The Best Medical Aids
The Best Hospital Plans
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 3 Family Members. The Medihelp MedAdd Medical Aid Plan starts from R3,354 ZAR.
👤 Main Member Contribution | R3,354 |
👥 Adult Dependent Contribution | R2,832 |
💙 Child Dependent Contribution | R1,134 |
🔁 Gap Cover | None |
🏥 Hospital Cover | Unlimited |
➡️ Oncology Cover | R262,000 |
🤓 Optometry Benefit | ☑️ Yes |
🦷 Dentistry Benefit | ☑️ Yes |
🧠 Mental Healthcare Program | ☑️ Yes |
🌎 International Cover | None |
The Medihelp MedAdd medical aid plan is one of 11, starting from R3,354 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.
MediHelp has the following 11 plans to choose from:
👤 Main Member | 👥 +1 Adult Dependent | 💙 +1 Child Dependent |
R3,354 | R2,832 | R1,134 |
👤 Main Member | 👥 +1 Adult Dependent | 💙 +1 Child Dependent |
R504 per month | R426 per month | R168 per month |
R6,048 per year | R5,112 per year | R2,016 per year |
Read more about the 5 Best Medical Aids under R1000
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 | A beneficiary’s Pap smear, mammography, prostate test, FOBT, or bone mineral density test activates a family consultation benefit. |
✅ R475 for Self-Medication | After a beneficiary claims the combo health screening (blood glucose, cholesterol, BMI, and blood pressure measurement) at a preferred pharmacy clinic, the family will receive R475 for non-prescribed medicine. |
☑️ 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 | Covered out-of-hospital. Subject to pre-approval and clinical protocols and must be prescribed by a medical doctor. Covered up to 100% of the MT. Unlimited cover. 20% co-payment if this benefit is not pre-approved before treatment. |
🤓 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. Covered up to 100% of the MT. |
👓 Spectacles or Contact Lenses | Spectacles – Frames or lens enhancement Limited to R285 per beneficiary/2 years. Lenses (1 x clear pair) Limited to single-vision or bifocal lenses per beneficiary/2 years. Multifocal lenses are covered at the cost of bifocal lenses. Contact lenses Limited to R670 per beneficiary/2 years. |
📌 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. Only available to two beneficiaries per year. 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. Only available to two beneficiaries per year. 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. Paid from the medical savings account. Fissure sealants for children between 5 and 16 (permanent teeth): Covered up to 100% of the MT. Paid from the medical savings account. |
😷 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. 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 R3,700 per admission. 35% co-payment for procedures not performed in a day procedure network. 20% co-payment for no authorization. |
🔎 Special Needs Patients – dentistry under general anesthesia in a day procedure | Covered up to 100% of the MT 35% co-payment for procedures not performed in a day procedure network. 20% co-payment for no 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. 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 have unlimited cover. 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. 20% co-payment for no 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 no authorization. |
👑 Crowns and Bridges | Covered up to 100% of the MT. Paid from the savings account. 20% co-payment for no authorization. |
🚩 Implants | Covered up to 100% of the MT. Paid from the savings account. 20% co-payment for no 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. |
📊 Periodontal Treatment | Covered up to 100% of the MT. Paid from the savings account. 20% co-payment for no 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 CPAP Apparatus | 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 R800 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 Near-drowning | 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 R2,320 per case. Air Transport Covered up to 100% of the MT. If not pre-approved, a 50% co-payment applies. Limited to R15,400 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 R390 limit per admission. |
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 R1,210 per family yearly. |
📍 Specialized Radiography | MRI and CT scans Subject to pre-authorization. Covered up to 100% of the MT. Unlimited Cover. Member pays the first R3,200 per examination and R2,700 out of the hospital. Angiography Covered up to 100% of the MT. Unlimited Cover. |
☑️ Clinical Technologist Services | Covered up to 100% of the MT. Unlimited Cover. |
❤️ Organ Transplants | Covered up to 100% of the MT. Unlimited Cover. Subject to pre-authorization and clinical protocols. Cornea implants Covered up to 100% of the MT. Limited to R32,600 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. |
✳️ 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 – R2,100 per year. Main Member + Dependents – R3,000 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. Limited to R27,600 per beneficiary per year, with a limit of R38,000 per family per year. If not pre-approved, a 20% co-payment applies. |
☑️ Oncology PMB Cases | Pre-authorization and Medihelp Oncology Program registration are required. Protocols, a DSP, and the MORP apply. Covered up to 100% of the MT. Unlimited Cover. 10% co-payment on non-DSP treatment. 20% co-payment for deviating from protocol. |
✅ Oncology Non-PMB Cases | Covered up to 100% of the MT. Limited to R242,000 per family per year. 10% co-payment on non-DSP treatment. 20% co-payment for deviating from protocol. |
✔️ Hospice Services and Subacute Care Facilities | Covered up to 100% of the MT. 20% co-payment if not pre-authorized Unlimited cover. |
📌 Palliative Care | Covered up to 100% of the MT. 20% co-payment if not pre-authorized Limited to R24,000 per family per year. |
📍 Private Nursing | Covered up to 100% of the MT. 20% co-payment if not pre-authorized Unlimited cover. |
☑️ Appendectomy – Conventional or Laparoscopic Procedure | Unlimited cover. Covered up to 100% of the MT. |
✅ Appendectomy – Conventional or Laparoscopic Procedure | Member pays the first R6,600 per admission. Covered up to 100% of the MT. |
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 R2,320 per case. Air Transport Covered up to 100% of the MT. If not pre-approved, a 50% co-payment applies. Limited to R15,400 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 R155 per month and up to R2,015 per beneficiary. Intra-uterine devices for women up to 50 years Every 60 months. Covered up to R2,420 per beneficiary. |
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HealthPrint’s Maternity and Infant program registration will activate these additional benefits per family per year.
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Additional GP visit
Self-Medication (R475)
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 R475 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 | 🥈 POLMED Aquarium | 🥉 LA Health Active |
👤 Main Member Contribution | R3,354 | R | R |
👥 Adult Dependent Contribution | R2,832 | R | R |
💙 Child Dependent Contribution | R1,134 | R | R |
🔁 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 | None | ☑️ Yes |
➡️ Oncology Cover | R262,000 | R271,400 | R228,000 |
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.
You might also consider the following options of MediHelp:
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.
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.
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