Medihelp in-hospital benefits: 2017

By Staff Writer -

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

Click here to compare in-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: In-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. Payout Rate:
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. Hospital Choice:
  • Unlimited
3. Specialised Radiology:
  • R1,500 co-payment, in or out of hospital
4. Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • In addition, scheme covers professional services for up to 30 days after discharge following hospital admission, including speech therapy, occupational therapy and physiotherapy. M =R1,650 and M+ =R2,200
5. Transplants:
6. Co-payments:
  • Back and neck fusion: R9,000 co-payment
  • Gastroscopy, Colonoscopy, Arthroscopy, Sigmoidoscopy in-hospital: R3,400 co-payment
  • Specialised radiology: R1,500 co-payment
7. Alternatives to hospitals:
  • Hospice and sub-acute facilities: paid by scheme, subject to authorisation
  • Private nursing: paid by scheme, subject to authorisation

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Medihelp Plus 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Unlimited
3. Specialised Radiology:
  • MRI, CT and Angiography: unlimited, in and out of hospital
  • PET Scans: R19,100 per case (non-PMB)
4. Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • In addition, scheme covers professional services for up to 30 days after discharge following hospital admission, including speech therapy, occupational therapy and physiotherapy. M =R1,650 and M+ =R2,200
5. Transplants:
  • Cornea implants: R24,750 per implant
  • Otherwise, unlimited
6. Co-payments: None
7. Alternatives to hospitals:
  • Hospice and sub-acute facilities: paid by scheme, subject to authorisation
  • Private nursing: paid by scheme, subject to authorisation

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Necesse Series (income based)

Medihelp Necesse A 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network
3. Specialised Radiology:
  • R14,200 per family, in and out of hospital
4. Supplementary Services: (Physio, etc)
  • Physiotherapy and occupational therapy: R8,500 per family
5. Transplants:
  • Cornea implants: R24,750 per implant
  • Otherwise, PMBs only
6. Co-payments:
7. Alternatives to hospitals:
  • Private nursing and sub-acute care: R19,200 per family, subject to authorisation.

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Medihelp Necesse B 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network
3. Specialised Radiology:
  • R14,200 per family, in and out of hospital
4. Supplementary Services: (Physio, etc)
  • Physiotherapy and occupational therapy: R8,500 per family
5. Transplants:
  • Cornea implants: R24,750 per implant
  • Otherwise, PMBs only
6. Co-payments:
7. Alternatives to hospitals:
  • Private nursing and sub-acute care: R19,200 per family, subject to authorisation.

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Medihelp Necesse C 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network
3. Specialised Radiology:
  • R14,200 per family, in and out of hospital
4. Supplementary Services: (Physio, etc)
  • Physiotherapy and occupational therapy: R8,500 per family
5. Transplants:
  • Cornea implants: R24,750 per implant
  • Otherwise, PMBs only
6. Co-payments:
7. Alternatives to hospitals:
  • Private nursing and sub-acute care: R19,200 per family, subject to authorisation.

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Medihelp Necesse D 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network
3. Specialised Radiology:
  • R14,200 per family, in and out of hospital
4. Supplementary Services: (Physio, etc)
  • Physiotherapy and occupational therapy: R8,500 per family
5. Transplants:
  • Cornea implants: R24,750 per implant
  • Otherwise, PMBs only
6. Co-payments:
7. Alternatives to hospitals:
  • Private nursing and sub-acute care: R19,200 per family, subject to authorisation.

View this plan | Sign up for this plan

Medihelp Necesse E 2017: In-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. Payout Rate:
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. Hospital Choice:
  • Network
3. Specialised Radiology:
  • R14,200 per family, in and out of hospital
4. Supplementary Services: (Physio, etc)
  • Physiotherapy and occupational therapy: R8,500 per family
5. Transplants:
  • Cornea implants: R24,750 per implant
  • Otherwise, PMBs only
6. Co-payments:
7. Alternatives to hospitals:
  • Private nursing and sub-acute care: R19,200 per family, subject to authorisation.

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