Medshield MediValue medical aid plan: 2019

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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.

MediValue
2018 Costs:
Total Cost pm:

Main member:

R

Adult:

R

Child:

R
2019 Costs:
Total Cost pm:

Main member:

R1,932
(15.00%)

Adult:

R1,689

Child:

R540
Savings (per year):
  • No savings option on this plan
Extended Fund: RM = R5,380
M1 = R5,860
M2= R6,600
M3= R7,670
M4+=R8,500
R R
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In brief (2018): See full benefits below

IN HOSPITAL PROCEDURES:
MediValue
Scheme Benefits: Gap Benefits:
Specialists:
  • Up to 100% scheme rate
  • You or gap cover pay the balance, if any
Hospital Choice:
  • Choose a Network Hospital
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • R5,560 per family, with 8% co-payment in and out of hospital
Supplementary Services: (Physio, etc)
  • Unlimited
  • Physio: R2,500 per person
Transplants:
Co-payments:
  • Endoscopic procedures: R2,000 co-payment
  • Functional Nasal Surgery: R2,000 co-payment
  • Laparoscopic procedures: R4,000 co-payment
  • Arthroscopic procedures: R4,000 co-payment
  • Wisdom teeth: R4,000 co-payment
  • Hernia Repair (except in infants): R3,000 co-payment
  • Nissen Fundoplication: R5,000 co-payment
  • Hysterectomy: R5,000 co-payment
Alternatives to hospitals:
  • Physical rehab, sub acute, nursing services, hospice: R28,000 per family, only immediately following an event
  • Terminal care: R11,100 per family, as sublimit of above
Casualty:
  • From day-to-day 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)
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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):
MediValue
Scheme Benefits Gap benefits
Main: Adult: Child:
General info:
GP consultations:
  • Nominated GP: From day-to-day benefit
  • Non-nominated GP: 2 consults per family. Therafter, a 40% co-payment, subject to day-to-day benefit
  • 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:
  • No extra benefit available
Specialists consultations:
  • 1 consult per family
  • , then from day-to-day benefit, unless PMB
Pathology:
  • Certain tests paid by scheme
General radiology:
  • Certain tests paid by scheme
Specialised radiology:
  • R6,000 per family, in and out of hospital with a 10% co-payment, unless PMB
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
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MATERNITY BENEFITS:
MediValue
Scheme Benefits Gap benefits
Hospital stay:
  • 100% scheme rate, including home births
Consultations:
    Medshield pays for:
  • 6 consults
  • Postnatal consults: 4 per pregnancy
Scans:
  • 2x 2D scans
  • 1 x Amniocentesis
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CANCER (ONCOLOGY):
MediValue
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • PMBs only
  • Social worker: 6 visits per family
  • Macular degeneration: R40,000 per family, subject to overall oncology limit
  • Breast reconstruction: R80,000 per family
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DENTISTRY:
MediValue
Scheme Benefits Gap benefits
Standard Dentistry:
  • Standard dentistry: from day-to-day benefit
Specialised Dentistry:
  • Specialised dentistry: R5,590 per family, including implants, orthodontic treatment, wisdom teeth
  • Crowns, bridges, inlays, partial metal base dentures, periodontics, study models: from day-to-day benefit
In-Hospital Dentistry:
  • Maxilo-facial surgery: R6,400 per family, non elective surgery only
Orthodontics:
  • See above
Maxillo Facial Surgery:
  • Maxillo-facial and oral surgery: R6,400 per family, non-elective surgery only
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MEDICATION:
MediValue
Scheme Benefits Gap benefits
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:
  • R450 per person and R670 per family, from day-to-day benefit, limited to R210 per script
Birth Control:
  • R160 per month per female
  • Mirena: 1 per female, if done in doctor's rooms.
On Discharge:
  • R400 supply
Biological:
  • No benefit, unless PMB level of care
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OPTOMETRY:
MediValue
Scheme Benefits Gap benefits
Optometry:
Limit:Paid by scheme, every 2 years
Consult:
Frames:R300 per person
Single lenses1 set per person
Bifocals:
Multifocals
Contacts
Refractive Surgery:
Notes:Reading glasses: R160
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MENTAL HEALTH:
MediValue
Scheme Benefits Gap benefits
In-hospital:
Out-of-hospital:
  • From day-to-day benefit, unless PMB
Trauma:
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OTHER BENEFITS:
MediValue
Scheme Benefits Gap benefits
General Appliances:
  • Overall appliance limit: R2,400 per family
  • Peak flow meters, nebulizers, glucometers and blood pressire monitors: R750 per person, subject to overall appliance limit
  • Stoma products etc: unlimited if pre-authorised
  • CPAP apparatus: part of overall appliance limit
  • Oxygen therapy equipment: PMBs only
  • Home ventilators: PMBs only
  • No benefit
1.1. Hearing Aids:
  • See Overall Appliance limit
  • No benefit
1.2. Wheelchairs:
  • See Overall Appliance limit
  • No benefit
Dialysis:
  • PMBs only
HIV:
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • No benefit
Other:
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WELLNESS/PREVENTATIVE BENEFITS:
MediValue
Scheme Benefits Gap benefits
Flu vaccination:
  • R95, 18yrs+
  • No benefit
Pneumonia vaccines:
  • Covered, for high risk individuals and 60yrs+
  • No benefit
Back Rehabilitation Programme:
  • No benefit
Biometric Screening:
  • Covered, 18yrs+
  • No benefit
Child Immunisation:
  • Covered
  • No benefit
Pap Smear:
  • Covered
  • No benefit
Mammogram:
  • Covered, 40yrs+ every 2 years
  • No benefit
PAS Test:
  • No benefit
HIV Test:
  • Covered
  • No benefit
Other:
  • Bone Density: Covered, 50yrs+ every 3 years
  • TB test
  • Adult vaccinations: R360 per family
  • HPV vaccination: Covered
  • No benefit
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PROSTHETICS:
MediValue
Scheme Benefits Gap benefits
Overal Limit:
  • Internal and external: PMBs only
Sub-limits:
  • Hips and knees: R30,000
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    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