Medihelp medicine benefits: 2017

By Staff Writer -

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

Click here to compare medicine 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: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
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

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2. Acute (presrcibed) medication:
  • Paid from day-to-day benefit
3. Over-the-counter:
  • Paid from day-to-day benefit
4. On Discharge:
  • Paid from day-to-day benefit
5. Birth Control:
  • Paid from day-to-day benefit
6. Notes:

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Medihelp Plus 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme
  • non-PMBs chronic medicine: R15,600 per person. 100% of MMAP if generic.
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-

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2. Acute (presrcibed) medication:
  • R5,350 per person, pooled per family.
3. Over-the-counter:
  • See "Acute Medicine" benefit
4. On Discharge:
  • R510 per admission
5. Birth Control:
  • See "Acute Medicine" benefit, above
6. Notes:
  • PMBs chronic: only 40% of the reference price is paid if medicine is outside the formulary and/or obtained from non-network provider
  • For acute and non-PMBs chronic medicines:
    • 80% of scheme rate where no generic is available
    • 70% of MMAP (maximum medical aid price) for voluntary use of original medicine where generic is available

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Necesse Series (income based)

Medihelp Necesse A 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from network pharmacy and according to formulary
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-

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2. Acute (presrcibed) medication:
  • If dispensed by GP: 100% of scheme rate
  • Paid from pharmacy: 100% of MMAP
3. Over-the-counter:
  • R100 per event, R260 per person per year
4. On Discharge:
  • R320 per admission
5. Birth Control:
6. Notes:

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Medihelp Necesse B 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from network pharmacy and according to formulary
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. Acute (presrcibed) medication:
  • If dispensed by GP: 100% of scheme rate
  • Paid from pharmacy: 100% of MMAP
3. Over-the-counter:
  • R100 per event, R260 per person per year
4. On Discharge:
  • R320 per admission
5. Birth Control:
6. Notes:

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Medihelp Necesse C 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from network pharmacy and according to formulary
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. Acute (presrcibed) medication:
  • If dispensed by GP: 100% of scheme rate
  • Paid from pharmacy: 100% of MMAP
3. Over-the-counter:
  • R100 per event, R260 per person per year
4. On Discharge:
  • R320 per admission
5. Birth Control:
6. Notes:

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Medihelp Necesse D 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from network pharmacy and according to formulary
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. Acute (presrcibed) medication:
  • If dispensed by GP: 100% of scheme rate
  • Paid from pharmacy: 100% of MMAP
3. Over-the-counter:
  • R100 per event, R260 per person per year
4. On Discharge:
  • R320 per admission
5. Birth Control:
6. Notes:

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Medihelp Necesse E 2017: Medicine 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. Chronic:
  • PMB chronic: paid by scheme, from network pharmacy and according to formulary
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. Acute (presrcibed) medication:
  • If dispensed by GP: 100% of scheme rate
  • Paid from pharmacy: 100% of MMAP
3. Over-the-counter:
  • R100 per event, R260 per person per year
4. On Discharge:
  • R320 per admission
5. Birth Control:
6. Notes:

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