Medihelp Unify medical aid plan: 2017 vs 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:
Unify
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R2,088 R1,716 R624
Cost 2017: (R1,944) (R1,602) (R588)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: Unlimited overall, with sub-limits
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Savings: R6,264 R5,112 R1,800
Children: Pay for all children
    In 2018, with this plan:
  • Lower scope co-payments if done in day hospital
  • Preventative care benefits increased
  • Removal of impacted teeth paid by scheme
See below for other changes
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Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family


IN HOSPITAL PROCEDURES:
Unify
2017 v 2018 benefits Gap benefits Notes
Payout Rate for Specialists: Fusion Gap:
  • Up to 600% scheme rate for specialists and other providers
  • 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
  • R350pm per family. More Info or download application below.

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Hospital Choice:
  • Unlimited
  • N/A
Specialised Radiology:
  • Co-payment: R1,550, unless PMB
  • Sublimit: none
  • Rate: 100% scheme rate
  • In and out of hospital
Fusion Gap:
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Professional services for up to 30 days after discharge following hospital admission: speech therapy, occupational therapy and physiotherapy. M=R1,700 per person and M+=R2,300 per family
Fusion Gap:
  • Up to 600% scheme rate for specialists and other providers
Transplants:
  • PMBs only
Co-payments:
    Back and neck fusion: R9,500 co-payment
  • Gastroscopy and Colonoscopy:
    • in doctor's rooms: no co-payment
    • in day hospital: R2,550 co-payment
    • in-hospital: R3,550 co-payment
  • Specialised radiology (MRIs and CT Scans): R1,550 co-payment
  • in-hospital dentistry: R2,900 co-payment
Fusion Gap:
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals:
  • Medical Appliances and CPAP apparatus: paid from day-to-day savings
  • Hyperbaric oxygen: R580 per family
  • Stoma products and urine bags: paid by scheme
  • No benefit
Casualty:
  • Paid from day-to-day benefits
  • 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.
Other:
  • Laparoscopic appendectomy: R15,800 per person
  • Robotic assisted laparoscopic procedure for prostatectomy: R100,400 per person
  • Neurostimulators: R101,200 per person
  • Hyperbaric oxygen in-hospital: R580 per family
  • Up to 500% of scheme rate
  • Certain in-hospital sublimits increased by R44,000 per event, unlimited for the year
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OUT OF HOSPITAL BENEFITS:
Unify
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • Paid from day-to-day benefit, unless PMB
  • Out of hospital treatment for conditions that are PMBs is always paid for by the scheme (not out of savings), but according to protocols
  • No benefit


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Childcare:
  • No benefit
Specialists consultations:
  • Paid from day-to-day benefits
  • No benefit
Pathology:
  • Paid from day-to-day benefits
  • No benefit
General radiology:
  • Paid from day-to-day benefits
  • No benefit
Specialised radiology:
  • R1,550 co-payment, in or out of hospital
  • No benefit
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:
Unify
2017 v 2018 benefits Gap benefits Notes
Hospital stay:
  • Hospital delivery: 100% scheme rate
  • Home delivery: R11,900
  • 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

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Consultations:
  • Paid from day-to-day benefits
  • No benefit
Scans:
  • Paid from day-to-day benefits
  • No benefit
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CANCER (ONCOLOGY):
Unify
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital):
  • R100,000 per family per year for non-PMB cases
  • PMBs covered in full
  • Oncology Booster: Once the oncology limit is reached, gap pays for full cover thereafter
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:
Unify
2017 v 2018 benefits Gap benefits Notes
Dentistry:
  • Paid from day-to-day benefits
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
  • Full cover for in-hospital co-payments

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Orthodontics:
  • Paid from day-to-day benefits
  • No benefit
Maxillo Facial Surgery:
  • No benefit, unless PMB
  • Dental reconstruction as result of trauma or oncology: R40,000 per event

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

MEDICATION:
Unify
2017 v 2018 benefits Gap benefits Notes
Chronic:
  • PMBs chronic: paid by scheme
  • No benefit

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Acute (presrcibed) medication:
  • Paid from day-to-day benefits
  • No benefit
Over-the-counter:
  • Paid from day-to-day benefits
  • No benefit
Birth Control:
  • Paid from day-to-day benefits
  • No benefit
On Discharge:
  • Paid from day-to-day benefits
  • No benefit
Biological:
  • Paid from day-to-day benefits
  • No benefit
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OPTOMETRY:
Unify
2017 v 2018 benefits Gap benefits Notes
Optometry:
  • Paid from day-to-day benefits
  • No benefit

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MENTAL HEALTH:
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2017 v 2018 benefits Gap benefits Notes
In-hospital:
  • R22,100 per person and R30,300 per family
  • Includes in and out of hospital treatment with psychiatrist
  • No benefit

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Out-of-hospital:
  • Paid from day-to-day benefits
  • No benefit
Trauma:
  • Netcare 911 phoneline
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OTHER BENEFITS:
Unify
2017 v 2018 benefits Gap benefits Notes
General Appliances:
  • Medical Appliances, CPAP apparatus and hyperbaric oxygen: paid from day-to-day savings
  • Stoma products and urine bags: paid by scheme
  • No benefit

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1.1. Hearing Aids:
  • Paid from day-to-day benefits
  • No benefit
1.2. Wheelchairs:
  • Paid from day-to-day benefits
  • No benefit
Dialysis:
  • PMB only
HIV:
  • Post exposure prophylaxis in the event of sexual assault or accidental exposure to HIV
  • Paid by scheme
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • Transport by road outside RSA: R1,900 per event
  • Transport by air outside RSA: R12,400 per event
  • 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:
Unify
2017 v 2018 benefits Gap benefits Notes
Flu vaccination:
  • Covered
  • No benefit

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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:
  • No benefit

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

2017 v 2018 benefits Gap benefits Notes
Overal Limit:
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Sub-limits:
  • An additional R40,000 per sublimit, per event

    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