Medimed Essential E 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:
Essential E
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R R R
Cost 2017: (R1,990) (R1,990) (R440)
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:
Income band: This plan is only available to households with income in pm band.
View other income bands

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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:
Essential E
2017 v 2018 benefits Gap benefits Notes
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

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Hospital Choice: 2018 benefits coming soon. 2017 benefits:
  • Network, or a 20% co-payment applies
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • 3 scans per family, up to R10,000 per family, in and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • R2,000 per person
Transplants: 2018 benefits coming soon. 2017 benefits:
  • R50,000 per family
  • Benefit is shared with Dialysis and Oncology Benefit
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: 2018 benefits coming soon. 2017 benefits:
  • R6,000 per person
Casualty:
  • Paid from day-to-day benefit
  • Other: 2018 benefits are coming soon!
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    OUT OF HOSPITAL BENEFITS:
    Essential E
    2017 v 2018 benefits Gap benefits Notes
    GP consultations: 2018 benefits coming soon. 2017 benefits:
    • Network GPs: Unlimited, paid by scheme
    • Non-network GPs: 6 consults per person, paid from day-to-day benefit


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    Childcare:
    • No benefit
    Specialists consultations: 2018 benefits coming soon. 2017 benefits:
    • R3,000 per person and R6,000 per family
    • Paid by scheme
    Pathology: 2018 benefits coming soon. 2017 benefits:
    • Unlimited
    • Paid by scheme
    General radiology: 2018 benefits coming soon. 2017 benefits:
    • Unlimited
    • Paid by scheme
    Specialised radiology: 2018 benefits coming soon. 2017 benefits:
    • 3 scans per family, up to R10,000 per family, in and out of hospital.
    • Paid by scheme
    Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
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    MATERNITY BENEFITS:
    Essential E
    2017 v 2018 benefits Gap benefits Notes
    Hospital stay: 2018 benefits coming soon. 2017 benefits:
    • Covered

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    Consultations: 2018 benefits coming soon. 2017 benefits:
    • No additional benefits (see out-of-hospital GP and Specialist benefit)
    Scans: 2018 benefits coming soon. 2017 benefits:
    • No additional benefits (see out-of-hospital radiology benefit)
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    CANCER (ONCOLOGY):
    Essential E
    2017 v 2018 benefits Gap benefits Notes
    Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
    • R50,000 per family, shared with dialysis and organ transplants benefit
    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:
    Essential E
    2017 v 2018 benefits Gap benefits Notes
    Dentistry: 2018 benefits coming soon. 2017 benefits:
    • R3,200 per person and R5,500 per family
    • One set of plastic dentures every two years
    • In-hospital (wisdom teeth and children under 12): R7,000 per family
    • Paid by scheme

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    Orthodontics: See above
    Maxillo Facial Surgery: See above

    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:
    Essential E
    2017 v 2018 benefits Gap benefits Notes
    Chronic: 2018 benefits coming soon. 2017 benefits:
    • PMB chronic: paid by scheme on authorisation

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    Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
    • Unlimited if prescribed by GP according to formulary
    • Paid by scheme
    Over-the-counter: 2018 benefits coming soon. 2017 benefits:
    • R100 per prescription, and R400 per family
    • Paid from day-to-day benefit
    Birth Control:
    On Discharge: 2018 benefits coming soon. 2017 benefits:
    • See "Acute Medicine" benefit
    Biological:
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    OPTOMETRY:
    Essential E
    2017 v 2018 benefits Gap benefits Notes
    Optometry: 2018 benefits coming soon. 2017 benefits:
    • Eye test: R235 per person every 2 years at network provider
    • Frames: R200 per person every two years
    • Lenses: R140 per person for single vision or R310 per person for bi/multifocals every 2 years
    • Contact Lenses: R650 per person, every 2 years as an alternative to glasses
    • Paid by scheme

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    MENTAL HEALTH:
    Essential E
    2017 v 2018 benefits Gap benefits Notes
    In-hospital: 2018 benefits coming soon. 2017 benefits:
    • R4,000 per person

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    Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
    • R3,000 per person and R6,000 per family, shared with out-of-hospital specialist benefit
    Trauma:
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    OTHER BENEFITS:
    Essential E
    2017 v 2018 benefits Gap benefits Notes
    General Appliances: 2018 benefits coming soon. 2017 benefits:
    • Paid from day-to-day benefit
    • No benefit

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    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:
    • R50,000 per family, shared with organ transplant and oncology benefits
    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:
    Essential E
    2017 v 2018 benefits Gap benefits Notes
    Flu vaccination: 2018 benefits are coming soon!
    • No benefit

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    Pneumonia vaccines: 2018 benefits are coming soon!
    • No benefit
    Back Rehabilitation Programme: 2018 benefits are coming soon!
    • No benefit
    Biometric Screening: 2018 benefits are coming soon!
    • No benefit
    Child Immunisation: 2018 benefits are coming soon!
    • No benefit
    Pap Smear: 2018 benefits are coming soon!
    • No benefit
    Mammogram: 2018 benefits are coming soon!
    • No benefit
    PAS Test: 2018 benefits are coming soon!
    • No benefit
    HIV Test: 2018 benefits are coming soon!
    • 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:

      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