full benefits here.
What’s new in 2018?
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Contributions:
Main: Adult: Child:
Cost 2018: R R R
Cost 2017: (R6,936) (R6,936) (R1,728)
Overal Limit:
  • Unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Children:
2018 Gap prices are to be confirmed, will be about R300 per family of under 65yrs, and R400 per family with a member who is 65yrs+.
Find out more
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IN HOSPITAL PROCEDURES:
Plus
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Payout Rate for Specialists:
  • 100% scheme rate
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice:
  • Unlimited
Specialised Radiology: 2018 benefits coming soon!
Supplementary Services: (Physio, etc) 2018 benefits coming soon!
Transplants:
  • Cornea implants: R26,100 per implant
  • Otherwise, unlimited
Co-payments:
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals:
  • Hospice and sub-acute facilities: paid by scheme, subject to authorisation
  • Private nursing: paid by scheme, subject to authorisation
  • No benefit
Casualty: 2018 benefits coming soon!
  • Casualty costs not covered by medical aid, in case of emergency treatment: R12,800 per incident. Cover also applies to costs covered by savings account.
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OUT OF HOSPITAL BENEFITS:
Plus
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
GP consultations: 2018 benefits coming soon!
  • No benefit
Childcare:
  • No benefit
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!
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
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MATERNITY BENEFITS:
Plus
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Hospital stay: 2018 benefits coming soon!
  • Premature birth, more than 6 weeks:R12,000 lump payment
  • In case of admission related to premature birth:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Consultations: 2018 benefits coming soon!
  • No benefit
Scans: 2018 benefits coming soon!
  • No benefit
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CANCER (ONCOLOGY):
Plus
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overall coverage (in and out of hospital): 2018 benefits coming soon! All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.
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DENTISTRY:
Plus
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Dentistry: 2018 benefits coming soon!
  • Full cover for in-hospital deductibles
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
Orthodontics: 2018 benefits coming soon!
  • No benefit
Maxillo Facial Surgery: 2018 benefits coming soon!
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MEDICATION:
Plus
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
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:
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OPTOMETRY:
Plus
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Optometry: 2018 benefits coming soon!
  • No benefit
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MENTAL HEALTH:
Plus
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
In-hospital: 2018 benefits coming soon!
  • No benefit
Out-of-hospital: 2018 benefits coming soon!
  • No benefit
Trauma:
  • Netcare 911 phoneline
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OTHER BENEFITS:
Plus
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
General Appliances: 2018 benefits coming soon!
  • No benefit
1.1. Hearing Aids: 2018 benefits coming soon!
  • No benefit
1.2. Wheelchairs: 2018 benefits coming soon!
  • No benefit
Dialysis:
  • Unlimited
HIV: 2018 benefits coming soon!
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: 2018 benefits coming soon!
  • No benefit
Other:
  • Oxygen out-of-hospital: Unlimited, at100% scheme rate
  • Death or permanent disability: R12,000. If cause of death was accidental: R24,000.
  • If Principal member of medical aid passes away or becomes disabled: Medical aid contributions will be paid for six months, up to R4,400 per month. Gap premium is also waived for 6 months
  • In event of vehicle accident where policy holder was not at fault: Gap will provide all legal assistance, fully covered.
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WELLNESS/PREVENTATIVE BENEFITS:
Plus
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
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
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2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overal Limit:
Sub-limits:

    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