Medimed Alpha medial 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.

COSTS and OVERVIEW:
Alpha
Quick Overview
Main: Adult: Child:
Total Cost pm: R R R
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: 2018 benefits coming soon. 2017 benefits:
  • Unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Children:
See full benefits below

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IN HOSPITAL PROCEDURES:
Alpha
Benefits Gap benefits
Payout Rate for Specialists: 2018 benefits coming soon. 2017 benefits:
  • 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: 2018 benefits coming soon. 2017 benefits:
  • Unlimited
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • 25% co-payment for non-PMBs
  • , in and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • 40% co-payment for non-PMBs
  • R4,500 per family, for in and out-of-hospital
Transplants: 2018 benefits coming soon. 2017 benefits:
  • R100,000 per family
  • Benefit is shared with Dialysis Benefit
Co-payments: 2018 benefits coming soon. 2017 benefits:
  • Member pays 25% or 40% co-payment to providers for in-hospital treatment of non-PMBs conditions. No co-payment for PMBs.
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals: 2018 benefits coming soon. 2017 benefits:
  • R5,000 per family
Casualty: 2018 benefits are coming soon!
Other: 2018 benefits coming soon. 2017 benefits:
  • Pathology and basic radiology: 25% co-payment for non-PMBs
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OUT OF HOSPITAL BENEFITS:
Alpha
Benefits Gap benefits
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • R3,300 per person and R7,900 per family with 25% co-payment
  • Shared with specialist benefit
Childcare:
  • No benefit
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • See GP benefit, above
Pathology: 2018 benefits coming soon. 2017 benefits:
  • 25% co-payment for non-PMBs
General radiology: 2018 benefits coming soon. 2017 benefits:
  • 25% co-payment for non-PMBs
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • 25% co-payment for non-PMBs
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • 40% co-payment for non-PMBs
  • R4,500 per family, for in and out-of-hospital
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MATERNITY BENEFITS:
Alpha
Benefits Gap benefits
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • 25% co-payment for doctors bill
Consultations: 2018 benefits coming soon. 2017 benefits:
  • 2 prenatal consults, paid by scheme
  • 1 paediatric consult, paid by scheme
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2 x 2D scans, paid by scheme
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CANCER (ONCOLOGY):
Alpha
Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • R200,000 per family
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DENTISTRY:
Alpha
Benefits Gap benefits
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry: Unlimited, with a 40% co-payment
  • Specialised dentistry: R4,500 per person and R9,000 per family, with a 40% co-payment
  • In-hospital (wisdom teeth and children under 12): R12,000 per family with a 25% co-payment for doctors and 40% co-payment for related costs
Orthodontics: See above
Maxillo Facial Surgery: 2018 benefits are coming soon!
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MEDICATION:
Alpha
Benefits Gap benefits
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMB chronic: paid by scheme on authorisation
  • Extended chronic conditions: R3,000 per person and R6,000 per family, paid at 75% scheme rate
Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • R3,300 per person, R7,900 per family
  • 60% scheme rate, member pays balance
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • R120 per prescription and R1,200 per family, subject to acute medicine limit (see above) and a 40% co-payment
Birth Control:
On Discharge:
Biological:
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OPTOMETRY:
Alpha
Benefits Gap benefits
Optometry: 2018 benefits coming soon. 2017 benefits:
  • 1 test, paid at100% scheme rate
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MENTAL HEALTH:
Alpha
Benefits Gap benefits
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • R6,500 per family, paid at100% scheme rate. Thereafter paid at 75% scheme rate up to a limit of R12,000 per family
Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • R3,300 per person and R7,900 per family with 25% co-payment
  • Shared with GPs and specialist benefit
Trauma:
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OTHER BENEFITS:
Alpha
Benefits Gap benefits
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • R4,000 per family
  • Nebulisers and glucometers: R500
  • 60% scheme rate, member pays balance
  • No benefit
1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
  • See "General Appliances" limit
  • No benefit
1.2. Wheelchairs: 2018 benefits coming soon. 2017 benefits:
  • See "General Appliances" limit
  • No benefit
Dialysis: 2018 benefits coming soon. 2017 benefits:
  • R100,000 per family
  • Benefit is shared with Organ Transplant Benefit
HIV: 2018 benefits coming soon. 2017 benefits:
  • Unlimited, subject to protocols
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: 2018 benefits are coming soon!
  • No benefit
Other: 2018 benefits are coming soon!
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WELLNESS/PREVENTATIVE BENEFITS:
Alpha
Benefits Gap benefits
Flu vaccination: 2018 benefits coming soon. 2017 benefits:
  • Covered up to R1,200 per person and R2,400 per family for all preventative care benefits
  • No benefit
Pneumonia vaccines: 2018 benefits are coming soon!
  • No benefit
Back Rehabilitation Programme: 2018 benefits are coming soon!
  • No benefit
Biometric Screening: 2018 benefits coming soon. 2017 benefits:
  • Covered up to R1,200 per person and R2,400 per family for all preventative care benefits
  • No benefit
Child Immunisation: 2018 benefits are coming soon!
  • No benefit
Pap Smear: 2018 benefits coming soon. 2017 benefits:
  • Covered up to R1,200 per person and R2,400 per family for all preventative care benefits
  • No benefit
Mammogram: 2018 benefits coming soon. 2017 benefits:
  • Covered up to R1,200 per person and R2,400 per family for all preventative care benefits
  • No benefit
PAS Test: 2018 benefits coming soon. 2017 benefits:
  • Covered up to R1,200 per person and R2,400 per family for all preventative care benefits
  • No benefit
HIV Test: 2018 benefits coming soon. 2017 benefits:
  • Covered up to R1,200 per person and R2,400 per family for all preventative care benefits
  • No benefit
Other:
  • No benefit
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PROSTHETICS:
Alpha
Benefits Gap benefits
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