The Best Medical Aids
The Best Hospital Plans
Overall, the Medihelp MedPlus Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and Specialist consultations to up to 3 Family Members. The Medihelp MedPlus Medical Aid Plan starts from R12,792 ZAR.
π€ Main Member Contribution | R12,792 |
π₯ Adult Dependent Contribution | R12,792 |
π Child Dependent Contribution | R3,192 |
π Annual Limit | Unlimited Hospital Cover |
π₯ Hospital Cover | Unlimited |
πΆ Prescribed Minimum Benefits | β Yes |
π Screening and Prevention | βοΈ Yes |
βοΈ Medical Savings Account | β Yes |
πΌ Maternity Benefits | βοΈ Yes |
π Home Care | β Yes |
The Medihelp MedPlus medical aid plan is one of 11, starting from R12,792 and includes extensive coverage in and out-of-hospital for GP and Specialist consultations, radiology, pregnancy, chronic medication, dentistry, prostheses, and fewer co-payments on treatment.Β Gap Cover is not available on the Medihelp MedPlus 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:
π€ Main Member | π₯ +1 Adult Dependent | π +1 Child Dependent |
R12,792 | R12,792 | R3,192 |
π Consultations:Β Treatment | Covered up to 100% of the MT. Unlimited cover provided. |
π GP Consultations, Specialists, Telemedicine and Virtual Consults, Nurse Visits at Network Pharmacies Pharmacists who offer primary care and emergency units | Covered up to 100% of the MT. Limited to R4,100 per beneficiary per year and pooled per family. |
βοΈ Physiotherapy (Out-of-hospital, treatment and material included) | Covered up to 100% of the MT. Limited to R4,100 per beneficiary per year and pooled per family. |
β Clinical Psychology and Psychiatric Nursing in and out-of-hospital | Covered up to 100% of the MT. Limited to R4,100 per beneficiary per year and pooled per family. |
π °οΈ Other Medical Services Out-of-Hospital (Including Occupational and speech therapy, dietician services, audiometry, podiatry, massage, orthoptic, chiropractic, homoeopathic, herbal, naturopathic, osteopathic and biokinetic services) | Covered up to 100% of the MT. Limited to R4,100 per beneficiary per year and pooled per family. |
π ±οΈ Care Extender:Β Additional GP Consultation | When a beneficiary claims for a Pap smear, mammography, prostate exam, faecal occult blood test (FOBT), or bone mineral density test, an additional consultation benefit is activated for the family. |
π©Ί Care Extender: 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. |
You might consider: 5 Best Limited Day to Day Cover Plans
Includes medicine obtained in the Preferred Pharmacy Network (PPN) and prescribed or dispensed by a medical doctor.Β Homeopathic, naturopathic, and osteopathic medicine β 25% of the available acute medicine benefit
βοΈ Acute and self-medication Generic Medicine β 100% of MMAP Original Medicine if no generic β 80% of the MT. Original medicine is voluntarily used even if generic is available β 70% of MMAP | Covered up to 100% of the MMAP Limited to R7,500 per beneficiary yearly and pooled per family. |
βοΈ Non-PMB Chronic Medicine Generic Medicine β 100% of MMAP Original Medicine if no generic β 80% of the MT. Original medicine voluntarily used even if generic is available β 70% of MMAP | Covered up to 100% of the MMAP Limited to R21,000 per beneficiary yearly. |
βοΈ PMB Chronic Medicine (Out-of-Hospital) | Covered up to 100% of the MHRP. Unlimited cover is provided. |
π§ͺ Basic Radiology (Out-of-Hospital) | Covered up to 100% of the MT. Subject to clinical protocols. A medical doctor must request it. Only black and white X-rays will be covered if a chiropractor requests it. |
π 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 Covered up to 100% of the MT. |
βοΈ 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. |
π€ 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. |
π Spectacles or Contact Lenses | Spectacles β Frames or lens enhancement Limited to R1,030 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 R1,730 per beneficiary/2 years. |
Read more about Motor Neuron Disease Treatment that is covered by medical aid schemes
π©ββοΈ 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. |
β Dentistry:Β Routine Check-ups | Covered up to 100% of the MT. Limited to two check-ups per beneficiary per year or per 6-month cycle. |
π¦· 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. |
β‘οΈ 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. |
π¦· Tooth Extractions and Root Canals on permanent teeth in the Dentistβs chair | Pre-authorization for 4> extractions in a single visit. Covered up to 100% of the MT. |
π Laughing Gas (Dentistβs Chair) | Covered up to 100% of the MT. |
π΄ Dentistry under conscious sedation (Dentistβs chair) | The benefit is only available for removing impacted teeth (3rd molars) Covered up to 100% of the MT. Extensive dental treatment is only offered for children <12 years. 20% co-payment for no authorization. |
π€ Dentistry under general anaesthesia 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. |
π Special Needs Patients β dentistry under general anaesthesia 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. |
π Plastic Dentures | Covered up to 100% of the MT. Limited to one set per beneficiary/4 years. |
π 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. |
π Specialized Dentistry | Subject to pre-authorization and DRC protocols. |
βοΈ 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. |
β 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. |
π 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. |
βοΈ Implants | Implants are subject to pre-approval. Covered up to 100% of the MT. Limited to 2 implants per beneficiary every 5 years. Limited to R2,800 for implant components per implant. A 20% co-payment applies if the treatment is not pre-authorized. |
π °οΈ Orthodontic Treatment | Covered up to 100% of the MT. Limited to R16,515 per beneficiary. Limited to once per beneficiary <18. Payment is made from the authorization date until the patient turns 18. |
π ±οΈ Periodontal Treatment | Covered up to 100% of the MT. 20% co-payment for no authorization. |
You might like 5 Best Dental Gap Cover
βοΈ 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 R18,000 per family every three years. |
β Wheelchairs | Covered up to 100% of the MT. Limited to R9,800 per beneficiary every 3 years. |
π
°οΈ Medical Appliances (back, leg, neck, and arm supports, crutches, orthopaedic footwear, nebulizers, etc. Hyperbaric oxygen treatment (as prescribed by a doctor) Insulin Pumps Glucometers (every 5 years) | Covered up to 100% of the MT. Limited to R2,100 per family per year. |
π
±οΈ Stoma Components Incontinence Products or Supplies | Covered up to 100% of the MT. Unlimited cover provided. |
β³οΈ Wigs (only for alopecia totalis or cancer) | Subject to pre-approval. Covered up to 100% of the MT. Limited to R2,100 per beneficiary every 3 years. |
βοΈ CPAP Apparatus | A doctor must prescribe it. Covered up to 100% of the MT. Limited to R10,900 per beneficiary every 2 years. |
π °οΈ 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. |
π
±οΈ 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. Unlimited cover provided. |
π 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. |
The Beneficiaryβs Country of Residence (RSA, Lesotho, Eswatini, Mozambique, Namibia, Zimbabwe, Botswana) includes road and air transport.
Outside the beneficiaryβs Country of Residence
Road Transport
Air Transport
(Only MedPlus hospital and day procedure network can be used)
1οΈβ£ 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. |
2οΈβ£ 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. |
3οΈβ£ Hospital Medicine upon Discharge | Covered up to 100% of the MT. There is a R660 limit per admission. |
POLL: 5 Best Medical Aids under R2000
Childbirth
Subject to pre-authorization, protocols, and case management
Home Delivery
Includes the following:
You might like 5 Best Private Hospitals to Give Birth
π Radiography | Covered up to 100% of the MT. Limited to R1,210 per family yearly. |
π Specialized Radiography | MRI and CT scans Subject to pre-authorization. Covered up to 100% of the MT. Unlimited Cover. Angiography Covered up to 100% of the MT. Unlimited Cover. |
π PET (non-PMB) | Limited to R25,000 per case. |
π Clinical Technologist Services | Covered up to 100% of the MT. Unlimited Cover. |
β€οΈ 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. |
π₯ In-hospital Oxygen | Covered up to 100% of the MT. Unlimited Cover. |
π Neurostimulators (Includes device and components) | Covered up to 100% of the MT. Limited to R131,250 per beneficiary per year. |
β³οΈ 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. |
π 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 β R2,100 per year. Main Member + Dependents β R3,000 per year. |
β‘οΈ 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. |
π§ Psychiatry Psychiatrist-provided hospital and outpatient treatments General ward accommodations Institution-supplied medication Outpatient consultations | Covered up to 100% of the MT. Limited to R49,000 per beneficiary per year, with a limit of R66,600 per family. If not pre-approved, a 20% co-payment applies. |
π Oncology Radiotherapy Brachytherapy Chemotherapy and associated adjuvant therapy PMB bone marrow/stem cell transplants (PMB legislation applies) | 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. 10% co-payment for deviating from protocol. |
βοΈ Non-PMB bone marrow/stem cell transplants in and out-of-hospital | Covered up to 100% of the MT. Limited to R359,000 per family per year. 10% co-payment on non-DSP treatment. 15% co-payment for deviating from protocol. |
π Hospice Services and Subacute Care Facilities | Covered up to 100% of the MT. 20% co-payment if not pre-authorized Unlimited cover. |
π Palliative Care | Covered up to 100% of the MT. 20% co-payment if not pre-authorized Limited to R30,700 per family per year. |
βοΈ Private Nursing | Covered up to 100% of the MT. 20% co-payment if not pre-authorized Unlimited cover. |
β Conventional or Laparoscopic Procedure | Unlimited cover. Covered up to 100% of the MT. |
β‘οΈ Robotic Laparoscopy | Covered up to 100% of the MT Hospitalization is covered up to R126,100 per beneficiary. |
β³οΈ Refractive Surgery | Subject to pre-authorization and clinical protocols. Covered up to 100% of the MT. |
Discover the 5 Best Hospital Plans Under R3000 in South Africa
A medical emergency is a sudden and unexpected occurrence that necessitates quick medical or surgical treatment to safeguard a patientβs 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 individualβs life. Netcare 911 is the designated service provider for Medihelpβs emergency transport services, and you must contact them in an emergency. Phone 082 911.Β Furthermore, you may also seek assistance at the nearby hospitalβs emergency room. However, the following conditions apply:
In the Beneficiaryβs Country of Residence (RSA, Lesotho, Eswatini, Mozambique, Namibia, Zimbabwe, Botswana), including road and air transport:
Outside the beneficiaryβs Country of Residence:
Road Transport
Air Transport
You might consider reading more about Health Insurance for Kids
π Mammogram | For women 40 β 75 years old. Every two years. A medical doctor must request it. |
π Pap Smear | For women 21 β 65 years old. Every three years. A medical doctor must request it. |
π Flu Vaccines | Once yearly. It must be done at network pharmacy clinics. |
π 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. |
πΌ Enhanced Maternity Benefits | 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 monthsβ iron supplements. Nine monthsβ folic acid supplements. HealthPrintβs Maternity and Infant program registration will activate these additional benefits per family per year. |
πΆ 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. Regular child immunizations in-network pharmacy clinics are covered for up to seven years. Vaccination of children against influenza at network pharmacy clinics. |
π 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 β 14 years or three between 15 β 26 years |
βοΈ Menβs Health | A prostate test (PSA level) was requested by a physician for men aged 40 to 75. Flu vaccination is administered at network pharmacies. |
β 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. |
β€οΈ Wellness Support | Back Treatment β 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 β Presented in partnership with LifeSense Disease Management |
π 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. |
As medical research advances, new medical services are introduced each year. However, Medihelp covers life-saving medical treatment first.Β 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.Β Furthermore, services must follow legislationβs PMB treatment algorithms and Medihelpβs managed healthcare guidelines, which may include pharmaceutical formularies.Β Medihelp will cover the cost of a substitute treatment if a protocol or formulary drug is ineffective or hazardous. However, the Medihelp MedPlus plan excludes several items, including but not limited to the following:
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:
Read more about the MediHelp Late Joiner fee
π Medical Aid Plan | π₯ Medihelp MedPlus | π₯ Profmed ProPinnacle | π₯ Discovery Health Executive Plan |
π International Cover | None | Up to R8 million | Up to US$1 million |
π€ Main Member Contribution | R12,792 | R11,883 | R10,303 |
π₯ Adult Dependent Contribution | R12,792 | R11,023 | R10,303 |
πΌ Child Dependent Contribution | R3,192 | R3,565 | R1,969 |
π Annual Limit | Unlimited Hospital Cover | β Yes | Unlimited |
π Hospital Cover | Unlimited | Unlimited | Unlimited |
βοΈ Home Care | βοΈ Yes | βοΈ Yes | βοΈ Yes |
π Maternity Benefits | β Yes | β Yes | β Yes |
π³ Medical Savings Account | βοΈ Yes | βοΈ Yes | βοΈ Yes |
The Medihelp MedPlus plan is the top-tier health insurance plan offered by Medihelp in South Africa. It provides the most comprehensive cover for medical expenses, including unlimited hospitalization and chronic medication benefits, among others.Β The Medihelp MedPlus plan includes full cover for in-hospital and day-to-day medical expenses, international travel insurance, and access to advanced medical technology and treatments.Β Additionally, the plan offers wellness benefits such as a health risk assessment, screening tests, and a personal health report.Β However, one drawback of the Medihelp MedPlus plan is its relatively high cost compared to other Medihelp plans. Therefore, it may not be suitable for individuals on a tight budget or those with low healthcare needs.
Overall, the Medihelp MedPlus plan offers significant advantages over other Medihelp plans regarding its comprehensive cover, advanced medical technology and treatments, and wellness benefits.Β Therefore, it is an excellent choice for individuals seeking high-quality healthcare and willing to invest in a top-tier health insurance plan.
You might also consider the following options of MediHelp:
The Medihelp MedPlus plan is the top-tier health insurance plan offered by Medihelp in South Africa, providing comprehensive medical cover, including unlimited hospitalization and chronic medication benefits.
The cost of the Medihelp MedPlus plan varies depending on factors such as age, location, and healthcare needs. However, it is generally more expensive than other Medihelp plans due to its comprehensive medical cover and advanced medical technology. For the primary member of MedPlus, the monthly contribution is R10,980.
The Medihelp MedPlus plan offers comprehensive medical cover, access to advanced medical technology and treatments, international travel insurance, and wellness benefits such as a health risk assessment, screening tests, and a personal health report.
One of the main drawbacks of the Medihelp MedPlus plan is its relatively high cost compared to other Medihelp plans, which may not be suitable for individuals on a tight healthcare budget or those with low healthcare needs.
The Medihelp MedPlus plan is an excellent choice for individuals seeking high-quality healthcare and willing to invest in a top-tier health insurance plan. However, it may not be the best option for individuals with low healthcare needs or a tight budget.
The Medihelp MedPlus plan offers more comprehensive medical cover and advanced medical technology than other Medihelp plans. Compared to other health insurance plans in South Africa, the Medihelp MedPlus plan is a top-tier one providing high-quality healthcare.
A hospital plan is a type of medical aid plan that covers only in-hospital treatment, including accommodation, nursing care, and medical procedures.Β Typically hospital plans have lower monthly premiums than comprehensive plans but provide limited cover for out-of-hospital expenses such as doctorβs visits and medication.
No, there is no waiting period for Prescribed Minimum Benefit (PMB) conditions with South African medical aids. PMBs are a set of medical conditions that all medical aids must cover in full, regardless of the type of plan or the memberβs waiting period.
Yes, most South African medical aids cover pregnancy and childbirth, including prenatal care, hospitalization, and postnatal care. However, some plans may have waiting periods for pregnancy-related benefits or may require additional premiums for maternity benefits.
Yes, foreigners living and working in South Africa can access medical aid plans. However, some medical aids may require proof of residency or work permit before enrolling, and premiums may be higher for non-residents.
Yes, many South African medical aids offer unique plans for students, including discounted rates and benefits tailored to their needs. In addition, these plans cover essential healthcare services, such as doctorβs visits, emergency treatment, and prescription medication.
Yes, some medical aid plans in South Africa offer immediate cover, depending on the type of plan and the memberβs health status.
You might also like
We work with leading medical aid companies in South Africa.
π Report a bug or outdated data to be updated to [email protected]
Β© Medicalaid.com | All rights Reserved |
Copyright 2024
Top 5 Medical Aids
Top 5 Gap Cover Plans