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Medihelp MedElite Medical Aid Plan

Overall, the Medihelp MedElite Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance to up to 3 Family Members. The Medihelp MedElite Medical Aid Plan starts from R7,368 ZAR.

👤 Main Member Contribution	R7,368
👥 Adult Dependent Contribution	R6,900
🍼 Child Dependent Contribution	R1,998
📉 Annual Limit	Unlimited Hospital Cover
🔁 Gap Cover	None
💶 Prescribed Minimum Benefits	☑️ Yes
➡️ Screening and Prevention	☑️ Yes
💳 Medical Savings Account	☑️ Yes
🏠 Home Care	☑️ Yes
⚕️ Oncology Cover	☑️ Yes

Medihelp MedElite Plan – 12 Key Point Quick Overview

☑️ Medihelp MedElite Plan Overview
☑️ Medihelp MedElite Plan Contributions and Medical Savings
☑️ MedElite Plan Benefits and Cover Comprehensive Breakdown
☑️ MedElite Day-to-Day Benefits
☑️ MedElite Hospitalization and Advanced Treatment
☑️ MedElite Radiology, Pathology, and Medical Technologist Services
☑️ MedElite Emergency Benefits
☑️ MedElite Added Insured Benefits
☑️ Medihelp MedElite Plan Exclusions and Waiting Periods
☑️ Medihelp MedElite Plan vs. Similar Plans from other Medical Schemes
☑️ Our Verdict on The Medihelp MedElite Plan
☑️ Medihelp MedElite Plan Frequently Asked Questions

Medihelp MedElite Plan Overview

The Medihelp MedElite medical aid plan is one of 11, starting from R7,368 and includes an overall day-to-day benefit of up to R13,900 (main member), PMB and non-PMB medicine, specialized dental services, in-hospital benefits, and more. Gap Cover is not available on the Medihelp MedElite 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

Medihelp MedElite Plan Contributions and Medical Savings

Medihelp MedElite Contributions

👤 Main Member	👥 +1 Adult Dependent	💙 +1 Child Dependent
R7,368	R6,900	R1,998

POLL: 5 Top Medical Aids under R200

Medihelp MedElite Medical Savings Account

👤 Main Member	👥 +1 Adult Dependent	💙 +1 Child Dependent
R738 per month	R690 per month	R198 per month
R8,856 per year	R8,280 per year	R2,376 per year

MedElite Plan Benefits and Cover Comprehensive Breakdown

MedElite Accumulative Unused Savings Contributions

MedElite’s flexible credit facility provides instantaneous access to all your HSA balance for the year. Any remaining balance is carried over to the following year and earns interest. 10% of your annual premium is accessible as a lump payment through the credit facility once yearly. These are as follows per member tier:

Main Member – R8,856 per year.
Adult Dependents – R8,280 per year.
Child Dependents – R2,376 per year.

These monies are used to pay for day-to-day medical expenses. The whole year’s contributions to the savings account are ready for use as a credit facility at the start of the year. Unused monies are carried forward to the following year. The rest of your monthly contributions fund your comprehensive core and covered benefits.

How Medihelp pays claims on MedElite

The day-to-day benefits listed below are paid from the credit facility of the savings account until it is emptied, except for PMB services.
Then, Medihelp pays your insured daily benefits until they are exhausted.
The payment for PMB services is limited to day-to-day benefits until they are depleted, after which payment is unlimited from core benefits.
Finally, once this is exhausted, payments will be made from the cumulative savings account.
Co-payments that Medihelp does not cover from the credit facility, such as co-payments during hospitalization or day-to-day benefits, can be paid from your available savings account balance.

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MedElite Day-to-Day Benefits

📌 Overall Annual Day-to-Day Benefit (Applies once the 10% savings account is depleted)	Main Member – R13,900 per year. Main Member + 1 Dependent – R16,100 per year. Main Member + 2 Dependents – R18,400 per year. Main Member + 3 Dependents+ – R20,700 per year.
📍 Consultations Treatment	Covered up to 100% of the MT. Unlimited cover provided.
☑️ GP Consultations Specialists Telemedicine and Virtual Consults Nurse Visits at Network Pharmacies Pharmacists who offer primary care and emergency units	Claims are paid from the savings account first. Once savings have been depleted, claims are covered up to 100% of the MT, up to the following amounts (subject to the OAL day-to-day benefit): Main Member – R3,550 per year. Main Member +1 Dependent – R4,600 per year. Main Member +2 Dependents – R5,750 per year. Main Member +3 Dependents> – R6,900 per year.
✅ Physiotherapy (Out-of-hospital, treatment and material included)	Claims are paid from the savings account first. Once savings have been depleted, claims are covered up to 100% of the MT, up to the following amounts (subject to the OAL day-to-day benefit): Main Member – R3,550 per year. Main Member +1 Dependent – R4,600 per year. Main Member +2 Dependents – R5,750 per year. Main Member +3 Dependents> – R6,900 per year.
✔️ Clinical Psychology and Psychiatric Nursing in and out-of-hospital	Claims are paid from the savings account first. Once savings have been depleted, claims are covered up to 100% of the MT, up to the following amounts (subject to the OAL day-to-day benefit): Main Member – R3,550 per year. Main Member +1 Dependent – R4,600 per year. Main Member +2 Dependents – R5,750 per year. Main Member +3 Dependents> – R6,900 per year.
➡️ Other Medical Services Out-of-Hospital (Including Occupational and speech therapy, dietician services, audiometry, podiatry, massage, orthoptic, chiropractic, homeopathic, herbal, naturopathic, osteopathic, and biokinetic services)	Claims are paid from the savings account first. Once savings have been depleted, claims are covered up to 100% of the MT, up to the following amounts (subject to the OAL day-to-day benefit): Main Member – R3,550 per year. Main Member +1 Dependent – R4,600 per year. Main Member +2 Dependents – R5,750 per year. Main Member +3 Dependents> – R6,900 per year.
📌 Care Extender Additional GP Consultation	When a beneficiary claims for a Pap smear, mammography, prostate exam, fecal occult blood test (FOBT), or bone mineral density test, an additional consultation benefit is activated for the family.
📍 Care Extender R490 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 R490 for non-prescribed medicine.

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MedElite Medicine

Includes medicine obtained in the Preferred Pharmacy Network (PPN) and prescribed or dispensed by a medical doctor. Homeopathic, naturopathic, and osteopathic medicine – 25% of the available acute medicine benefit.

💊 Acute and self-medication Generic Medicine – 100% of MMAP Original Medicine if no generic – 80% of the MT. Original medicine is voluntarily used even if generic is available – 70% of MMAP	Claims are paid from the savings account first. Once savings have been depleted, claims are covered up to 100% of the MT, up to the following amounts (subject to the OAL day-to-day benefit): M = R4 600 per year M+1 = R5 750 per year M+2 = R6 900 per year M+3+ = R8 050 per year
📌 Non-PMB Chronic Medicine Generic Medicine – 100% of MMAP Original Medicine if no generic – 80% of the MT. Original medicine is voluntarily used even if generic is available – 70% of MMAP	Paid up to 100% of the MMAP. The following limits apply: Main Member – R5,450 per year. Main Member +1 Dependent – R8150 per year. Main Member +2 Dependents – R10,900 per year. Main Member +3 Dependents> – R11,700 per year.
📍 PMB Chronic Medicine (Out-of-Hospital)	Pre-approval and registration on Medihelp’s PMB drug management program are required. Covered up to 100% of the MHRP. The unlimited cover is provided.
📈 Basic Radiology (Out-of-Hospital)	Subject to clinical protocols. A medical doctor must request it. Only black and white X-rays will be covered if a chiropractor requests it. This benefit is covered by the savings account. Once the savings account is depleted, it is covered up to 100% of the MT. There is a limit of R3,300 per family per year. This benefit is subject to the OAL.
📉 Pathology and Medical Technologist Services (Out-of-Hospital)	Subject to clinical protocols. A medical doctor must request it. Subject to using the Pathology DSP – Ampath This benefit is covered by the savings account. Once the savings account is depleted, it is covered up to 100% of the MT. There is a limit of R3,300 per family per year. This benefit is subject to the OAL.
📊 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 R810 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 R1,080 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 specific item codes.
🪥 Dentistry Routine Check-ups	Covered up to 100% of the MT. Limited to two check-ups per beneficiary per year or per 6-month cycle.
😊 Oral Hygiene	Scale and Polish Treatments: Covered up to 100% of the MT. Limited to two treatments per beneficiary per year or per 6-month cycle. Fluoride Treatment for children between 5 and 13: Covered up to 100% of the MT. Limited to two treatments per beneficiary per year or per 6-month cycle. Fissure sealants for children between 5 and 16 (permanent teeth): Covered up to 100% of the MT.
🙂 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 one filling per tooth yearly.
🦷 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.
💤 Laughing Gas (Dentist’s Chair)	Covered up to 100% of the MT.
😴 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. Member must pay the first R1,008 per admission. Extensive dental treatment is only offered for children <12 years. 20% co-payment for no authorization. 35% co-payment if not performed in a day procedure hospital or facility.
😷 Dentistry under general anesthesia in a day procedure facility, including the removal of impacted teeth	Covered up to 100% of the MT Removal of impacted teeth (3rd molars) Extensive dental treatment for children <7 (only once per beneficiary yearly) 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 Unlimited cover provided. 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. Limited to one set per beneficiary/4 years.
❌ X-Rays	Intra-Oral X-Rays Covered up to 100% of the MT. Extra-Oral X-Rays Covered up to 100% of the MT. One per beneficiary every three years.
➡️ Specialized Dentistry	Subject to pre-authorization and DRC protocols.
🅰️ Partial Metal Frame Dentures	Covered up to 100% of the MT. Two partial frames (upper or lower) per beneficiary every 5 years. 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. A 20% co-payment applies if not authorized.
👑 Crowns and Bridges	Covered up to 100% of the MT. One crown per family yearly, once per tooth every five years. 20% co-payment for no authorization.
🔎 Orthodontic Treatment	Covered up to 100% of the MT. Limited to R13,900 per beneficiary. 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. 20% co-payment for no authorization.
🚑 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 External Breath Prostheses Medical Appliances CPAP Apparatus	Covered up to 100% of the MT. Limited to R9,300 per family every three years.
👩🏻‍🦼 Wheelchairs	Covered up to 100% of the MT. Limited to R7,400 per beneficiary every 3 years.
🩺 Medical Appliances (back, leg, neck, and arm supports, crutches, orthopedic footwear, nebulizers, etc.	Covered up to 100% of the MT. Limited to R1,750 per family per year.
🧪 Hyperbaric oxygen treatment (as prescribed by a doctor)	Covered up to 100% of the MT. Limited to R1,750 per beneficiary yearly.
✅ CPAP Apparatus	A doctor must prescribe it. Covered up to 100% of the MT. Limited to R11,400 per beneficiary every 2 years.

MedElite Hospitalization and Advanced Treatment

☑️ 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 andGunshot Wounds	Subject to authorization, PMB protocols, and case management. Covered up to 100% of the cost or the contracted tariff. Unlimited cover provided.
☑️ Post-Exposure Prophylaxis (HIV/AIDS)	Subject to authorization, PMB protocols, and case management. Covered up to 100% of the cost or the contracted tariff. Unlimited cover provided.

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.

MedElite Hospitalization

(Only MedElite 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. Additional co-payments on specific 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 specific procedures may apply.
☑️ Hospital Medicine upon Discharge	Covered up to 100% of the MT. There is an R560 limit per admission.

Medihelp Childbirth and Home Delivery

Childbirth

Subject to pre-authorization, protocols, and case management
Unlimited Cover.
Covered up to 100% of the MT.
If not pre-approved, a 20% co-payment applies.

Home Delivery

Includes the following:
Professional Nursing Fee
Equipment
Material and Medicine

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MedElite Radiology, Pathology, and Medical Technologist Services

In-Hospital cover only.
Subject to clinical protocols and approved hospital admission.
Members must use Ampath as the contracted Pathology DSP.
Covered up to 100% of the MT.
Unlimited cover provided.

📈 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 R1,900 per examination and R1,400 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.
☑️ Neurostimulators (Includes device and components)	Covered up to 100% of the MT. Limited to R98,300 per beneficiary per year.
✅ 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	In-hospital protocols might apply. 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 R40,100 per beneficiary per year, with a limit of R55,700 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 R454,000 per family per year. 10% co-payment on non-DSP treatment. 15% 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 R28,500 per family per year.
📍 Private Nursing	Covered up to 100% of the MT. 20% co-payment if not pre-authorized Unlimited cover.
☑️ Conventional or Laparoscopic Procedure	Unlimited cover. Covered up to 100% of the MT.
✅ Conventional or Laparoscopic Procedure	Member pays the first R6,600 per admission. Covered up to 100% of the MT.
🩺 Robotic Laparoscopy	Covered up to 100% of the MT Hospitalization is covered up to R126,100 per beneficiary.
📌 Refractive Surgery	Subject to pre-authorization and clinical protocols. Covered up to 100% of the MT. Hospitalization is covered up to R21,800 per family for beneficiaries between 18 and 50. A 20% co-payment applies if there is no pre-authorization.

MedElite Emergency Benefits

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 admissions must be reported to Medihelp on the following business day by calling 086 0200 678.
If you visit an emergency facility but are not hospitalized, the care you receive will be covered by your regular plans.
Facilities costs are not included.

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.

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MedElite Added Insured Benefits

With a strong emphasis on preventative care, early diagnosis of potential health problems, and maternity benefits and childcare, these benefits are offered annually in addition to your insured benefits unless otherwise specified.
Protocols and item codes may be applicable.
Members can look for network provider information on Medihelp’s website or app using the provider search option.
You can also sign up for HealthPrint, a free online health and fitness program offered by Medihelp, to activate the specified benefits.

📌 Mammogram	For women 40 – 75 years old. Every two years. A medical doctor must request it.
📍 Pap Smear	For women 21 – 65 years old. Every three years. A medical doctor must request it.
☑️ Flu Vaccines	Once yearly. It must be done at network pharmacy clinics.
✅ Contraceptives	Oral, injectable, or implantable contraceptives Female beneficiaries up to 50 years. Covered up to R170 per month and up to R2,210 per beneficiary. Intra-uterine devices for women up to 50 years Every 60 months. Covered up to R2,600 per beneficiary.
✔️ Enhanced Maternity Benefits HealthPrint’s Maternity and Infant program registration will activate these additional benefits per family per year.	Ten prenatal and postnatal consultations with a midwife, general practitioner, or gynecologist. However, a recommendation from a network GP to the gynecologist is not required. Two prenatal and postnatal visits to a lactation consultant, dietician, or antenatal classes. Two 2D ultrasound imaging. Antenatal supplements: Nine months’ iron supplements. Nine months’ folic acid supplements.
🍼 Child Benefits	Babies <2 years receive two additional visits to a general practitioner, pediatrician, or ear, nose, and throat specialist. However, a network Physician reference is not required to see these specialists. The entire series of regular child immunizations in-network pharmacy clinics are covered for up to seven years. Vaccination of children against influenza at network pharmacy clinics.
📈 Routine Screening and Immunization	A combo test, including blood glucose, cholesterol, BMI & blood pressure measurement. Individual tests, including blood glucose or cholesterol. HIV testing, counseling & support A tetanus vaccine A flu vaccination Two HPV vaccinations for children between 10 – 14 years or three between 15 – 26 years
📉 Men’s Health	A prostate test (PSA level) was requested by a physician for men aged 40 to 75. Flu vaccination is administered at network pharmacies.
📊 Screening and Immunization for beneficiaries 45>	An FOBT test for recipients 45-75 years Women aged 65 and older can access one bone mineral density test every two years if requested by a physician. A Pneumovax vaccine on a 5-year cycle for each 55-year-old with asthma or COPD who is registered.
❤️ Wellness Support	Back Treatment – this benefit covers back therapy at a DBC facility as an alternative to surgery for eligible patients. Moreover, treatment is a precondition for spinal surgery. One dietitian consultation with each registered HealthPrint member whose BMI is greater than 30 and whose BMI was determined by a BMI test. An oncology schedule is provided in conjunction with Independent Clinical Oncology Network oncologists (ICON) HIV program – Presented in partnership with LifeSense Disease Management
💙 Care Extender Benefit	Additional GP visit Once your increased insured benefits pay for a Pap smear, mammography, prostate test, FOBT, or bone mineral density test, the family will receive a one-time GP visit benefit. Test protocols will apply to this benefit. 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.

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Medihelp MedElite Plan Exclusions and Waiting Periods

Medihelp MedElite Exclusions

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 MedElite plan excludes several items, including but not limited to the following.

Services not mentioned in the Rules or not aimed at generally accepted medical treatment of a condition or handicap harmful or threatening to necessary bodily functions
The process of aging is not considered a medical condition or handicap
Traveling, accommodation/lodging costs, meals, and administration costs of a beneficiary are not covered
Service provider costs are not covered unless they relate to a prescribed minimum benefit.
Services not mentioned in the Rules or not aimed at generally accepted medical treatment of a condition or handicap harmful or threatening to necessary bodily functions
The process of aging is not considered a medical condition or handicap
Traveling, accommodation/lodging costs, meals, and administration costs of a beneficiary are not covered
Service provider costs are not covered unless they relate to a prescribed minimum benefit.
Services not mentioned in the Rules or not aimed at generally accepted medical treatment of a condition or handicap harmful or threatening to necessary bodily functions
The process of aging is not considered a medical condition or handicap
Traveling, accommodation/lodging costs, meals, and administration costs of a beneficiary are not covered
Service provider costs are not covered unless they relate to a prescribed minimum benefit.
Services not mentioned in the Rules or not aimed at generally accepted medical treatment of a condition or handicap harmful or threatening to necessary bodily functions
The process of aging is not considered a medical condition or handicap
Traveling, accommodation/lodging costs, meals, and administration costs of a beneficiary are not covered
Service provider costs are not covered unless they relate to a prescribed minimum benefit.

Medihelp MedElite Waiting Periods

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:

The general waiting period is up to three months from the date of membership. During this time, you will not be eligible for benefits other than the minimum prescribed benefits (PMB). During this waiting period, the Scheme will not pay any claims you file.
From the day you join, a condition-specific waiting period of up to 12 months applies. During this period, you will not be eligible for benefits related to a specific ailment for which you get medical advice, a diagnosis, care, or treatment (this excludes PMB).

Medihelp MedElite Plan vs. Similar Plans from other Medical Schemes

🔎 Medical Aid Plan	🥇 Medihelp MedElite	🥈 Momentum Extender Plan	🥉 Discovery Health Classic Comprehensive
🌎 International Cover	None	Up to R8 million	R5 million
👤 Main Member Contribution	R6,324	R5,544	R6,810
👥 Adult Dependent Contribution	R5,922	R9,748	R6,441
🍼 Child Dependent Contribution	R1,716	R7,173	R1,358
🔁 Gap Cover	None	✅ Yes	✅ Yes
🚑 Hospital Cover	Unlimited	Unlimited	Yes
💶 Prescribed Minimum Benefits	✅ Yes	✅ Yes	✅ Yes
📉 Screening and Prevention	☑️ Yes	☑️	☑️
🔍 Medical Savings Account	✅ Yes	✅ Yes	✅ Yes

Our Verdict on The Medihelp MedElite Plan

Medihelp MedElect is a medical scheme plan offered by Medihelp that covers hospitalization, chronic medication, and day-to-day medical expenses. The plan also includes a savings account that can be used to pay for medical expenses not covered by the plan. One of the critical features of Medihelp MedElect is its comprehensive medical coverage, which includes unlimited hospitalization cover, chronic medication cover, and day-to-day medical expense coverage. The plan also offers a savings account that can be used to pay for out-of-pocket medical expenses. One benefit of Medihelp MedElect is its comprehensive medical cover, which can provide peace of mind to members. The plan also offers a savings account that can help members to build up savings for future medical expenses. However, one of the drawbacks of Medihelp MedElect is its relatively high cost compared to other plans offered by Medihelp. This may not be affordable for everyone, particularly those on a tight budget.

Compared to other Medihelp plans, Medihelp MedElect offers more comprehensive coverage than some other plans but comes with a higher monthly contribution. For example, Medihelp MedAdd, MedMove!, and MedPrime Elect are lower-cost plans that offer more limited coverage. However, they could be more suitable for those on a tighter budget. While it may be more expensive than other plans offered by Medihelp, it may be worth considering for those who value comprehensive cover and are willing to pay a higher monthly contribution. Ultimately, the choice between plans depends on individual medical needs and budget.

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Medihelp MedElite Plan Frequently Asked Questions

What are the benefits of the MedElite medical aid plan?

MedElite offers a range of benefits, including unlimited hospital cover, chronic medication benefits, emergency medical services, and cover for specialist consultations and surgeries. It also includes maternity benefits, preventative care, and a wellness program.

How much does the MedElite medical aid plan cost?

MedElite’s contributions are R7,368 for the primary member, R6,900 for adult dependents, and R1,998 for child dependents.

How can I join MedElite medical aid plan?

To join MedElite, visit the Medihelp website or contact their customer service center. You must provide personal and medical information and choose the plan that best suits your needs and budget.

Are there any income-based medical aid options in South Africa?

Yes, there are medical aid plans in South Africa designed explicitly for lower-income individuals and families, with premiums based on income.

Does MedElite cover dental care?

Yes, MedElite covers dental care for specific procedures, such as fillings, extractions, and root canal treatment. However, orthodontic treatment and cosmetic dentistry are not covered.

Does MedElite cover pregnancy?

Yes, MedElite covers pregnancy and childbirth, including prenatal and postnatal care, delivery, and the cost of a midwife or obstetrician.

Are there any waiting periods for pregnancy benefits on MedElite medical aid plan?

Yes, there is a 12-month waiting period for pregnancy benefits on MedElite medical aid plan.

Is there free dental care available in South Africa?

Yes, some government-run clinics and hospitals offer free dental care to South African citizens who cannot afford private dental treatment.

Why are there exclusions on medical aid?

Exclusions on medical aid plans are implemented to manage costs and ensure that premiums remain affordable for members. Certain medical conditions or treatments may not be covered if they are too expensive or not essential.

How do I choose the best medical aid plan for my needs?

When choosing a medical aid plan in South Africa, it is essential to consider factors such as your budget, healthcare needs, and the provider’s reputation. In addition, comparison websites and consulting with a financial advisor may be helpful.

Does MedElite medical aid plan offer cover for pensioners?

Yes, MedElite medical aid plan covers pensioners. It provides access to various healthcare services, including specialist consultations and chronic medication benefits.

Is there a medical aid plan in South Africa specifically for pensioners?

Yes, there are medical aid plans in South Africa that cater specifically to pensioners, offering reduced premiums and additional cover for chronic conditions.

Are there any tax benefits for having medical aid in South Africa?

Yes, there are tax benefits for having medical aid in South Africa, including deductions for monthly premiums and certain medical expenses.

Is there free dental care in South Africa?

Free dental care is available in South Africa through the public healthcare system. However, the quality and availability of these services can vary.

Adriaan Schoeman

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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