Medshield Medical Aid

Overall, Medshield offers 11 medical aid plans (PemiumPlus, MediBonus, MediSaver, MediPlus Prime, and others) starting from R1,584 per month. Additionally, Medshield offers 24/7 emergency support but does not offer native comprehensive gap cover any policy.

Medical Aid Medshield at a Glance

Medshield Regulation

The Council for Medical Schemes regulates Medshield Medical Scheme.  The Council governs South Africa’s medical plan business for Medical Schemes (CMS), a regulating body set up under the Medical Schemes Act, No. 131 of 1998 (the Act). The CMS is responsible for a range of tasks related to the oversight of medical insurance plans, such as:

• Responsible for registering medical insurance plans and ensuring they comply with the law and other laws.
• Making sure healthcare plans have the money to pay claims.
• Examining and authorizing proposed price hikes for medical plans.
• Accepting and examining member complaints and initiating disciplinary action against medical plans that violate the Act or other applicable rules.
• Helping medical insurance plans follow the law and other laws.

Furthermore, if a medical scheme is found to violate the law, the CMS has the authority to issue administrative fines and penalties.

Read more about the role of the Medical Aid Ombudsman – Complaints Procedure

Medshield Plan Overview

Discover: what is the difference between medical insurance and medical aid

MediCurve

It is impossible to predict when you will require medical care or treatment and, more critically, whether you will have sufficient cash to afford the charges. MediCurve provides first-time medical coverage that matches the lifestyle of the young and healthy.  Members can expect the following from this plan:

• A digital plan for the youthful, carefree, and healthy individual with simple online enrollment
• Submit claims online and manage your health using any mobile device
• Unrestricted Family Practitioner consultations, including virtual, in-person, Videomed, and SmartCare consultations guided by a registered nurse.
• Ambulance Services
• Major Medical Benefits In-Hospital
• Oncology Benefits
• Family Practitioner Benefits
• Chronic Medicine Benefits
• Maternity Benefits
• Wellness Benefits
• Dental Benefits, and more.

MediPhila

There is no way of knowing when you or a family member will require expensive medical care.  As a member of MediPhila, you can enjoy limitless hospital coverage for PMB-eligible diseases and generous limits for In-Hospital treatments not covered by PMB. In addition, the Out-of-Hospital benefit limit for certain services covers your fundamental everyday healthcare requirements.  Furthermore, the following are features of the MediPhila plan:

• With a Daily Restrictions Sub-limit, particular benefits are payable from the Annual Limit.
• Unlimited PMB-provided services are acquired according to the Scheme’s approved protocols.
• The specific limit for non-PMB services is according to the Scheme’s authorized Rules and Protocols.
• Medshield has programs to assist you if you have been diagnosed with a specific ailment, including any of the 26 Chronic disorders listed.
• Medshield’s comprehensive programs will aid you in disease management. Simply enrolling in the relevant program will get you access to all benefits.
• At-home delivery of your chronic medication
• Medications must be obtained from a MediPhila-approved pharmacy.
• For your first, second, or third child, Medshield provides you with a comprehensive maternity benefit and access to quality services throughout your pregnancy, at birth, and after delivery.

MediSwift

MediSwift is an unlimited hospital plan that covers in-hospital costs associated with major medical emergencies.  MediSwift provides unlimited In-Hospital coverage via the Compact Hospital Network, with In-Hospital procedures reimbursed at the Medshield Tariff (100%) and an added physiotherapy & biokinetics benefit for amateur athletes.  MediSwift provides no Day-to-Day coverage as a hospital plan, leaving healthy, active persons to manage their own everyday healthcare.

Medshield MediValue has 2 options: MediValue Compact & MediValue Compact

MediValue is the optimal alternative for persons requiring comprehensive coverage for hospital operations and emergencies and partial coverage for daily healthcare.  MediValue also provides unrestricted In-Hospital services via the applicable Hospital Network and limited Out-of-Hospital coverage for basic healthcare needs. Medshield has divided the MediValue option into two sub-categories, MediValue Prime and MediValue Compact, to provide more options. All benefits offered and displayed are identical for all categories. However, MediValue Compact requires networks, care coordination, the nomination of a Family Practitioner, and the Family Practitioner-to-Specialist referral process.

MediCore

In a catastrophic medical emergency, everyone should have unlimited in-hospital coverage.  Through the Medshield Hospital Network, MediCore provides unlimited In-Hospital coverage, with specific In-Hospital operations reimbursed at a higher rate (Medshield Private Tariff 200%) than the Medshield Tariff (100%).  Furthermore, this plan has no Day-to-Day benefits. Therefore, it is suitable for persons in good health who can manage their own daily medical expenses.

Medshield MediPlus has 2 options: MediPlus Prime and MediPlus Compact

MediPlus is the solution for middle- to upper-income earners who require hospitalization and outpatient coverage. Members receive unlimited In-Hospital coverage through the applicable Hospital Network, and the daily Out-of-Hospital coverage includes the following benefits:

• Basic and Specialized Dentistry
• Optical
• Day-to-Day Limit for Family Practitioner (FP) visits
• Specialists
• Radiology
• Pathology, and many others.

Medshield has divided the MediPlus option into two subcategories, MediPlus Prime and MediPlus Compact, to provide more options. All benefits offered and represented are identical for both categories.  However, MediPlus Compact requires networks, care coordination, the nomination of a Family Practitioner, and the Family Practitioner-to-Specialist referral process.

MediSaver

MediSaver is ideal for those who wish to take charge of their healthcare costs and plan to start their own family.  Members of MediSaver have access to unrestricted in-hospital care through the Compact Hospital Network. In addition, members are responsible for their out-of-hospital expenses through a Health Savings Account.

MediBonus

MediBonus allows families and individuals to manage their daily healthcare costs with a Day-to-Day Limit and unlimited In-Hospital insurance for certain In-Hospital treatments charged at a Medshield Private Tariff of 200%. MediBonus is a trustworthy medical aid option for a family.

PremiumPlus

Unlimited In-Hospital Coverage with Selected In-Hospital Procedures Paid at a Medshield Private Tariff of 200% and the Freedom to Manage Everyday Healthcare Expenses with a Personal Savings Account are just two benefits PremiumPlus offers to families and professionals.

Medshield – Advantages Over Competitors

• Medshield has been in operation for over 55 years, making it a reliable medical aid in South Africa.
• Medshield has an AA- GCR rating.
• Medshield offers home care and several other benefits, including medicine delivery.
• There are over 200 hospitals in Medshield’s network.
• Medshield offers affordable and comprehensive coverage to South Africans.
• Medshield offers an Android and iOS app to its members.

Poll 1: 5 Best GP Network Plans on Medical Aid

Poll 2: 5 Best Limited Day to Day Cover Plans

Medshield Medical Savings Account

Medshield offers two plans that have Medical Savings Accounts, namely:

• ✅ MediSaver
• ✅ PremiumPlus

MediSaver

The members’ day-to-day benefits on this plan consist of a Personal Savings Account. Furthermore, they are allocated six months in advance for Out-of-Hospital services.

PremiumPlus

Comprises a Personal Savings Account for Out-of-Hospital services, a Self-payment Gap Cover, and an Above Threshold Benefit for certain benefits.

How to apply for Medical Aid with Medshield

Medical Aid Quote Medshield Medical Scheme process explained

To apply for Medical Aid through Medshield, you must:

• Visit the Medshield website and navigate to the “Join Medshield” page.
• Download the appropriate application form for the type of Medical Aid for which you wish to apply. The forms are available in PDF format and can be completed electronically or printed and completed by hand.
• Fill out the application form with all the required information, including your details, medical history, and contact information.
• Gather any additional documentation required, such as proof of income, ID documents, and a letter from your current Medical Aid (if you are switching from another provider).
• Submit your completed application form and supporting documentation by email, fax, or post to Medshield.
• Wait for Medshield to process your application and contact you with the outcome.
• Alternatively, you can apply for Medshield Medical Aid by contacting their call center or visiting one of their branches.
• New Members may be subject to late-joiner penalties or a waiting period for pre-existing conditions.

Get a Medshield Medical Aid quote from our Dedicated Medical Aid Specialists Broker

How to Submit a Claim with Medshield

To submit a claim to Medshield, members can scan and email their claim. Alternatively, members can post their claim to Medshield or drop it off at a Medshield branch.  Before submitting a claim, members must ensure that they provide the following information:

• The receipt of payment.
• The First and Last name of the patient who received treatment.
• Name and Practice Number of the provider.
• The ICD 10 Code
• The correct Tariff Codes
• The amount being claimed
• The date on which treatment was received
• The Account Details of the Service Provider

How to Submit a Compliment or Complaint with Medshield

Compliments and Complaints can be directed to Medshield via the following:

• Telephone
• Email

All complaints will be managed according to the escalated complaints system to guarantee a fair and timely resolution.

How to Switch my Medical Aid to Medshield

To switch from your present medical aid to Medshield Medical Aid, you must notify your current medical aid of canceling coverage.  After advising your current medical plan of your desire to quit coverage, you can apply to Medshield Medical Aid via their website or by completing the application procedures over the phone.

You might also like: 5 Best Medical Aids for Child Only in South Africa

Medshield Customer Support

You can contact Medshield customer support by calling their customer service number, which can be found on their website, or by searching for it online. Additionally, you may also be able to contact them through email or by filling out a contact form on their website.

For a better understanding:  How to Calculate Medical Aid Credits

Medical Aid Comparisons : Medshield vs Sizwe Hosmed vs Platinum Health – A Comparison

You might also like Medshield comparisons with other medical aid schemes:

• Medshield vs. Discovery Health
• Medshield vs. KeyHealth
• Medshield vs. BestMed Medical Scheme
• Medshield vs. Sizwe Hosmed Medical Fund
• Medshield vs. Momentum Medical Scheme
• Medshield vs. Bonitas
• Medshield vs. Fedhealth
• Medshield vs. Medihelp
• Medshield vs. Medimed

Medshield Recent User Reviews

Satisfied Member.

I am writing to express my deepest appreciation for the excellent service provided by Medshield. I am extremely satisfied with the company. I am particularly grateful for their presence and support when my child was ill. Additionally, I would like to commend the prompt response of the company. Finally, I request the Marketing team to contact me, as I would like to submit a positive review of Medshield personally. – Norma Todd

Great Support.

I emailed the credit department requesting a confirmation letter for my SARS submission at 10 pm one night. I was pleased to receive the requested letter first thing in the morning, indicating a prompt and efficient response. I must commend the department for its exceptional service. – David Potts

Best in The Industry.

Medshield medical scheme is by far the best in the industry. Very professional client service, affordable premiums and I must say, after juggling different schemes in financial services for more than 12 years, I can honestly say I’ve found the best! – Daisy Petty

Medshield – Our Verdict

Medshield prides itself on being transparent regarding its plans. Furthermore, Medshield plans are affordable, easily accessible, and easy to understand. Medshield offers plans for every type of budget in South Africa, and the scheme is reputable in the industry.  Medshield has an AA- GCR rating and a proven payment record. In addition, Medshield offers a range of benefits across all plans and provides dedicated customer support across communication channels.

Read more in-depth the following plans MedShield has to offer:

• ✅ MedShield MediCurve
• ✅ MedShield PremiumPlus
• ✅ MedShield MediValue Prime
• ✅ MedShield Value Compact
• ✅ MedShield MediSwift
• ✅ MedShield MediSaver
• ✅ MedShield MediPlus Prime
• ✅ MedShield MediPlus Compact
• ✅ MedShield MediPhila
• ✅ MedShield MediCore
• ✅ MedShield MediBonus

Medshield Pros and Cons

Medshield Frequently Asked Questions

Is Medshield a good medical aid in South Africa?

Medshield is a well-established medical insurance company founded in 1968 and, following its merger with Oxygen, now covers over 250 000 lives.

Does Medshield have a waiting period?

Typically, there is a waiting period for pre-existing conditions. This is to prevent new members from abusing medical insurance for a short period to finance pricey procedures and then canceling their membership shortly after that.

How much does it cost for Medshield MediValue per month in 2024?

MediValue starts from 2,478 ZAR on the Compact option.

Where can I find my Medshield tax certificate?

You can log into the client portal on Medshield and find your tax certificate on your portfolio. In addition, Medshield will email your tax certificate yearly.

Where can I compare Medshield options?

You can compare Medshield’s options on the official website.

How do I Downgrade my Plan with Medshield?

Changes to options must be requested by no later than the 31st of December to take effect on the 1st of the following fiscal year, as per the Scheme’s rules. In addition, members can downgrade their plan with Medshield by downloading and printing the “Option Change Request” form.

How do I add a Beneficiary to Medshield?

If you want to add a child or adult dependent, you can log into your Medshield profile and print the “Member Record Amendment/Dependent Registration” form.