Medihelp other benefits: 2017

By Staff Writer -

Below is a full list of how each Medihelp plan pays for “other” benefits.

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: Other 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. General Appliances:
  • Stoma products and urine bags: paid by scheme
  • 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:

1.1. Hearing Aids:
  • Paid from day-to-day benefit
1.2. Wheelchairs:
  • Paid from day-to-day benefit
2. Dialysis:
3. HIV:
  • Post exposure prophylaxis in the event of sexual assault or accidental exposure to HIV
  • Paid by scheme
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
4. Emergency Transport:
  • Netcare 911
5. International Coverage:
6. Other:
  • Oxygen out-of-hospital: Unlimited, at 100% scheme rate

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Medihelp Plus 2017: Other 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. General Appliances:
  • Insulin pumps, glucometers, medical appliances and hyperbaric oxygen: R1,650 per person
  • Stoma products and urine bags: paid by scheme
  • Wigs: R1,650 every three years
  • CPAP apparatus: R8,400 per person every two years
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:

1.1. Hearing Aids:
  • R13,560 per person every 3 years
1.2. Wheelchairs:
  • R7,440 per person every 3 years
2. Dialysis:
  • Unlimited
3. HIV:
  • Post exposure prophylaxis in the event of sexual assault or accidental exposure to HIV
  • Paid by scheme
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
4. Emergency Transport:
  • Netcare 911
5. International Coverage:
6. Other:
  • Oxygen out-of-hospital: Unlimited, at 100% scheme rate

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Necesse Series (income based)

Medihelp Necesse A 2017: Other 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. General Appliances:
  • Medical, surgical and orthopaedic appliances: R8,550 per family
  • CPAP: R8,400 per person every 24 months
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:

1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
2. Dialysis:
3. HIV:
  • Post exposure prophylaxis in the event of sexual assault or accidental exposure to HIV
  • Paid by scheme
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
4. Emergency Transport:
  • Netcare 911
5. International Coverage:
6. Other:
  • Oxygen out-of-hospital: Unlimited, at 100% scheme rate

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Medihelp Necesse B 2017: Other 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. General Appliances:
  • Medical, surgical and orthopaedic appliances: R8,550 per family
  • CPAP: R8,400 per person every 24 months
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:

1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
2. Dialysis:
3. HIV:
  • Post exposure prophylaxis in the event of sexual assault or accidental exposure to HIV
  • Paid by scheme
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
4. Emergency Transport:
  • Netcare 911
5. International Coverage:
6. Other:
  • Oxygen out-of-hospital: Unlimited, at 100% scheme rate

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Medihelp Necesse C 2017: Other 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. General Appliances:
  • Medical, surgical and orthopaedic appliances: R8,550 per family
  • CPAP: R8,400 per person every 24 months
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:

1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
2. Dialysis:
3. HIV:
  • Post exposure prophylaxis in the event of sexual assault or accidental exposure to HIV
  • Paid by scheme
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
4. Emergency Transport:
  • Netcare 911
5. International Coverage:
6. Other:
  • Oxygen out-of-hospital: Unlimited, at 100% scheme rate

View this plan | Sign up for this plan

Medihelp Necesse D 2017: Other 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. General Appliances:
  • Medical, surgical and orthopaedic appliances: R8,550 per family
  • CPAP: R8,400 per person every 24 months
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:

1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
2. Dialysis:
3. HIV:
  • Post exposure prophylaxis in the event of sexual assault or accidental exposure to HIV
  • Paid by scheme
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
4. Emergency Transport:
  • Netcare 911
5. International Coverage:
6. Other:
  • Oxygen out-of-hospital: Unlimited, at 100% scheme rate

View this plan | Sign up for this plan

Medihelp Necesse E 2017: Other 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. General Appliances:
  • Medical, surgical and orthopaedic appliances: R8,550 per family
  • CPAP: R8,400 per person every 24 months
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:

1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
2. Dialysis:
3. HIV:
  • Post exposure prophylaxis in the event of sexual assault or accidental exposure to HIV
  • Paid by scheme
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
4. Emergency Transport:
  • Netcare 911
5. International Coverage:
6. Other:
  • Oxygen out-of-hospital: Unlimited, at 100% scheme rate

View this plan | Sign up for this plan


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