Medshield MediCore 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:
MediCore
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R R R
Cost 2017: (R1,926) (R1,623) (R438)
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:
MediCore
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:
  • 1 scan per family, with 10% co-payment
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Physiotherapy: Unlimited
Transplants: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Co-payments: 2018 benefits coming soon. 2017 benefits:
  • Hernia repair: R3,000
  • Diagnostic laparoscopy: R2,000
  • Reflux: R5,000
  • Hysterectomy: R5,000
  • Functional nasal surgery: R5,000
  • Back surgery: R5,000
  • Scopes: R1,500, in hospital
  • 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: R30,000 per family
Casualty: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Other: 2018 benefits coming soon. 2017 benefits:
  • Sleep Studies: Unlimited diagnostic polysomnograms
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OUT OF HOSPITAL BENEFITS:
MediCore
2017 v 2018 benefits Gap benefits Notes
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • 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
  • Otherwise, no benefit


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Childcare:
  • No benefit
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • 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
  • Otherwise, no benefit
Pathology: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
General radiology: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
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MATERNITY BENEFITS:
MediCore
2017 v 2018 benefits Gap benefits Notes
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • 200% scheme rate

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Consultations: 2018 benefits coming soon. 2017 benefits:
  • 6 consults, paid by scheme
  • 4 post-natal consults with midwife, paid by scheme
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2 x 2D scans
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CANCER (ONCOLOGY):
MediCore
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • PMBs only
  • 6 visits per family from social worker, for psychological support during treatment
  • 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:
MediCore
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: no benefit

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Orthodontics: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Maxillo Facial Surgery: 2018 benefits coming soon. 2017 benefits:
  • R10,000 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:
MediCore
2017 v 2018 benefits Gap benefits Notes
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMBs chronic: paid by scheme

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Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • No benefit
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • R140 per monthly script
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • R300 per admission
Biological:
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OPTOMETRY:
MediCore
2017 v 2018 benefits Gap benefits Notes
Optometry: 2018 benefits coming soon. 2017 benefits:
  • No benefit

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MENTAL HEALTH:
MediCore
2017 v 2018 benefits Gap benefits Notes
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • R30,000 per family, in the hospital network

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Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Trauma:
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OTHER BENEFITS:
MediCore
2017 v 2018 benefits Gap benefits Notes
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • Stoma products: Unlimited
  • CPAP apparatus:PMBs only
  • Oxygen therapy equipment:
  • PMBs only
  • Ventilators:PMBs only
  • No benefit

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1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
1.2. Wheelchairs: 2018 benefits coming soon. 2017 benefits:
  • No benefit
  • No benefit
Dialysis: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
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 are coming soon!
  • No benefit
Other: 2018 benefits are coming soon!
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WELLNESS/PREVENTATIVE BENEFITS:
MediCore
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