Medihelp out-of-hospital benefits: 2017

By Staff Writer -

Below is a full list of how each Medihelp plan pays for Out of hospital benefits.

Click here to compare out-of-hospital benefits across all schemes, or use the menu bar above for more options. Or go to the Medihelp home page.

Dimension series plans

Plus and Unify plans

Medihelp Unify 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some co-payments.Scheme pays out-of-hospital claims for: specialised radiology (co-payment). Limits apply. All else paid from savings or from out-of-pocket, unless PMB.
1. GP consultations:
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,944 R1,602 R588
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology (co-payment). Limits apply. All else paid from savings or from out-of-pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R5,832 R4,824 R1,800

Compare with these plans:

2. Specialists consultations:
  • Paid from day-to-day benefit
3. Pathology:
  • Paid from day-to-day benefit
4. General radiology:
  • Paid from day-to-day benefit
5. Specialised radiology:
  • Paid by scheme, with a R1,500 co-payment, in or out of hospital
6. Supplementary Services: (Physio, etc)
  • Physio: paid from day-to-day benefit
  • Also, speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge following hospital admission. Limited to R1,650 per person and R2,200 per family

View this plan | Sign up for this plan

Medihelp Plus 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Scheme pays out-of-hospital claims for: radiology, pathology, GPs, specialists, supplementary services, psychologists, medicine, optometry, dentistry, maternity, infant paediatrics, medical appliances. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Consult: R3,100 per person. Shared with GPs, specialists, physiotherapy, supplementary services and ER
  • Treatment (medical and surgical services, anesthesia, material and medicine used during service:Unlimited
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,936 R6,936 R1,728
Children: Pay for all children.
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, medical appliances, GPs, specialists, psychologists, supplementary health, medication, radiology and pathology, dentistry and optometry. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • See GP benefit, above
3. Pathology:
  • Unlimited.
4. General radiology:
  • Unlimited
5. Specialised radiology:
  • Unlimited for MRI, CT and Angiography, in and out of hospital
  • PET scans: R19,100 per case (non-PMB)
  • Paid by scheme
6. Supplementary Services: (Physio, etc)
  • See GP benefit, above
  • Also, speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge following hospital admission. Limited to R1,650 per person and R2,200 per family

View this plan | Sign up for this plan

Necesse Series (income based)

Medihelp Necesse A 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Plan aimed at students. Network hospitals only. Income based plan. Scheme pays out-of-hospital claims for: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Network GP: 9 consults per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R438 R438 R438
Children: Pay for all children
Income limit: R0-R400 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • M =R2,800 and M+ =R3,900
  • This benefit covers specialist consultations, surgical and non-surgical procedures, endoscopic procedures, radiology interventions, pathology, acute medicine
3. Pathology:
  • Paid by scheme
4. General radiology:
  • Paid by scheme
5. Specialised radiology:
  • R17,500 per family, in and out of hospital
  • Paid From Overall Annual Limit (OAL)
6. Supplementary Services: (Physio, etc)
  • Physiotherapy and Occupational therapy: R1,800 per person and R2,800 per family

View this plan | Sign up for this plan

Medihelp Necesse B 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals only. Income based plan. Scheme pays out-of-hospital claims for: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Network GP: 9 consults per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,404 R1,110 R600
Children: Pay for all children
Income limit: R401-R5,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • M =R2,800 and M+ =R3,900
  • This benefit covers specialist consultations, surgical and non-surgical procedures, endoscopic procedures, radiology interventions, pathology, acute medicine
3. Pathology:
  • Paid by scheme
4. General radiology:
  • Paid by scheme
5. Specialised radiology:
  • R17,500 per family, in and out of hospital
  • Paid From Overall Annual Limit (OAL)
6. Supplementary Services: (Physio, etc)
  • Physiotherapy and Occupational therapy: R1,800 per person and R2,800 per family

View this plan | Sign up for this plan

Medihelp Necesse C 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals only. Income based plan. Scheme pays out-of-hospital claims for: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Network GP: 9 consults per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,464 R1,170 R660
Children: Pay for all children
Income limit: R5,001-R7,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • M =R2,800 and M+ =R3,900
  • This benefit covers specialist consultations, surgical and non-surgical procedures, endoscopic procedures, radiology interventions, pathology, acute medicine
3. Pathology:
  • Paid by scheme
4. General radiology:
  • Paid by scheme
5. Specialised radiology:
  • R17,500 per family, in and out of hospital
  • Paid From Overall Annual Limit (OAL)
6. Supplementary Services: (Physio, etc)
  • Physiotherapy and Occupational therapy: R1,800 per person and R2,800 per family

View this plan | Sign up for this plan

Medihelp Necesse D 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals only. Income based plan. Scheme pays out-of-hospital claims for: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Network GP: 9 consults per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,656 R1,290 R726
Children: Pay for all children
Income limit: R7,001-R11,000 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • M =R2,800 and M+ =R3,900
  • This benefit covers specialist consultations, surgical and non-surgical procedures, endoscopic procedures, radiology interventions, pathology, acute medicine
3. Pathology:
  • Paid by scheme
4. General radiology:
  • Paid by scheme
5. Specialised radiology:
  • R17,500 per family, in and out of hospital
  • Paid From Overall Annual Limit (OAL)
6. Supplementary Services: (Physio, etc)
  • Physiotherapy and Occupational therapy: R1,800 per person and R2,800 per family

View this plan | Sign up for this plan

Medihelp Necesse E 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals only. Income based plan. Scheme pays out-of-hospital claims for: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Network GP: 9 consults per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,932 R1,506 R834
Children: Pay for all children
Income limit: R11,001+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, maternity, GPs, specialists, supplementary health and medication, dentistry, optometry, medical appliances, radiology and pathology. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • M =R2,800 and M+ =R3,900
  • This benefit covers specialist consultations, surgical and non-surgical procedures, endoscopic procedures, radiology interventions, pathology, acute medicine
3. Pathology:
  • Paid by scheme
4. General radiology:
  • Paid by scheme
5. Specialised radiology:
  • R17,500 per family, in and out of hospital
  • Paid From Overall Annual Limit (OAL)
6. Supplementary Services: (Physio, etc)
  • Physiotherapy and Occupational therapy: R1,800 per person and R2,800 per family

View this plan | Sign up for this plan


Medical Aid Bible helps South Africans choose the best medical aid plan for their needs. Quickly view the benefits on any open plan, and compare any two plans with a simple click.
.