Medshield MediPhila medical 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.

MediPhila
2018 Costs:
Total Cost pm:

Main member:

R

Adult:

R

Child:

R
2019 Costs:
Total Cost pm:

Main member:

R
(%)

Adult:

R

Child:

R
In brief (2018): See full benefits below

IN HOSPITAL PROCEDURES:
MediPhila
Scheme Benefits: Gap Benefits:
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:
  • Network
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • 1 scan per family, with 10% co-payment and subject to overall hospital limit
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Subject to Overall Annual Limit (see above)
Transplants: 2018 benefits coming soon. 2017 benefits:
Co-payments: 2018 benefits coming soon. 2017 benefits:
  • Endoscopic procedures: R1,500 co-payment if done 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:
  • PMBs only
Casualty: 2018 benefits coming soon. 2017 benefits:
  • Shared with GP benefit and, for facility fees, subject to day-to-day limit
Other: 2018 benefits are coming soon!
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)

No phone calls!
Our quote will include the right gap cover for this plan

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):
MediPhila
Scheme Benefits Gap benefits
Main: Adult: Child:
General info:
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • Network GP: M= 8 consults, M1= 9 consults, M2+=11 consults. Thereafter, only with authorisation
  • Non-network GP: 2 consults . Thereafter, 40% co-payment subject to above GP consult limits
  • 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
Childcare:
  • No extra benefit available
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • Two consultations per family, then from day-to-day benefit
Pathology: 2018 benefits coming soon. 2017 benefits:
  • Covered if referred by GP
General radiology: 2018 benefits coming soon. 2017 benefits:
  • Covered if referred by GP
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • 1 scan per family, with 10% co-payment and subject to overall hospital limit. In and out of hospital.
Supplementary Services: (Physio, etc) 2018 benefits are coming soon!

No phone calls!
Our quote will include the right gap cover for this plan

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MATERNITY BENEFITS:
MediPhila
Scheme Benefits Gap benefits
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • Unlimited
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:
  • 2x 2D scans, paid by scheme
  • 1x Amniocentesis, paid by scheme

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Our quote will include the right gap cover for this plan

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CANCER (ONCOLOGY):
MediPhila
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • PMBs only
  • 4 visits per family from social worker, for psychological support during treatment
  • Macular degeneration: R20,000 per family

No phone calls!
Our quote will include the right gap cover for this plan

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DENTISTRY:
MediPhila
Scheme Benefits Gap benefits
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry: R1,135 per family, paid by scheme
  • Specialised dentistry: R5,000 per family incl wisdom teeth, paid by scheme
  • Crowns, bridges, inlays, dentures, periodontics, models, orthodontics, implants: no benefit
Orthodontics: 2018 benefits are coming soon!
Maxillo Facial Surgery: 2018 benefits coming soon. 2017 benefits:
  • PMBs only

No phone calls!
Our quote will include the right gap cover for this plan

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MEDICATION:
MediPhila
Scheme Benefits Gap benefits
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMBs chronic: paid by scheme
Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • R1,135 per family, from day-to-day benefit
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • Shared with Acute medicine benefit, and limited to M= R285 and M1+= R395 with R60 limit per script
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • R96 per monthly script
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • R150 per admission
Biological:

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Our quote will include the right gap cover for this plan

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OPTOMETRY:
MediPhila
Scheme Benefits Gap benefits
Optometry: 2018 benefits coming soon. 2017 benefits:
  • R640 per person, every 2 years
  • Paid from day-to-day benefit

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Our quote will include the right gap cover for this plan

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MENTAL HEALTH:
MediPhila
Scheme Benefits Gap benefits
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Out-of-hospital: 2018 benefits are coming soon!
Trauma:

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Our quote will include the right gap cover for this plan

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OTHER BENEFITS:
MediPhila
Scheme Benefits Gap benefits
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
  • No benefit
1.1. Hearing Aids: 2018 benefits are coming soon!
  • No benefit
1.2. Wheelchairs: 2018 benefits are coming soon!
  • 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: 2018 benefits are coming soon!
  • No benefit
International Insurance: 2018 benefits are coming soon!
  • No benefit
Other: 2018 benefits are coming soon!

No phone calls!
Our quote will include the right gap cover for this plan

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WELLNESS/PREVENTATIVE BENEFITS:
MediPhila
Scheme Benefits Gap benefits
Flu vaccination: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • 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
  • No benefit
Child Immunisation: 2018 benefits are coming soon!
  • No benefit
Pap Smear: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Mammogram: 2018 benefits are coming soon!
  • 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:
  • TB test
  • HPV vaccine
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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PROSTHETICS:
MediPhila
Scheme Benefits Gap benefits
Overal Limit:
Sub-limits:

No phone calls!
Our quote will include the right gap cover for this plan


    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