Medshield MediBonus 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:
MediBonus
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R R R
Cost 2017: (R4,119) (R2,829) (R819)
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:

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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:
MediBonus
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
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • R18,030 per family, with 10% co-payment in and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Physiotherapy: Unlimited
Transplants: 2018 benefits coming soon. 2017 benefits:
  • 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: 2018 benefits coming soon. 2017 benefits:
  • Physical rehabilitation, sub-acute facilities, nursing services, hospice: R70,000 per family
Casualty: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Other: 2018 benefits coming soon. 2017 benefits:
  • Sleep Studies: Unlimited diagnostic polysomnograms
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OUT OF HOSPITAL BENEFITS:
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2017 v 2018 benefits Gap benefits Notes
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
  • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
  • Scopes: most paid by scheme if done in rooms


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Childcare:
  • No benefit
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
  • Breast fine needle biopsy, vasectomy, prostate needle biopsy, circumcision: paid by scheme if done in rooms
  • Scopes: most paid by scheme if done in rooms
Pathology: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
General radiology: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
  • 1 Bone densitometry scan per person
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • R18,030 per family, with 10% co-payment for non-PMBs
  • In and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
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MATERNITY BENEFITS:
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2017 v 2018 benefits Gap benefits Notes
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • 200% scheme tariff

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Consultations: 2018 benefits coming soon. 2017 benefits:
  • 12 consults
  • Antenatal classes: R500 per family
  • 4 post-natal consultations with midwife
  • Paid by scheme
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2x 2D scans
  • 1x Amniocentesis
  • Paid by scheme
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CANCER (ONCOLOGY):
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2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • R450,000 per family
  • Biological medicine: R180,000, subject to above limit
  • 6 visits per family from social worker, for psychological support during treatment
  • Macular degeneration: R40,000 per family
  • Breast reconstruction: R80,000 per family
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:
MediBonus
2017 v 2018 benefits Gap benefits Notes
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry:unlimited, including in-hospital for under 6yr olds. Paid by scheme.
  • Specialised dentistry: R15,000 per family for wisdom teeth, implants, orthodontic treatment, crowns, bridges, inlays, periodontics etc. Paid by scheme.

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Orthodontics: 2018 benefits coming soon. 2017 benefits:
  • See above
Maxillo Facial Surgery: 2018 benefits coming soon. 2017 benefits:
  • R15,900 per family, at200% scheme rate

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:
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2017 v 2018 benefits Gap benefits Notes
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMBs chronic: paid by scheme
  • non-PMBs: Additional 54 conditions covered
  • R11,910 per person and R23,815 per family, thereafter unlimited for PMBs

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Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • Limited to M= R725 and M1+= R1,245 with R185 limit per script. From day-to-day benefit.
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • R140 per monthly script
  • Mirena: one per female every four years. Includes consultation, insertion if done in rooms.
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • R700 per admission
Biological:
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OPTOMETRY:
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2017 v 2018 benefits Gap benefits Notes
Optometry: 2018 benefits coming soon. 2017 benefits:
  • R2,675 per person, every 2 years
  • Paid by scheme
  • Refractive surgery: R15,400 per family

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MENTAL HEALTH:
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2017 v 2018 benefits Gap benefits Notes
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • R35,000 per family, in the hospital network, in and out-of-hospital

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Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • R35,000 per family, in the hospital network, in and out-of-hospital
Trauma:
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OTHER BENEFITS:
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2017 v 2018 benefits Gap benefits Notes
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • R11,500 per family
  • Peak flow meters, nebulizers, glucometers and blood pressure monitors: R750 per person, subject to above limit
  • Stoma products: Unlimited
  • Oxygen therapy equipment and home ventilators: Unlimited
  • 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:
  • Unlimited
HIV: 2018 benefits coming soon. 2017 benefits:
  • 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: 2018 benefits coming soon. 2017 benefits:
  • Up to R500,000 per person per journey, with R350,000 limit on pre-existing conditions
  • No benefit
Other: 2018 benefits are coming soon!
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WELLNESS/PREVENTATIVE BENEFITS:
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2017 v 2018 benefits Gap benefits Notes
Flu vaccination: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit

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Pneumonia vaccines: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • 60yrs+
  • No benefit
Back Rehabilitation Programme: 2018 benefits are coming soon!
  • No benefit
Biometric Screening: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Child Immunisation: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Pap Smear: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Mammogram: 2018 benefits coming soon. 2017 benefits:
  • Covered for 40yrs+, every 2 years.
  • No benefit
PAS Test: 2018 benefits are coming soon!
  • No benefit
HIV Test: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Other: 2018 benefits coming soon. 2017 benefits:
  • Bone densitometry: 50yrs+, every 3 years
  • TB test
  • Adult vaccinations: R320 per family
  • HPV vaccination
  • 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