Medshield MediCore medical aid plan: 2019

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MediCore
2019 Costs:
Total Cost pm:

Main member:

R2,358

Adult:

R1,995

Child:

R546
Savings (per year):
  • No savings option on this plan
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IN HOSPITAL PROCEDURES:
MediCore
Scheme Benefits: Notes and Links:
Specialists:
  • 100% - 200% scheme rate
  • You or gap cover pay the balance, if any
Gap Cover
  • Gap cover is available for this plan. Budget about R350 for a fully comprehensive gap cover that will increase the scheme rate to 500% and pay most co-payments and increase sublimits.
Hospital Choice:
  • Choose a Network Hospital
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • 1 scan per family, with 10% co-payment
Supplementary Services: (Physio, etc)
  • Unlimited
  • Physio: R2,500 per person
Transplants:
Co-payments:
  • Endoscopic procedures: R2,000 co-payment
  • Functional Nasal Surgery: R5,000 co-payment
  • Laparoscopic procedures: R4,000 co-payment
  • Arthroscopic procedures: R4,000 co-payment
  • Wisdom teeth: R3,500 co-payment
  • Hernia Repair (except in infants): R3,000 co-payment
  • Back and Neck surgery: R8,000 co-payment
  • Nissen Fundoplication: R5,000 co-payment
  • Hysterectomy: R5,000 co-payment
  • non-PMB internal prosthesis: 25% co-payment
Alternatives to hospitals:
  • Physical rehab, sub acute, nursing services, hospice: R36,500 per family, only immediately following an event
  • Terminal care: R33,500 per family, as sublimit of above
Casualty:
  • No benefit, unless PMB
Other:
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)
What next?
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All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
MediCore
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
General info:
GP consultations:
  • These procedures are paid for by Medshield if done in doctor's rooms:
    • Breast fine needle biopsy
    • Prostate needle biopsy
    • Circumcision
    • Excision wedge ingrown toenail skin of nail fold
    • Drainage skin abcess/curbuncle/whitlow/cyst
    • Vasectomy
    • Excision pterygium with or without draft
    • excission ganglion wrist
    • Excission of non-malignant lesions less than 2 cm
    • Routine diagnostic endoscopic procedures
Childcare:
Specialists consultations:
  • No benefit, unless PMB
Pathology:
  • No benefit, unless PMB
General radiology:
  • No benefit, unless PMB
Specialised radiology:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
What next?
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MATERNITY BENEFITS:
MediCore
Scheme Benefits Notes and Links:
Hospital stay:
  • 200% scheme rate, including home births
Consultations:
    Medshield pays for:
  • 6 consults
  • Postnatal consults: 4 per pregnancy
Scans:
  • 2x 2D scans
What next?
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CANCER (ONCOLOGY):
MediCore
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • PMBs only
  • Social worker: 6 visits per family
  • Breast reconstruction: R80,000 per family
What next?
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DENTISTRY:
MediCore
Scheme Benefits Notes and Links:
Standard Dentistry:
  • Standard dentistry: no benefit
Specialised Dentistry:
  • Specialised dentistry: no benefit
In-Hospital Dentistry:
  • Maxilo-facial surgery: R6,400 per family, non elective surgery only
  • In-hospital: only for children under 6yrs
Orthodontics:
  • No benefit, unless PMB
Maxillo Facial Surgery:
  • Maxillo-facial and oral surgery: R11,000 per family, non-elective surgery only
  • Maxillo-facial surgery: 200% scheme rate
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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MEDICATION:
MediCore
Scheme Benefits: Notes and Links:
Chronic:
  • Conditions covered:27 CDL conditions
  • Co-payment for use of non-formulary: 40%
Acute (presrcibed) medication:
  • From day-to-day benefit
Over-the-counter:
  • No benefit
Birth Control:
  • R160 per month per female
On Discharge:
  • R300 supply
Biological:
  • No benefit, unless PMB level of care
What next?
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OPTOMETRY:
MediCore
Scheme Benefits: Notes and Links:
Optometry:
Limit:No benefit
Consult:n/a
Frames:n/a
Single lensesn/a
Bifocals:n/a
Multifocalsn/a
Contactsn/a
Refractive Surgery:n/a
Notes:n/a
What next?
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Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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MENTAL HEALTH:
MediCore
Scheme Benefits Notes and Links:
In-hospital:
Out-of-hospital:
  • No benefit, unless PMB
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Trauma:
What next?
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Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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OTHER BENEFITS:
MediCore
Scheme Benefits Notes and Links:
General Appliances:
  • No benefit, unless PMB
  • No benefit
1.1. Hearing Aids:
  • No benefit, unless PMB
1.2. Wheelchairs:
  • No benefit, unless PMB
Dialysis:
  • PMBs only
HIV:
Emergency Transport:
International Insurance:
Other:
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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WELLNESS/PREVENTATIVE BENEFITS:
MediCore
Scheme Benefits: Notes and Links:
Flu vaccination:
  • R95, 18yrs+
Pneumonia vaccines:
  • Covered, for high risk individuals and 60yrs+
Back Rehabilitation Programme:
Biometric Screening:
  • Covered, 18yrs+
Child Immunisation:
  • Covered
Pap Smear:
  • Covered
Mammogram:
  • No benefit
PAS Test:
HIV Test:
  • Covered
Other:
  • TB test
  • HPV vaccination: Covered
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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PROSTHETICS:
MediCore
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal and external: R30,600 per family, with a 25% co-payment for non-PMB internal prosthesis cases
Sub-limits:
  • Hips and knees: R30,000
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.


    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