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Medihelp MedVital Medical Aid Plan

Overall, the Medihelp MedVital Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and care extender benefits to up to 3 Family Members. The Medihelp MedVital Medical Aid Plan starts from R2,598 ZAR.

Medihelp MedVital Plan – 11 Key Point Quick Overview

☑️ Medihelp MedVital Plan Overview
☑️ Medihelp MedVital Plan Contributions
☑️ MedVital Plan Benefits and Cover Comprehensive Breakdown
☑️ MedVital Benefit Table
☑️ MedVital Hospitalization and Advanced Treatment
☑️ MedVital Emergency Benefits
☑️ MedVital Added Insured Benefits
☑️ Medihelp MedVital Plan Exclusions and Waiting Periods
☑️ Medihelp MedVital Plan vs. Similar Plans from other Medical Schemes
☑️ Our Verdict on The MedVital Plan
☑️ MedVital Plan Frequently Asked Questions

Medihelp MedVital Plan Overview

The Medihelp MedVital medical aid plan is one of 11, starting from R2,598 and includes Consultations, PMB and non-PMB medication, care extender benefits, in-hospital services, trauma benefits, and more. Gap Cover is not available on the Medihelp MedVital 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 MedVital Plan Contributions

👤 Main Member	👥 +1 Adult Dependent	💙 +1 Child Dependent
R2,598	R1,998	R894

MedVital Plan Benefits and Cover Comprehensive Breakdown

MedVital Day-to-Day Benefits

Covered up to 100% of the Medihelp Tariff (MT).
There is a limit of R1,400 dedicated to day-to-day for the main member and R2,700 for the main member plus dependents.

MedVital Consultations

GP appointments and follow-up appointments
Specialists
Telemedicine, virtual consultations, and visits from nurses at network pharmacies.
Pharmacies providing primary care and emergency units, including primary care drug therapists, in terms of consultations and follow-ups.
Physiotherapy, including material and treatment.

MedVital Medication

The medication is obtained through the Medihelp Preferred Pharmacy Network and prescribed or given by a physician.
Acute and non-PMB chronic medication and self-medication, including emergency room drugs and immunizations.
Generic medicine – 100% of the MMAP Original medicine if no generic equivalent – 80% of the MT.
70% of the MMAP comprises original medication taken willingly when a generic alternative is available.
Homeopathy, naturopathy, and osteopathy account for 25% of the possible daily benefit.

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MedVital Benefit Table

📌 Care Extender: Additional GP Consultation	A beneficiary’s Pap smear, mammography, prostate test, FOBT, or bone mineral density test activates a family consultation benefit.
📍 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.
💊 PMB Chronic Medicine	Pre-approval and registration on Medihelp’s PMB drug management program are required. Covered up to 100% of the MT. Unlimited cover
☑️ Oxygen	Covered out-of-hospital. Subject to pre-approval and clinical protocols. A medical doctor must prescribe it. Covered up to 100% of the MT. Unlimited cover.
🦷 Dentistry under conscious sedation in the dentist’s rooms	Impacted tooth extraction (3rd molars covered on the dentist’s account) Covered up to 100% of the MT. If not pre-approved, a 20% co-payment applies.
💉 Dental procedures performed under general anesthesia in a MedVital Network Day facility	Impacted tooth extraction (3rd molars covered on the dentist’s account) Covered up to 100% of the MT. Member is responsible for the first R3,700 per admission. If not pre-approved, a 20% co-payment applies. There is a 35% co-payment if the procedure is not performed in the Medihelp day procedure network.
✅ Services in and out of the hospital, including fitting, cost of repairs, maintenance, spares, accessories, and adjustments on the following: Stoma Components Incontinence Products/Supplies	Unlimited Cover. Covered up to 100% of the MT.

MedVital Hospitalization and Advanced Treatment

1️⃣ 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.
2️⃣ Trauma Benefits This applies to major trauma requiring hospitalization, for example: Motor Vehicle Accidents Stab Wounds	Subject to authorization, PMB protocols, and case management. Covered up to 100% of the cost or the contracted tariff.
3️⃣ Post-Exposure Prophylaxis (HIV/AIDS)	Subject to authorization, PMB protocols, and case management. Covered up to 100% of the cost or the contracted tariff.
4️⃣ 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.
5️⃣ Emergency Transport Services via Netcare 911 – 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.
6️⃣ 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.
7️⃣ Day Procedures	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.
8️⃣ Hospital Medicine upon Discharge	Covered up to 100% of the MT. There is an R390 limit per admission.
9️⃣ Home Delivery: Includes the following Professional Nursing Fee Equipment Material and Medicine	Covered up to 100% of the MT. Limited to R14,900 per event. If not pre-approved, a 20% co-payment applies.

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.

📌 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 R3,400 per examination and R2,900 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 R21,800 per beneficiary per year, with a limit of R33,100 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 R21,800 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.
➡️ Prostatectomy: Conventional or Laparoscopic Procedure	Unlimited cover. Covered up to 100% of the MT.

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MedVital 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.

MedVital 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.

Medihelp MedVital Women’s Health

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 R150 per month and up to R1,950 per beneficiary.

Intra-uterine devices for women up to 50 years:

Every 60 months.
Covered up to R2,150 per beneficiary.

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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.
Dual 2D ultrasound imaging.

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.
In network pharmacy clinics, the full series of regular child immunizations 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 girls and boys between 10 – 14 years or three between 15 – 26 years

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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

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.

Medihelp MedVital Plan Exclusions and Waiting Periods

Medihelp MedVital 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 MedVital plan excludes several items, including but not limited to the following:

Infertility treatment is other than that specified in the Medical Schemes Act of 1998 Regulations.
Treatment of alcoholism and drug abuse, as well as services rendered by institutions registered per the Prevention and Treatment for Substance Abuse Act 70 of 2008 or other institutions whose services are similar, unless otherwise specified in the Regulations to the Medical Schemes Act of 1998.
Therapy for impotence
The artificial insemination of a human, as defined in section 61 of the National Health Act of 2003.
Immunizations (including immunization processes and materials) are required by an employer, excluding flu vaccinations and routine childhood immunizations.
Workout, counseling, and rehabilitation regimens
Services provided by social workers and counselors who are not qualified clinical psychologists Expenses of home visits and home programs
When only housing and basic care services are provided.
All operations and services are excluded except for removing impacted teeth (3rd molars – dentist’s account solely for certain item codes).
Dentures made of plastic
Snoring aids
Mouthguards
Blood pressure apparatus
Commode
Raised toilet seat
Hospital beds for home usage
Vision-improving devices
Mattresses and cushions
Bras without external breast prosthesis
Where the reason for hospitalization is dental fear or anxiety; Where there are many hospitalizations; Where the sole reason for hospitalization is to acquire a sterile facility; The cost of dental materials for procedures conducted under general anesthesia.

Medihelp MedVital 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 MedVital Plan vs. Similar Plans from other Medical Schemes

🔎 Medical Aid Plan	🥇 Medihelp MedVital	🥈 Medshield MediValue	🥉 Fedhealth FlexiFED 2
👤 Main Member Contribution	R2,598	R2,736	R2,491
👥 Adult Dependent Contribution	R1,998	R2,388	R2,227
🚼 Child Dependent Contribution	R894	R771	R740
📉 Annual Limit	None	Unlimited Hospital Cover	Unlimited Hospital Cover
🏥 Hospital Cover	Unlimited	Unlimited	Unlimited
💶 Oncology Cover (Maximum ZAR)	R242,000	Unlimited for PMBs	R311,900
💳 Prescribed Minimum Benefits	✅ Yes	✅ Yes	✅ Yes
🩺 Screening and Prevention	☑️ Yes	☑️ Yes	☑️ Yes
💳 Medical Savings Account	None	None	✅ Yes

Our Verdict on The MedVital Plan

MedVital is a cost-effective healthcare option that covers minor medical expenses, private hospitalization, and emergency medical services. In contrast, MedVital Elect is a more affordable version of the MedVital Plan. In addition, it is a network option that offers similar benefits to the MedVital Plan but limits the member’s choice of healthcare providers to those within the Medihelp Elect network. Members can only visit hospitals, doctors, and other healthcare providers in the Medihelp Elect network. The main difference between MedVital and MedVital Elect is the cost and the choice of healthcare providers. Overall, MedVital offers members more flexibility in terms of healthcare provider choice, but it also comes at a higher cost.

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MedVital Plan Frequently Asked Questions

What is MedVital?

MedVital is a healthcare plan offered by the South African medical scheme, Medihelp. It provides comprehensive coverage for hospitalization, chronic medication, day-to-day healthcare, and other medical expenses.

What benefits are covered under the MedVital plan?

The MedVital plan covers a range of benefits, including in-hospital treatment, specialist consultations, chronic medication, acute medication, radiology, pathology, maternity care, GP consultations, optometry, dentistry, and prescription medication.

Is MedVital an affordable healthcare solution?

Yes, MedVital is designed to be a cost-effective healthcare option for Medihelp members.

What is MedVital Elect?

MedVital Elect is a network option that offers similar benefits to the MedVital plan but limits the member’s choice of healthcare providers to those within the Medihelp Elect network.

Can members save on their premiums by choosing MedVital Elect?

Yes, members who choose MedVital Elect can enjoy a 25% reduction in their premiums compared to the standard MedVital plan.

What is the difference between MedVital and MedVital Elect?

The main difference between MedVital and MedVital Elect is the cost and the choice of healthcare providers. MedVital offers members more flexibility in terms of healthcare provider choice, but it also comes at a higher cost. In contrast, MedVital Elect is more affordable. However, it restricts the member’s choice of healthcare providers to those within the network.

Does MedVital cover emergency medical services?

Yes, MedVital provides coverage for emergency medical services, including emergency transportation and treatment.

Does MedVital cover maternity care?

Yes, MedVital covers maternity care, including antenatal consultations, delivery, and postnatal care.

Does MedVital cover chronic medication?

Yes, MedVital provides coverage for chronic medication, subject to certain limits and conditions.

Does MedVital cover optometry?

No, MedVital does not provide cover for optometry. Therefore, members must pay out-of-pocket when they need to see an optometrist, receive glasses, or contact lenses, or undergo surgical procedures relating to optometry.

Can I choose my own healthcare provider with MedVital?

Yes, MedVital allows members to choose their own healthcare providers, subject to the scheme’s rules and limits.

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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