Medshield MediPhila 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:
MediPhila
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R R R
Cost 2017: (R1,041) (R1.041) (R261)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: 2018 benefits coming soon. 2017 benefits:
  • non-PMBs: R500,000 per person and R1,000,000 maximum per family
  • PMBs: unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Children:

.

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:
MediPhila
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

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
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:
  • PMBs only
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!
.
.
.
.
OUT OF HOSPITAL BENEFITS:
MediPhila
2017 v 2018 benefits Gap benefits Notes
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


Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Childcare:
  • No benefit
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!
.
.
MATERNITY BENEFITS:
MediPhila
2017 v 2018 benefits Gap benefits Notes
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • Unlimited

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
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
.
.
.
.
CANCER (ONCOLOGY):
MediPhila
2017 v 2018 benefits Gap benefits Notes
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
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.
.
.
DENTISTRY:
MediPhila
2017 v 2018 benefits Gap benefits Notes
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

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Orthodontics: 2018 benefits are coming soon!
Maxillo Facial Surgery: 2018 benefits coming soon. 2017 benefits:
  • PMBs only

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:
MediPhila
2017 v 2018 benefits Gap benefits Notes
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMBs chronic: paid by scheme

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
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:
.
.
.
.
OPTOMETRY:
MediPhila
2017 v 2018 benefits Gap benefits Notes
Optometry: 2018 benefits coming soon. 2017 benefits:
  • R640 per person, every 2 years
  • Paid from day-to-day benefit

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
.
.
MENTAL HEALTH:
MediPhila
2017 v 2018 benefits Gap benefits Notes
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
Out-of-hospital: 2018 benefits are coming soon!
Trauma:
.
.
.
.
OTHER BENEFITS:
MediPhila
2017 v 2018 benefits Gap benefits Notes
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
  • No benefit

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
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:
  • No benefit
International Insurance: 2018 benefits are coming soon!
  • No benefit
Other: 2018 benefits are coming soon!
.
.
WELLNESS/PREVENTATIVE BENEFITS:
MediPhila
2017 v 2018 benefits Gap benefits Notes
Flu vaccination: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit

Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
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

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:
Compare to:
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
  • Coming soon!
Links will open in a side by side
comparison view
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