The Best Medical Aids
The Best Hospital Plans
Overall, the Medimed Medisave Essential Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and privateΒ hospitalization to up to 3 Family Members. The Medimed Medisave Essential Medical Aid Plan starts from R1,600 ZAR.
π€ Main Member Contribution | R1,600 β R2,760 |
π₯ Adult Dependent Contribution | R1,600 β R2,760 |
πΌ Child Dependent Contribution | R510 β R640 |
π Gap Cover | β Yes |
π Annual Limit | None |
π Mental Healthcare Program | Only hospitalization |
π¦ Hospital Cover | Unlimited |
π΅ Optometry Benefit | Only consultations |
β‘οΈ Oncology Cover | R50,000 |
βͺοΈ Pre and Postnatal Care | Only Prenatal |
The Medimed Medisave Essential medical aid plan is one of 4, starting from R1,600, and includes cover for private hospitalization, maternity care, chronic medication, and emergency medical services.Β Gap Cover is available on the Medimed Medisave Essential Plan, along with 24/7 medical emergency assistance. According to the Trust Index, Medimed has a trust rating of 3.0.
Medimed Medical Aid has a late joiner fee and also has the following plans to choose from:
π΄ Income Bracket | π€ Main Member | π₯ Adult Dependent | πΌ Child Dependent |
π΅ R0 β R10,000 | R1,600 | R1,600 | R510 |
πΆ R10,001 β R16,000 | R1,910 | R1,910 | R560 |
π· R16,001 β R22,000 | R2,340 | R2,340 | R610 |
π΄ R22,000> | R2,760 | R2,760 | R640 |
π΄ Income Bracket | π€ Main | π₯ Main + Spouse | πΌ Main + S + 1C | βοΈ Main + S + 2C |
π΅ R0 β R10,000 | R1,920 | R3,840 | R4,452 | R5,064 |
πΆ R10,001 β R16,000 | R2,292 | R4,584 | R5,256 | R5,928 |
π· R16,001 β R22,000 | R2,808 | R5,616 | R6,348 | R7,080 |
π΄ R22,000> | R3,312 | R6,624 | R7,392 | R8,160 |
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βοΈ Hospitalization | – |
π₯ Hospital Limit | Unlimited cover provided. Covered up to 100% when using preferred providers. Covered up to 80% when using non-preferred providers. |
π§ Hospitalisation Alternatives | Limited to R6,000 per beneficiary. |
π¨ Auxiliary Services | Limited to R2,000 per beneficiary. Covered up to 60% of the Medimed Scheme Tariff. The benefit is for in and out-of-hospital treatment. |
π© In-Hospital Dentistry | Limited to R10,000 per family per year. Limited to impacted wisdom teeth and treatment for children <12. |
π¦ Emergencies and Ambulance Services | Unlimited cover. ER24 is the preferred provider. |
πͺ GP and Specialist Services | Unlimited cover provided. |
π₯ Pathology | Unlimited cover provided. |
π§ Internal Prostheses | Limited to R30,000 per family. Pre-approval is required. |
π¨ External Prostheses | Limited to R3,000 per family. Pre-approval is required. |
π© Prescribed Minimum Benefits (PMB) | Unlimited when obtained from a DSP and subject to protocols. |
π¦ Psychiatric Hospitalisation | Limited to R4,000 per beneficiary. Pre-approval is required. |
πͺ Basic Radiology | Unlimited cover provided. |
π₯ Specialized Radiology | Overall maximum of R10,000 per beneficiary and R15,000 per family. |
βοΈ Birth/Delivery | – |
π§ In-Hospital | Gynecologists/Obstetricians paid up to 200% of the Medimed Scheme Tariff. |
π¨ Home Delivery | Registered midwives are covered by up to 100% of the Medimed Scheme Tariff. Limited to R12,000 per pregnancy. Subject to non-admission/hospitalization protocols. |
π© Co-payments | Conservative back and neck β R3,000 per event. Arthroscopy, endometrial ablation, laparoscopy, and hysterectomy β R5,000 per event. Nissan, spinal surgery, joint replacements 0 R10,000 per event. |
βοΈ Major Medical Expenses | – |
π¦ Dialysis | Limited to R50,000 per family. Covered up to 100% of the Medimed Scheme Tariff. Pre-authorization is required. |
πͺ Organ Transplants | Combine limit with Dialysis. Pre-authorization is required. |
π₯ Oncology | Combine limit with Dialysis. Pre-authorization is required from ICON. |
π§ HIV/AIDS | Unlimited cover provided. Subject to managed care protocols. Pre-authorization is required. |
π¨ Chronic Medication | – |
π© Chronic Disease List | Covered up to 100% of the momTYB CDA. Pre-authorization is required. |
π °οΈ Out-of-Hospital Expenses | – |
π ±οΈ Acute Medication | Unlimited – prescribed or dispensed by a specific GP Medication is reimbursed based on a medication formulary. This is to help your chosen GP manage your condition more cost-effectively. |
π Acute Medication not on the formulary | If a generic equivalent is available on the formulary, the Scheme will pay the maximum of the generic formulary alternative, with the member responsible for the difference. The member will be liable for the entire amount if no generic equivalent exists. |
π Basic and Specialised Dentistry | Limited to R3,200 per beneficiary and up to R5,500 per family per year. Members can receive one set of plastic dentures every two years. |
π©ββοΈ GP Consultations | Unlimited cover from a selected GP. There is an additional R500 benefit for a family per casualty. |
πΌ Maternity | Beneficiaries who register on the Medimed Maternity Program are covered up to 100% of the Scheme Tariff on the following: Two prenatal visits. Two 2D scans. One Paediatrician visit. One maternity bag per pregnancy. Antenatal vitamins up to R100 for 9 months (paid from the acute benefit and covered up to 60%) |
π₯° Optometry | 2-year benefit for contact lenses or glasses per beneficiary. The benefit is available via a PPN. |
π Optometrist Consultation/Examination | Covered up to 100% of the cost with a network provider or R365 with a non-network provider. |
ποΈ Contact Lenses | Limited to R840 per beneficiary. Multifocal lenses are covered up to the same value as bifocal lenses. |
π Pathology and Basic Radiology | Unlimited cover. Requires a referral from the selected GP. |
π Second Opinion Benefit | Limited to two consultations per family from another doctor of the same group. Includes medicine per the formulary. |
π Specialist Consultations and Procedures | Limited to R3,000 per beneficiary and R6,000 per family. Subject to a referral from the preferred GP. |
π΄ Casualty Consultations | Will be paid from the funds available in the MSA. |
π Out-of-Town GP Consults and Acute Medicine | Limited to 6 consultations per beneficiary. |
π‘ Prescriptions from a Company Doctor | Limited to R300 per family. |
π’ Over-the-Counter Medication | Limited to R120 per prescription up to a maximum of R450 per family. |
π£ Appliances | Will be paid from the funds available in the MSA. Pre-approval is required. |
π΅ Auxiliary Benefits | Will be paid from the funds available in the MSA. |
Members who do not reside in the Nelson Mandela Metropole and who do not have access to a Network Provider receive the following benefit:Β Up to R2,500 per beneficiary and a maximum of R5,000 per family.
The Medisave Essential option does not include after-hours services at private hospitals (including preferred provider hospitals).Β Unless you have an emergency, you must always consult with your chosen GP, unless you have an emergency, in which case you may consult with any other GP in the relevant GP group. An emergency is defined as any life-threatening situation that necessitates immediate medical attention.
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Medimed Medisave Essential has some of the following exclusions:
Infertility tests and treatments are not covered unless according to the Prescribed Minimum Benefits.Β Medical treatment necessitated due to non-compliance with prescribed therapy is not covered.
The following Waiting Periods might apply to the Medimed Medisave Essential Plan:
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Furthermore, no waiting periods may be imposed on a person who applies for membership or admission as a dependent and was previously a beneficiary of a medical scheme, terminating less than 90 days immediately before the date of application in the following cases:
No waiting periods may be imposed on a child dependent born during the membership period.
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π Medical Aid Plan | π₯ Medimed Medisave Essential | π₯ Medshield MediSwift | π₯ Bonitas BonStart |
π€ Main Member Contribution | R1,600 β R2,760 | R2,037 | R1,378 |
π₯ Adult Dependent Contribution | R1,600 β R2,760 | R1,986 | R1,378 |
πΌ Child Dependent Contribution | R510 β R640 | R522 | R1,378 |
π Annual Limit | None | Unlimited Hospital Cover | Unlimited Hospital Cover |
β‘οΈ Hospital Cover | Unlimited | Unlimited | Unlimited |
Overall, Medimed Medisave Essential is an entry-level plan that provides some basic cover for medical treatment and procedures in hospitals. Furthermore, a medical savings account covers consultations, prescriptions, medicine, and appliances. An advantage of the Medimed Medisave Essential option is that unlimited hospital coverage is provided within the DSP network. Furthermore, PMBs have unlimited coverage, and Medimed offers emergency services via ER24.Β However, because this is a basic medical aid plan, the drawback is that many treatments and procedures are not covered. Therefore, Medisave Essential is unsuitable for those needing extensive medical cover in and out-hospital.
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Medisave Essential is one of the health insurance plans offered by Medimed South Africa. It provides essential medical coverage at an affordable price.
Medisave Essential covers hospitalization, outpatient services, diagnostic tests, and more.
Medisave Essential does not have deductibles. Instead, several limits apply to treatments and procedures.
Yes, Medisave Essential covers pre-existing conditions after a waiting period of 12 months.
Yes, you can see any doctor that accepts the plan.
Yes, Medisave Essential covers in and out-of-hospital basic and specialized dentistry.
Yes, Medisave Essential covers vision care.
Medisave Essential provides some basic cover for optometry, including examination, frames and prescription lenses, and contact lenses.
Yes, Medisave Essential covers some prescription drugs.
The cost of Medisave Essential varies depending on factors, with the main member paying R1600 per month.
No, while Medimed is an open scheme, its services are focused on healthcare benefits in the Eastern Cape.
You may be eligible to enroll in Medisave Essential outside of the open enrollment period if you have a qualifying life event.
Yes, you can switch to Medisave Essential during the open enrollment period or if you have a qualifying life event.
You will be responsible for paying for any medical care not covered by your plan.
You can search for doctors that accept Medisave Essential on the Medimed South Africa website or by calling customer service.
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