Overall, the Medihelp MedAdd Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and allied healthcare services to up to its members. The Medihelp MedAdd Medical Aid Plan starts from R4,038 ZAR.
| 👤 Main Member Contribution | R4,038 |
| 👥 Adult Dependent Contribution | R3,402 |
| 💙 Child Dependent Contribution | R1,368 |
| 🔁 Gap Cover | No |
| 🏥 Hospital Cover | Unlimited |
| ➡️ Oncology Cover | ☑️ Yes |
| 🤓 Optometry Benefit | ☑️ Yes |
| 🦷 Dentistry Benefit | ☑️ Yes |
| 🧠 Mental Healthcare Program | ☑️ Yes |
| 🌎 International Cover | ☑️ Yes |
The Medihelp MedAdd medical aid plan is one of 11, starting from R4,038, and includes generous medical savings, day-to-day benefits when savings are depleted, consultations, oncology, dental and optometry benefits, allied healthcare services, radiology, pathology, and more. Gap Cover is not available on the Medihelp MedAdd Plan. However, Medihelp offers 24/7 medical emergency assistance. According to the Trust Index, Medihelp has a trust rating of 4.2.
Overall, Medihelp offers 11 medical aid plans:
| 👤 Main Member | 👥 +1 Adult Dependent | 💙 +1 Child Dependent |
| R4,038 | R3,402 | R1,368 |
| 👤 Main Member | 👥 +1 Adult Dependent | 💙 +1 Child Dependent |
| R606 per month | R510 per month | R204 per month |
| R7,272 per year | R6,120 per year | R2,448 per year |
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MedAdd is a handy credit option that allows you to immediately access the cash in your medical savings account for the current year. In addition, any unused money is carried forward and earns interest the next year.
Each month, a portion of your contributions equal to 15% is allocated to a savings account as follows:
Except for services relating to prescribed minimum benefits (PMB), qualifying claims are paid from the savings account first until the account is empty.
Claims are then reimbursed until the insured’s daily benefits are exhausted. PMB services are paid from day-to-day benefits until depleted, then from core benefits without limitation.
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Benefits are first paid from the available Medical Savings Account. Once funds are depleted, the following limits apply to day-to-day benefits:
| ☑️ Additional GP Consultation | One additional GP consultation activated for the family per year once a beneficiary claims for a Pap smear, mammogram, prostate test, faecal occult blood test (FOBT) or bone mineral density test. |
| ✅ R1000 for Self-Medication | Additional R1000 will be activated for the family to use for non-prescribed medicine once beneficiary claims for the combo health screening. |
| ☑️ PMB Chronic Medicine | Pre-approval and registration on Medihelp’s PMB drug management program are required. Covered up to 100% of the MHRP. There is a 60% co-payment for non-compliance with the formulary and DSP. The unlimited cover is provided. |
| ✅ Clinical Psychology and Psychiatric Nursing in and out-of-hospital | Covered up to 100% of the MT. Claims for services and treatment are paid from the medical savings account. |
Allied Medical Services (Out of Hospital) include:
| ➡️ Oxygen | 100% of the MT Unlimited. 20% co-payment if not pre-authorised. |
| 🤓 Optometry | Subject to pre-authorization by a PPN. Services must be via a PPN provider. There is a limit of 1 composite consultation, including refraction test, tonometry, and visual field test per 2-year cycle. Eye examination at a non-network optometrist: R420 per beneficiary per 24-month cycle Covered up to 100% of the MT. |
| 👓 Spectacles or Contact Lenses | Spectacles: – Frames and/or lens enhancements (at PPN network optometrist) – R330 per beneficiary per 24-month cycle. – Frames and/or lens enhancements (at non-network optometrist) – R245 per beneficiary per 24-month cycle. – Lenses at a PPN network optometrist One pair of standard clear lenses – Single vision or bifocal lenses (multifocal lenses paid at cost of bifocal lenses) per beneficiary per 24-month cycle. – Lenses at a non-network optometrist One pair of standard clear lenses – R225 for single vision lenses & R480 for multifocal/bifocal lenses per beneficiary per 24-month cycle. Contact Lenses – (benefits at a network and non-network optometrist): R745 per beneficiary per 24-month cycle. |
| 📌 Conservative Dental Services | Benefits are subject to Dental Risk Company (DRC) protocols, contracted to Medihelp as a DSP. Benefits are subject to protocols and are limited to certain item codes. |
| 📍 Routine Check-ups | Covered up to 100% of the MT. Limited to once every six months for beneficiaries <18. The benefit is paid from the savings account for beneficiaries 18>. |
| 🦷 Oral Hygiene | – Scale and Polish Treatments: Covered up to 100% of the MT. Limited to once every six months for beneficiaries <18. The benefit is paid from the savings account for beneficiaries 18>. – Fluoride Treatment for children between 5 and 13: Covered up to 100% of the MT. Limited to once every six months for beneficiaries 5 – 13 years. The benefit is paid from the savings account for beneficiaries 18>. – Fissure sealants for children between 5 and 16 (permanent teeth): Covered up to 100% of the MT. Paid from the medical savings account. First and second permanent molars once per tooth. |
| 😷 Fillings | Treatment plans and x-rays might be requested where multiple fillings are necessary. Pre-approval is required for 4> fillings per year and 2 fillings on front teeth per visit. Covered up to 100% of the MT. Limited to 1 filling per tooth per year for beneficiaries <18. Fillings for beneficiaries 18> are paid from the available medical savings. |
| ✳️ Tooth Extractions and Root Canals on permanent teeth in the Dentist’s chair | Pre-authorization for 4> extractions in a single visit. Covered up to 100% of the MT. Beneficiaries under 18 have unlimited cover. Surgical extractions paid from available savings. Treatment for beneficiaries 18> is paid from the available medical savings. |
| 😊 Laughing Gas (Dentist’s Chair) | Covered up to 100% of the MT. Paid from the medical savings account. |
| 💤 Dentistry under conscious sedation (Dentist’s chair) | The benefit is only available for removing impacted teeth (3rd molars) Covered up to 100% of the MT 20% co-payment for no authorization. |
| 😴 Dentistry under general anesthesia in a day procedure facility, including the removal of impacted teeth and extensive dental treatment for children <7 (only once per beneficiary yearly) | Covered up to 100% of the MT Member must pay the first R4,225 per admission. 35% co-payment for procedures not performed in a day procedure network. 20% co-payment for late authorization. |
| 🔎 Special Needs Patients – dentistry under general anesthesia in a day procedure | Covered up to 100% of the MT. Unlimited cover. 35% co-payment for procedures not performed in a day procedure network. 20% co-payment for late authorization. |
| 🦷 Plastic Dentures | Covered up to 100% of the MT. Paid from the medical savings account. Limited to one set per beneficiary/4 years. |
| ❌ X-Rays | – Intra-Oral X-Rays Covered up to 100% of the MT. Pre-authorisation for more than six per year. Beneficiaries under 18 have unlimited cover. Treatment for beneficiaries 18> is paid from the available medical savings. – Extra-Oral X-Rays Covered up to 100% of the MT. Beneficiaries under 18 one per beneficiary in a three-year period. Treatment for beneficiaries 18> is paid from the available medical savings. |
| 🪥 Specialized Dentistry | Subject to pre-authorization and DRC protocols. |
| ☑️ Partial Metal Frame Dentures | Covered up to 100% of the MT. Paid from the savings account. Two partial frames (upper and lower jaw) per beneficiary every five years. 20% co-payment for late authorization. |
| 🙂 Maxillofacial Surgery and Oral Pathology | Benefits for temporomandibular joint (TMJ) benefit limited to non-surgical treatment or interventions. Covered up to 100% of the MT. Paid from the savings account. 20% co-payment for late authorization. |
| 👑 Crowns and Bridges | Covered up to 100% of the MT. Paid from the savings account. 20% co-payment for late authorization. |
| 🚩 Implants | Covered up to 100% of the MT. Paid from the savings account. 20% co-payment for late authorization. |
| 🔁 Orthodontic Treatment | Covered up to 100% of the MT. Paid from the savings account. Limited to once per beneficiary <18. Payment is made from the authorization date until the patient turns 18. Subject to pre-authorisation and orthodontic needs analysis. |
| 📊 Periodontal Treatment | Covered up to 100% of the MT. Paid from the savings account. Conservative non-surgical therapy only. Subject to pre-authorisation and a treatment plan. 20% co-payment for late authorization. |
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| ☑️ Services in and out of the hospital, including fitting, cost of repairs, maintenance, spares, accessories, and adjustments on the following: – Artificial Eyes – Speech and Hearing Aids – Artificial Limbs – Wheelchairs – External Breath Prostheses – Medical Appliances – Glucometers (per five-year cycle) – CPAP Apparatus (Prescribed by medical doctor every 2 years) | Covered up to 100% of the MT. Paid from the savings account. |
| ☑️ Hyperbaric Oxygen Treatment (In and Out-of-Hospital) | Covered up to 100% of the MT. Limited to R920 per family per year. |
| ☑️ Stoma Components Incontinence Products or Supplies | Covered up to 100% of the MT. The unlimited cover is available. |
| 📌 Chronic Illness and PMB | Subject to protocols, pre-authorization, DSPs, and the specialist network. Covered up to 100% of the cost or the contracted tariff. Unlimited cover provided. Co-payments can apply if not using a DSP or deviating from the code. |
| 📍 Trauma Benefits This applies to major trauma requiring hospitalization, for example: – Motor Vehicle Accidents – Stab Wounds – Gunshot Wounds – Head Trauma – Burns | Subject to authorization, PMB protocols, and case management. Covered up to 100% of the cost or the contracted tariff. |
| ☑️ Post-Exposure Prophylaxis (HIV/AIDS) | Subject to authorization, PMB protocols, and case management. Covered up to 100% of the cost or the contracted tariff. |
| ☑️ In the Beneficiary’s Country of Residence (RSA, Lesotho, Eswatini, Mozambique, Namibia, Zimbabwe, Botswana), including road and air transport. | Unlimited Cover. Covered up to 100% of the MT. If not pre-approved, a 50% co-payment applies. |
| ☑️ Outside the beneficiary’s Country of Residence | – Road Transport: Covered up to 100% of the MT. If not pre-approved, a 50% co-payment applies. Limited to R2,600 per case. – Air Transport: Covered up to 100% of the MT. If not pre-approved, a 50% co-payment applies. Limited to R17,700 per case. |
(Only MedAdd hospital and day procedure network can be used)
| ✅ Intensive Care and high-care wards – Ward Accommodation – Theatre fees – Treatment and medicine in the ward – In-hospital consultation with GPs and specialists – Surgery – Anesthesia | Unlimited Cover. Covered up to 100% of the MT. If not pre-approved, a 20% co-payment applies. If not admitted to a hospital/day procedure facility in the network, a 35% co-payment applies. Additional co-payments on certain procedures may apply. |
| ✅ Day Procedures (Including Ophthalmological, endoscopic, ear, nose, and throat procedures, dental procedures, removal of skin lesions, circumcisions, and procedures as pre-authorized) | Unlimited Cover. Covered up to 100% of the MT. If not admitted to a hospital/day procedure facility in the network, a 35% co-payment applies. Additional co-payments on certain procedures may apply. |
| ✅ Hospital Medicine upon Discharge | Covered up to 100% of the MT. There is an R440 limit per admission. Excludes PMB/chronic medicine. |
Childbirth
Subject to pre-authorization, protocols, and case management:
Home Delivery
Includes the following:
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| 📌 Radiography | Covered up to 100% of the MT. Limited to R1,365 per family yearly. Subject to clinical protocols and on request of medical doctor. |
| 📍 Specialized Radiology – MRI and CT imaging – Angiography | Covered 100% of the MT. R22 000 per family per year Member pays the first R2 100 per examination in hospital and R2 100 out of hospital. |
| ☑️ Clinical Technologist Services | Covered up to 100% of the MT. Unlimited Cover. In hospital – services must be prescribed by medical doctor/dentist. |
| ❤️ Organ Transplants | Covered up to 100% of the cost. PMB Only. Unlimited Cover. Subject to pre-authorization and clinical protocols. – Cornea implants: Covered up to 100% of the MT. Limited to R37,600 per implant yearly. |
| ☑️ In-hospital Oxygen | Covered up to 100% of the MT. Unlimited Cover. |
| ✅ Renal Dialysis – Acute Renal Dialysis – Chronic/Peritoneal Renal Dialysis | Covered up to 100% of the MT. Unlimited Cover. Subject to pre-authorization and clinical protocols. 20% co-payment if not pre-approved. 30% co-payment if not obtained from DSP. |
| ✳️ Post-Hospital Care – Speech therapy, occupational therapy, and physiotherapy 30 days after discharge | Accessible day-to-day benefits cover prescription medication and medical equipment. Covered up to 100% of the MT. Limited to the following: Main Member – R2,415 per year. Main Member + Dependents – R3,465 per year. |
| 📌 Other Medical Services – Dietitian services, physiotherapy, and occupational therapy – Speech therapy – Audiometry and orthoptic services – Podiatry | Must be pre-approved and requested by the treating physician Covered up to 100% of the MT. Unlimited Cover. |
| 📍 Psychiatry – Psychiatrist-provided hospital and outpatient treatments – General ward accommodations – Institution-supplied medication – Outpatient consultations | Covered up to 100% of the MT. – Hospitalisation and professional psychiatric services: Limited to R31,800 per beneficiary per year, with a limit of R43,800 per family per year. – Treatment of depression out of hospital, subject to registration on Mental Health programme: R3 150 per beneficiary yearly. – Medicine: R100 per beneficiary per month, subject to in-hospital limit. If not pre-approved, a 20% co-payment applies. 35% co-payment for voluntary admission to non-network hospital. Subject to pre-authorisation, protocols, and services rendered in an approved or network hospital/facility and prescribed by medical doctor. |
| ☑️ Oncology: PMB and non-PMB cases. All services relating to treatment and care In and out of hospital | Pre-authorization and Medihelp Oncology Program registration are required. Protocols, a DSP, and the MORP apply. Covered up to 100% of the MT. R273 000 per family per year. Deviation from protocols may result in additional copayment. 20% co-payment if not pre-authorised. 30% co-payment for voluntary use of non-network services. |
| ✔️ Hospice Services and Subacute Care Facilities | Covered up to 100% of the MT. 20% co-payment if not pre-authorized Unlimited cover. Services rendered in an approved facility & prescribed by medical doctor. |
| 📌 Palliative Care | Covered up to 100% of the MT. 20% co-payment if not pre-authorized Limited to R27,700 per family per year. |
| 📍 Private Nursing | Covered up to 100% of the MT. 20% co-payment if not pre-authorized Unlimited cover. Subject to pre-authorisation, programmes, and protocols. General day-to-day care excluded from benefits. |
| ☑️ Prostatectomy – Conventional or Laparoscopic Procedure | Covered up to 100% of the MT. Member pays the first R7,520 per admission. Subject to pre-authorisation. |
A medical emergency is a sudden and unexpected occurrence that necessitates quick medical or surgical treatment to safeguard a patient’s health.
Failure to offer medical or surgical treatment would result in severe impairment of bodily functioning or severe dysfunction of a bodily organ or portion or jeopardize the individual’s life.
Netcare 911 is the designated service provider for Medihelp’s emergency transport services, and you must contact them in an emergency. Phone 082 911. Furthermore, you may also seek assistance at the nearby hospital’s emergency room. However, the following conditions apply:
Emergency Transport Services via Netcare 911
| 📌 In the Beneficiary’s Country of Residence (RSA, Lesotho, Eswatini, Mozambique, Namibia, Zimbabwe, Botswana), including road and air transport. | Unlimited Cover. Covered up to 100% of the MT. If not pre-approved, a 50% co-payment applies. |
| 📌 Outside the beneficiary’s Country of Residence | – Road Transport: Covered up to 100% of the MT. If not pre-approved, a 50% co-payment applies. Limited to R2,600 per case. – Air Transport: Covered up to 100% of the MT. If not pre-approved, a 50% co-payment applies. Limited to R17,700 per case. |
| 1️⃣ Mammogram | For women 40 – 75 years old. Every two years. A medical doctor must request it. |
| 2️⃣ Pap Smear | For women 21 – 65 years old. Every three years. A medical doctor must request it. |
| 3️⃣ Flu Vaccines | Once yearly. It must be done at network pharmacy clinics. |
| 4️⃣ Contraceptives | – Oral, injectable, or implantable contraceptives: Female beneficiaries up to 50 years. Covered up to R170 per month and up to R2,310 per beneficiary. – Intra-uterine device every 60 months. Covered up to R2,730 per beneficiary. |
💙Try our free Menstrual Cycle Calculator
HealthPrint’s Maternity and Infant program registration will activate these additional benefits per family per year.
💙READ: Health Insurance for Kids
Additional GP visit
Self-Medication (R1000)
Once your enhanced insured benefits pay for a combo health screening (blood glucose, cholesterol, BMI, and blood pressure), the family will receive a one-time R1000 for self-medication.
As medical research advances, new medical services are introduced each year. However, Medihelp covers life-saving medical treatment first. The Medical Schemes Act requires medical schemes to cover the diagnostic, treatment, and care costs of the mandated minimum benefits (PMB) without co-payments or limits.
Furthermore, services must follow legislation’s PMB treatment algorithms and Medihelp’s managed healthcare guidelines, which may include pharmaceutical formularies. Medihelp will cover the cost of a substitute treatment if a protocol or formulary drug is ineffective or hazardous.
💙 However, the Medihelp MedAdd plan excludes several items, including but not limited to the following:
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During waiting periods, members are eligible for membership but not for benefits. For example, Medihelp could implement either a general or condition-specific waiting period as follows:
| 🔎 Overview | 🥇 Medihelp MedAdd (2026) | 🥈Discovery Health Classic Saver (2025) | 🥉Bonitas Standard Option (2026) |
| 👤 Main Member Contribution | R4,038 per month (includes R7,272 annual savings) | R4,535 per month (includes R10,872 annual savings) | R5,929 per month |
| 👥 Adult Dependent Contribution | R3,402 per month (includes R6,120 annual savings) | R3,577 per month (includes R8,580 annual savings) | R5,139 per month |
| 💙 Child Dependent Contribution | R1,368 per month (includes R2,448 annual savings) | R1,817 per month (includes R4,344 annual savings) | R1,740 per month |
| 🔁 Gap Cover | None | None | None |
| 📉 Annual Limit | Unlimited Hospital Cover | Unlimited | Unlimited Hospital Cover |
| 💶 Prescribed Minimum Benefits | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 💻 Screening and Prevention | ✅ Yes | ✅ Yes | ✅ Yes |
| 💳 Medical Savings Account | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| ➡️ Oncology Cover | 75% | 80% | 80% |
👉 Medihelp’s MedAdd is a medical aid plan offering comprehensive coverage for various healthcare needs. It provides unlimited private hospital cover, including in-hospital specialists, surgeries, diagnostic procedures, and full coverage for chronic medication (subject to scheme protocols).
👉 Members have access to day-to-day benefits, such as GP consultations, specialist consultations, diagnostic tests, emergency medical services coverage, and international travel insurance. The plan also offers value-added services, such as access to wellness programs and lifestyle benefits.
👉 However, while MedAdd provides peace of mind for members who may require expensive medical treatment, it may be more expensive than other medical aid plans, particularly for those who do not require comprehensive coverage.
👉 The plan may have certain exclusions or limitations that should be carefully reviewed before joining. But ultimately, the plan’s benefits make it a strong option for those seeking comprehensive healthcare coverage in South Africa.
💙 Read more about MediHelp HealthPrint
Medihelp MedAdd is a medical aid plan that provides comprehensive cover for a wide range of healthcare needs, including in-hospital treatment, chronic medication, and day-to-day medical expenses.
MedAdd offers unlimited private hospital cover, chronic medication cover (subject to scheme protocols), and day-to-day benefits, such as GP consultations, specialist consultations, and diagnostic tests. It also includes emergency medical services coverage and international travel insurance.
The benefits of MedAdd include comprehensive coverage for a wide range of healthcare needs, unlimited private hospital coverage, full coverage for the chronic medication (subject to scheme protocols), day-to-day benefits, emergency medical services coverage, and international travel insurance.
The cost of MedAdd varies depending on several factors, such as the level of coverage required and the individual’s healthcare needs. As a result, it may be more expensive than other medical aid plans, particularly for those not requiring comprehensive coverage.
MedAdd might cover pre-existing conditions, subject to certain exclusions and limitations.
Scheme protocols determine the level of coverage for certain medical conditions and treatments. For example, MedAdd covers chronic medication subject to scheme protocols, meaning certain conditions and medications may be excluded from full coverage.
MedAdd allows members to choose their own healthcare providers, including doctors and specialists. However, certain benefits may be subject to network provider arrangements, which should be reviewed before joining the plan.
Emergency medical services provide financial protection for emergency medical treatment, such as ambulance services and emergency hospitalization. MedAdd includes emergency medical services coverage as part of the plan benefits.
Yes. MedAdd includes international travel insurance, which provides financial protection for emergency medical treatment while traveling outside South Africa.
Value-added services are additional benefits included with MedAdd at no extra cost. These services include wellness programs, lifestyle benefits, and access to health information and resources.
MedAdd may have certain exclusions and limitations, such as age restrictions, waiting periods, and sub-limits for certain benefits.
Private hospital cover provides financial protection for in-hospital treatment at a private hospital. MedAdd offers unlimited private hospital cover, meaning members can access expensive medical treatment without worrying about a cap on benefits.
Day-to-day benefits provide financial protection for routine healthcare expenses, such as GP consultations, specialist consultations, and diagnostic tests. MedAdd offers a range of day-to-day benefits as part of the plan.
Chronic medication cover provides financial protection for ongoing medication for certain medical conditions. MedAdd covers chronic medication subject to scheme protocols, meaning certain conditions and medications may be excluded from full coverage.
Medihelp allows members to change their MedAdd plan, subject to certain terms and conditions.
Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.
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