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Medshield MediBonus Medical Aid Plan

Overall, the Medshield MediBonus Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and in-hospital procedures to up to 3 Family Members. The Medihelp MedAdd Medical Aid Plan starts from R7,587 ZAR.

👤 Main Member Contribution	R7,587
👥 Adult Dependent Contribution	R5,328
🍼 Child Dependent Contribution	R1,578
🌎 International Cover	Only Organ Transplants
🔁 Gap Cover	None
⚕️ Hospital Cover	Unlimited
🏠 Home Care	☑️ Yes
📌 Medical Savings Account	None
💶 Prescribed Minimum Benefits	☑️ Yes
📍 Oncology Cover	R552,925

Medshield MediBonus – 14 Key Point Quick Overview

☑️ Medshield MediBonus Overview
☑️ Medshield MediBonus Plan Contributions
☑️ Medshield MediBonus Plan Benefits and Cover Comprehensive Breakdown
☑️ MediBonus Chronic Disease List
☑️ MediBonus Dentistry Benefits
☑️ MediBonus Maternity Benefits
☑️ Medshield MOM Program and Benefits
☑️ MediBonus SmartCare Services and Benefits
☑️ MediBonus Prescribed Minimum Benefits
☑️ MediBonus COVID-19 Benefits and Access to Care
☑️ MediBonus Plan Exclusions and Waiting Periods
☑️ Medshield MediBonus Plan vs. Similar Plans from other Medical Schemes
☑️ Our Verdict on The MediBonus Plan
☑️ MediBonus Plan Frequently Asked Questions

Medshield MediBonus Overview

The Medshield MediBonus medical aid plan is one of 11, starting from R7,587 and includes In-Hospital procedures covered up to 200%, generous day-to-day limits, quick and streamlined claims procedures, hospital-at-home benefits, and more. Gap Cover is not available on the Medshield MediBonus Plan. However, Medshield offers 24/7 medical emergency assistance. According to the Trust Index, Medshield has a trust rating of 4.1.

MedShield has the following medical aid plans to offer:

Medshield MediBonus Plan Contributions

👤 Main Member	👥 +1 Adult Dependent	🍼 +1 Child Dependent
R7,587	R5,328	R1,578

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Medshield MediBonus Plan Benefits and Cover Comprehensive Breakdown

MediBonus Hospital-At-Home

Medshield offers a Hospital-at-Home service delivered by Quro Medical.
The Hospital-at-Home service offers an alternative to hospitals as the center of patient care and management.
Hospital-at-Home provides active treatment at home instead of a general hospital ward for a specified period without compromising the quality of care.
Patients more vulnerable to hospital-acquired infections and developing new health complications may benefit from care at home.
Patients who usually need admission to a general hospital ward are eligible for Hospital-at-Home.
Quro Medical works with each patient and their treating doctor to develop a personalized treatment plan to deliver at home.
Treatment plans are amended accordingly if a patient’s medical needs change during treatment.
The clinical team at Quro Medical arranges routine home visits customized to the individual’s specific needs that may occur daily or more frequently to provide the necessary treatment and care.
Other channels allow patients to access advice and support outside of home visits.

MediBonus Major Medical Benefits In-Hospital

📌 Overall Annual Limit	There is no overall annual limit.
📍 Extended Benefit Cover of up to 200%	This only applies to specific services and procedures in hospitals.
🚑 Hospitalization	Unlimited cover. Subject to the relevant Management Healthcare Program. Pre-approval is needed for specialist services. Specialist visits and consults must be pre-authorized.
➡️ Surgical Procedures	Covered as part of an authorized event. Unlimited cover provided. Extended Benefit Cover of up to 200%.
💊 Medicine upon discharge	Limited to R830 per admission. Per the Maximum Generic Pricing of Medicine Price List and Medshield Formulary.
🔁 Hospitalisation Alternatives Physical Rehabilitation Sub-Acute Facilities Nursing Services Hospice Terminal Care	Clinical Protocols will apply. There is an R98,780 limit per family yearly, subject to the hospitalization limit. DSPs must be used, or a 25% co-payment will apply for using a non-MediBonus Network Hospital. Terminal care is limited to R41,400 per family per year and is subject to the Alternatives to Hospitalisation Limit.
🩺 General, Medical, and Surgical Appliances	Limited to R15,760 per family per year. Pre-approval is required. Services must be obtained from a DSP, Network Provider, or Preferred Provider.
☑️ Hiring or buying of Appliances, External Accessories, or Orthotics	Limits Apply
✅ Peak Flow Meters, Nebulizers, Glucometers, and Blood Pressure Monitors (needs motivation)	Limited to R885 per beneficiary yearly. Subject to the Appliance Limit
🦻 Hearing Aids (including repairs)	Subject to the Appliance Limit
👩🏻‍🦼 Wheelchairs (including repairs)	Subject to the Appliance Limit
✔️ Stoma Products and Incontinence Sheets relating to Stoma Therapy	Unlimited if pre-approved.
😴 CPAP Apparatus for Sleep Apnea	Subject to the Appliance Limit
➡️ Oxygen Therapy Equipment	Unlimited cover. Subject to pre-authorization and the relevant Managed Healthcare Program. Clinical Protocols will apply.
📈 Home Ventilators	Unlimited cover. Subject to pre-authorization and the relevant Managed Healthcare Program. Clinical Protocols will apply.
🩸 Blood, Blood Equivalents, and Blood Products	Unlimited cover. Subject to pre-authorization and the relevant Managed Healthcare Program. Clinical Protocols will apply.
👨‍⚕️ Medical Practitioner Consultations and Visits during hospital admission	Unlimited cover. Forms part of an authorized event during hospitalization and includes Medical and Dental Specialists or FPs. Extended Benefit cover of up to 200%.
🤓 Refractive Surgery Includes the following: LASIK Radial Keratotomy Phakic Lens Insertion	Limited to R19,760 per family per year. The benefit includes hospitalization. Without pre-authorization, the account will be settled from daily benefits limits. Subject to pre-authorization by the relevant Managed Healthcare Program. Services must be obtained from the Medshield Hospital Network, and the Medshield Specialist Network might be required.
💤 Sleep Studies Diagnostic Polysomnograms	Unlimited Cover Subject to pre-authorization by the relevant managed healthcare program. Clinical protocols will apply.
✳️ CPAP Titration	Unlimited cover. Subject to pre-authorization by the relevant managed healthcare program. Clinical protocols will apply.
❤️ Organ, Tissue, and Haemopoietic Stem Cell (Bone Marrow) Transplants Immuno-Suppressive Medication Post Transplantation biopsies and scans. Related radiology and pathology	Subject to the relevant managed healthcare program. 25% upfront co-payment for the use of a non-Medshield Network Hospital. Organ harvesting is limited to the Republic of South Africa. Workup costs for the donor in Solid Organ Transplants are included. No benefits for international donor search costs. Hemopoietic stem cell (bone marrow) transplantation is limited to allogenic grafts and autologous grafts derived from the South African Bone Marrow Registry.
🌎 International Corneal Grafts and Transplants	Limited to R46,615 per beneficiary. Subject to the OAL. Clinical protocols apply.
🚩 Local Corneal Grafts and Transplants	Limited to R19,980 per beneficiary. Subject to the OAL. Clinical protocols apply.
⚕️ Pathology and Medical Technology	Unlimited cover. Clinical protocols apply. Must be part of an authorized event but excludes allergy and Vitamin D testing.
🦵 Physiotherapy	Limited to R2,955 per beneficiary yearly. Once this is exhausted, the benefit is subject to the day-to-day limit unless specific authorization is obtained.
🦾 Internal Prostheses and Devices	Subject to pre-authorization by the relevant Managed Healthcare Program. Only for surgically implanted devices. Limited to R53,280 per family yearly. 25% co-payment unless related to PMB. Hips and knees sub-limit: R35,510 per beneficiary.
🔍 External Prostheses	Must be pre-approved. Treatment can only be obtained from a DSP, Network Provider, or Preferred provider. The benefit includes Ocular Prostheses. Clinical protocols apply. Subject to prostheses and the device’s internal limit. There are no co-payments on external prostheses.
📍 Long Leg Callipers	Subject to prostheses and the device’s internal limit. There are no co-payments on external prostheses.
1️⃣ Basic Radiology	Unlimited cover. Clinical protocols will apply.
2️⃣ Specialized Radiology	Limited to R24,750 per family yearly for in- and out-of-hospital. Subject to pre-authorization by the Managed Healthcare Program. Services must be obtained from the Medshield DSP or Network Provider.
3️⃣ CT Scans, MUGA Scans, MRI Scans, Radio Isotope Studies	Subject to the Specialised Radiology Limit. Clinical protocols will apply.
4️⃣ CT Colonography (Virtual colonoscopy)	There is no co-payment on this benefit. Clinical protocols apply.
5️⃣ Interventional Radiology replacing Surgical Procedures	Unlimited cover, but clinical protocols apply.
❤️ Chronic Renal Dialysis Hemodialysis and Peritoneal Dialysis include the following: Material Medication Related Radiology and Pathology	Unlimited cover. A non-DSP will incur a 35% upfront co-payment. Use of a DSP with Rand one for PMB and non-PMB.
🧡 Non-Surgical Procedures and Tests	Unlimited cover. It must be as part of an authorized event. Members must use the Medshield Specialist Network.
🧠 Mental Health	Limited to R45,790 per family per year in and out-of-hospital. 25% upfront co-payment for non-Medshield Network Hospitals. DSP from Rand one applies for PMB and non-PMB admissions.
💜 Rehabilitation for Substance Abuse	Subject to the mental health limit.
👩‍⚕️ Consultations and Visits, Procedures, Assessments, Therapy, Treatment, or Counselling	Subject to the mental health limit.
😷 HIV and Aids	According to the Managed Healthcare Protocols. Pre-authorization and Managed Healthcare Program registration are required.
💉 Anti-retroviral and related medicines	Voluntary out-of-formulary or PMB medication from a non-DSP supplier requires a 35% upfront co-payment.
💊 HIV/AIDS-related Pathology and Consultations	Voluntary out-of-formulary or PMB medication from a non-DSP supplier requires a 35% upfront co-payment.
📌 National HIV Counselling and Testing (HCT)	Voluntary out-of-formulary or PMB medication from a non-DSP supplier requires a 35% upfront co-payment.
📍 Infertility Interventions and Investigations	Clinical Protocols apply. Limited to interventions and investigations only. Pre-authorization and Managed Healthcare Program registration are required.

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MediBonus Oncology Benefits

📌 Oncology Limit	Limited to R552,925 per family per year. There is a 40% co-payment if members use a non-DSP.
📍 Active Treatment (Includes Stoma Therapy, Incontinence Therapy, and Brachytherapy)	Subject to the Oncology Limit. ICON Standard Protocols apply.
☑️ Oncology Medicine	Subject to the Oncology Limit. ICON Standard Protocols apply.
✅ Radiology and Pathology	Subject to the Oncology Limit.
✳️ PET and PET-CT	Limited to 2 scans per family per annum. Subject to the Oncology Limit.
💗 Integrated Continuous Cancer Care	Six visits per family per annum. Subject to the Oncology Limit
💊 Specialized Drugs for Oncology, Non-Oncology, and Biological Drugs	Limited to R223,520 per family yearly. Subject to the Oncology medicine limit. Pre-authorization is required from the Oncology Managed Healthcare provider. Clinical Protocols will apply. 20% upfront payment for non-PMBs.
➡️ Vitreoretinal Benefit	Subject to pre-approval. Specialized Drugs Limit applies.
⚕️ Breast Reconstruction (only after an oncology event)	Subject to pre-authorization. Clinical protocols apply. The benefit is only for Post Mastectomy (all stages) Services must be obtained from a DSP network or provider. Member must use the Medshield Specialist Network. Limited to R94,105 per family yearly and limited to (and included) in the hospitalization limit. Co-payments and prostheses limits will not apply for Breast Reconstruction.

MediBonus Chronic Medicine Benefits

Members must use a DSP Provider on MediBonus

Limited to R16,490 per beneficiary and R32,980 per family per year.
Medications will be approved per the Medshield Formulary and will be available beginning with Phase one.

Supply of Medication (One month in advance)

Limited to R16,490 per beneficiary and R32,980 per family per year.
Medications will be approved per the Medshield Formulary and will be available beginning with Phase one.

MediBonus Chronic Disease List

Medshield MediBonus covers 26 CDL conditions plus an additional 44, including:

☑️ Addison’s disease
☑️ Asthma
☑️ Bi-Polar Mood Disorder
☑️ Bronchiectasis
☑️ Cardiac failure
☑️ Cardiomyopathy
☑️ Chronic renal disease
☑️ Chronic obstructive pulmonary disease
☑️ Coronary artery disease
☑️ Crohn’s disease

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MediBonus Dentistry Benefits

🦷 Basic Dentistry: In-Hospital	Unlimited cover provided. The in-hospital cover is only for kids under 6 for comprehensive Basic Dental). Subject to Managed Healthcare Program pre-authorization. Treatment without authorization incurs a 20% penalty. MediBonus members must use the Medshield Hospital Network.
🪥 Basic Dentistry: Out-of-Hospital	Unlimited cover provided. According to the Dental Managed Healthcare Program, protocols. Members must use the Medshield Dental Network. Pre-authorization is required for plastic dentures. A 20% penalty will be imposed if permission is not obtained before treatment.
📌 Specialized Dentistry	There is a limit of R19,380 per family yearly. All services are subject to pre-approval by the applicable Managed Healthcare Program. A 20% penalty will be imposed if permission is not obtained before treatment. Protocols and the Medshield Dental Network apply according to the Dental Managed Healthcare Program.
📍 Impacted Teeth, Wisdom Teeth, and Apicectomy Only hospitalization, general anesthetics, or conscious sedation for bone impactions. Practitioners only cover out-of-hospital apicectomy of permanent teeth. Pre-authorization and Hospital Managed Healthcare Programs apply. Dental Managed Healthcare Programs, Protocols, and Medshield Dental Network apply. Pre-authorization for general anesthesia and conscious sedation pre-authorization, in- and out-of-hospital. No authorization is needed for local anesthetic apicectomy, impacted tooth removal, or wisdom tooth removal.	The Specialist Dentistry Restriction applies. An R900 co-payment is required for wisdom teeth extraction in a Day Clinic. An upfront co-payment of R2,000 is required if the procedure is performed in-hospital. There is no co-payment if the procedure is performed under conscious sedation in the Practitioners’ rooms.
☑️ Dental Implants Covers implant-related services. Must be pre-approved. The Dental Managed Healthcare Programme, Protocols, and Medshield Dental Network apply.	The Specialist Dentistry Limit applies.
✅ Orthodontic Treatment Pre-approval is required. Protocols and the Medshield Dental Network apply according to the Dental Managed Healthcare Program.	The Specialist Dentistry Limit applies.
👑 Crowns, Bridges, Inlays, Mounted Study Models, Partial Chrome Cobalt Frame Base Dentures, and Periodontics Includes consultations, visits, and treatment for all types of dentistry, including technician fees. Pre-approval is required. Protocols and the Medshield Dental Network apply according to the Dental Managed Healthcare Program.	The Specialist Dentistry Limit applies.
😊 Maxillo-facial Surgery	Limited to R20,870 per family yearly. Extended benefit cover of up to R200%. Subject to pre-approval. The benefit is only for non-elective surgery. Subject to the Dental Management Healthcare Program and Protocols. Must use a provider from the Medshield Hospital Network. It might be subject to using the Medshield specialist network.

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MediBonus Maternity Benefits

There will be benefits during pregnancy, after birth, and following delivery. However, pre-authorization with the applicable Managed Healthcare Program is required before hospital admission. Unless otherwise specified, benefits are allocated for each pregnancy subject to the Total Yearly Limit. A complimentary baby bag from Medshield can be obtained during the third trimester.

Ladies can make use of our free Ovulation Calculator

🍼 Antenatal Consultations	Twelve Consultations per pregnancy. It might be subject to the use of the Medshield Specialist Network.
👶 Antenatal Classes and Postnatal Midwife Consults	Eight Visits per event.
📈 Scans	Two 2D scans per pregnancy.
📉 Amniocentesis Tests	One per pregnancy
🏥 Confinement In-Hospital	Unlimited cover. Extended benefit cover of up to 200%.
👨‍⚕️ Delivery by a Family Practitioner or Medical Specialist	Unlimited cover.
💙 Confinement in a registered birthing unit or out-of-hospital	Unlimited cover Must use a Medshield Network.
👩‍⚕️ Delivery by a registered Midwife or a Practitioner	Covered up to 200% of the Medshield Private rates (only for a registered Midwife).
🔍 Hire a water bath and oxygen cylinder	Unlimited cover.

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Medshield MOM Program and Benefits

To support women on their journey to motherhood, Medshield MOM has launched a dedicated website that provides information and resources for all stages of pregnancy, birth, and postpartum. This website is an easily accessible hub of valuable health, fitness, nutrition, motherhood, babies, toddlers, and more content tailored to the pre-and post-partum phases. As a Medshield member, you can take advantage of the pregnancy-related benefits. The Medshield MOM website will ensure you are fully informed of your options.

Some of the features and advantages include, but are not limited to, the following:

A guide for your journey from start to finish.
Convenient, dependable, and easily accessible pregnancy resources.
A toddler benefit that includes information on child immunization, child nutrition, a nurse helpline available 24/7, and digital/online kid yoga.
Advice formulated by professionals.
Reminders through email to arrange doctor’s appointments and request hospital pre-authorizations, etc.
Emails containing updates on your unborn child’s growth and development.
Mothers can register and enter the specific week of their pregnancy journey. Then, they will begin getting content based on that time and continuing ahead.
The Medshield MOM bags are made locally utilizing recyclable, eco-friendly materials. These distinctive bags are filled with excellent Bennetts products for your child.

MediBonus SmartCare Services and Benefits

SmartCare gives access to Videomed and telephone plus video consultations through a select group of healthcare professionals. SmartCare is a developing healthcare benefit aiming to provide members with convenient care access. SmartCare services include the following Acute and Chronic consultations.

1️⃣ Pharmacy/clinic private nurse practitioner consultations	Unlimited cover.
2️⃣ Nurse-led Videomed family practitioner (FP) consultations	One visit per family is subject to the Overall Yearly Limit, followed by the Family Practitioner (FP) Consultations and Visits Limit.
3️⃣ WhatsApp doc advice line	Unlimited cover.

MediBonus Day-to-Day Benefits

📌 Day-to-Day Limit	The following limits apply: Main Member – R12,000 Main Member + 1 Dependent – R17,990 Main Member + 2 Dependents – R19,980 Main Member + 3 Dependents – R21,975 Main Member + 4> Dependents – R23,760
📍 Family Practitioner (FP) Consultations and Visits Out-of-Hospital	Subject to the day-to-day limit.
☑️ Medshield Family Practitioner Network (Consults and Visits out-of-hospital)	Two visits per beneficiary, according to the OAL.
✅ Extended FP visits for emergency and chronic FP consultations (In-person only)	Registration in the Disease Management Program is required. Pre-approval is needed. Chronic Disease List and Clinical Protocols Apply. Once the Day-to-Day Limit and Care Plan FP visits have been depleted, visits are unlimited. There is a limit of one FP consultation per beneficiary.
👩‍⚕️ Medical Specialist Consultations and Visits	Must use the Medshield Specialist Network. Subject to the day-to-day limit.
🚑 Casualty and emergency visits	Subject to the day-to-day limit.
💊 Acute Medicine	Subject to the day-to-day limit.
➡️ Pharmacy Advised Therapy (PAT)	Subject to the day-to-day limit. Limited to R250 per script and one script per beneficiary daily.
🤓 Optometry	Subject to one pair of Optical Lenses and a frame or Contact lenses per beneficiary every 2 years. The Optical Service Date Cycle will determine the extent of this benefit. Subject to the OAL.
👓 Optometric Refraction Eye Tests	One test per beneficiary per 24-month optical cycle. Subject to the OAL. Subject to the Optical Limit.
📈 Spectacles or Contact Lenses	Subject to the Optical Limit.
📉 Frame or lens enhancement	Limited to R1,165 per beneficiary. Limited to (and included in) the Optical Limit.
📊 Reading Glasses	There is a limit of R190 per beneficiary. Subject to the OAL. Must be supplied by a registered Optometrist, Ophthalmologist, Supplementary Optical Practitioner, or a registered Pharmacy.
➡️ Pathology and Medical Technology	Subject to the Day-to-Day Limit. Subject to the relevant Pathology Managed Healthcare program and protocols.
😷 Covid-19 PCR/Antigen Test	The 1st test is included in the OAL, and subsequent tests provide no benefit unless the result is positive and subject to PMB.
☑️ Physiotherapy, Biokinetics, and chiropractics	Subject to the Day-to-Day Limit.
✅ Basic Radiology	Subject to the Day-to-Day Limit. There is a limit of one bone densitometry scan per beneficiary yearly in or out-of-hospital. Subject to the Radiology Managed Healthcare Program and Protocols. Subject to the Medshield Basic Radiology formulary.
📌 Specialized Radiology	Limited to R24,750 In- and Out-of-Hospital, per family yearly. Limited to (and included in) the Specialised Radiology Limit. Subject to pre-authorization by the relevant Managed Healthcare Program
📍 Non-Surgical Procedures	Subject to the Day-to-Day Limit.
☑️ Procedures and Tests performed in the Practitioner’s rooms	Unlimited cover. Medshield Private Rate covers up to 200%.
✅ Routine diagnostic Endoscopic Procedures performed in the Practitioner’s rooms	If done in practitioner’s rooms, it is limited to and included in the overall annual limit. Medshield Private Rate covers up to 200%. In-Hospital co-payment is not required for children aged 8 and under.
🧠 Mental Health Includes the following: Consultations and Visits Procedures Assessments Therapy Treatment or Counselling	Limited to R5,550 per family yearly. Limited to (and included in) the day-to-day limit of R45,790.
⚕️ Intrauterine Devices and Alternatives	Covers consultation, pelvic ultrasound, sterile tray, device, and insertion, if performed the same day. Subject to the applicable clinical protocols. The Medshield Specialist Network must be utilized. It should be performed at the practitioner’s office. Only covered if no hormonal contraceptives are taken, but only upon application Limited to 1 per female recipient. Subject to the Yearly Maximum Limit. Included are all IUD brands up to the cost of the Mirena device. One Mirena/Kyleena device per female patient every five years. Implanon – one per female recipient every three years. One Nova T/Copper device per female patient every two years.
🩺 Additional Medical Services Including the following: Audiology Genetic Counselling Hearing Aid Acoustics Occupational Therapy Orthoptics Podiatry Speech Therapy and Private Nurse Practitioners Dietetics	The in-hospital referral is subject to authorization. Subject to the Day-to-Day Limit.
🧪 Alternative Healthcare Service (Only applies to Acupuncturists, Homeopaths, Naturopaths, Osteopaths, and Phytotherapists)	Subject to the Day-to-Day Limit.

MediBonus Wellness Benefits

Medshield’s Wellness Benefit program empowers members to proactively manage their health by undergoing preventative tests and procedures. The company strongly advises its members to schedule the necessary tests at least once per year. Medshield members must use pharmacies included in their benefit options’ Pharmacy Network to access the Wellness Benefits. Members must note that benefits are subject to the Overall Annual Limit. Once that limit has been reached, the benefits will be subject to the Day-to-Day limit. However, consultations for specific services are excluded from these limits.

💉 Adult Vaccination	Limited to R1,795 per family per annum. After the limit is reached, it is taken from the daily benefit.
💊 Birth Control (Contraceptive Medicine)	Limited to a maximum of 13 prescriptions per year per female recipient between the ages of 14 and 55, with an R200 limit per prescription. Subject to Acute Medical Benefit Limit. Only relevant in the absence of intrauterine devices and alternatives.
🦵 Bone Density Testing for Osteoporosis and bone fragmentation	One per beneficiary 50 years> every three years.
😷 COVID-19 Vaccines	Subject to the Overall Annual Limit. Protocols apply.
📌 Flu Vaccines	One per beneficiary aged 18 or older is included in the Yearly limit. After that, it is paid from the daily benefit.
📍 Pap Smear	One per female beneficiary.
📈 Health Risk Assessment on the SmartCare Network Cholesterol Blood Glucose Blood Pressure Body Mass Index (BMI)	One per beneficiary 18>
📉 Pneumococcal Vaccination	One per annum for high-risk individuals and beneficiaries 60 years>.
📊 National HIV Counselling Testing (HCT)	One test per beneficiary.
📌 HPV Vaccination	One course of two injections per female beneficiary between 9 to 13 years old. Subject to qualifying criteria.
📍 Mammogram (Breast Screening)	One per female beneficiary 40 years> every 2 years.
☑️ PSA Screening for male beneficiaries	Subject to the day-to-day limit.
✅ Tuberculosis Test	One test per beneficiary.

Wellness Benefits – Child Immunisations

This benefit and immunization program as per the Department of Health Protocols according to these age groups:

🍼 At Birth	Tuberculosis (BCG) Polio OPV
👶 6 Weeks	Polio (OPV) Diphtheria Tetanus, Pertussis (Whooping Cough) Hepatitis B Hemophilus Influenza B (HIB) Rotavirus Pneumococcal
📌 10 Weeks	Polio, Diphtheria, Tetanus, Pertussis (Whooping Cough) Hepatitis B Hemophilus Influenza B (HIB) Pneumococcal Rotavirus (Optional
📍 14 Weeks	Polio Diphtheria Tetanus Pertussis (Whooping Cough) Hepatitis B Hemophilus Influenza B (HIB) Rotavirus Pneumococcal
❤️ 6 Months	Measles MV (1)
🧡 9 Months	Measles, Pneumococcal, and Chickenpox CP
💛 12 Months	Measles MV (2)
💚 15 Months	Chickenpox CP
💙 18 Months	Polio, Diphtheria, Tetanus, Pertussis (Whooping Cough) Measles Mumps and Rubella (MMR)
6️⃣ 6 Years	Polio Diphtheria and Tetanus (DT)

MediBonus Prescribed Minimum Benefits

Medshield members are entitled to cover Prescribed Minimum Benefits (PMBs), regardless of their chosen benefit option. Medshield assumes the cost of PMB treatments if they are provided by one of Medshield’s Designated Service Providers (DSPs) in compliance with the Scheme Rules.

The Medical Schemes Act 131 of 1998 mandates that all medical plans must cover the costs associated with the following:

Any potentially fatal medical emergency.
A set of 26 Chronic Disease List (CDL) diseases that are well-defined.
271 DTP diagnoses.

In-Hospital Admissions for treating PMBs:

If you are diagnosed with a PMB disease requiring hospitalization, you must comply with the Medshield hospital authorization process.
It would help if you utilized a hospital that is a part of the Hospital Network for your selected insurance package, as all stay, and treatment fees have negotiated prices.
Specialist services obtained during hospitalization are reimbursed at the Scheme rate.
If the Scheme rate does not cover the entire claim amount, you must apply to the Scheme and request that the Specialist’s rate be paid at cost instead of the Scheme rate.

Out-of-Hospital treatment and managing PMBs:

Members diagnosed with any 26 CDL conditions covered by Medshield and MediBonus must apply to Mediscor for approval.
The member automatically receives a Care Plan (treatment plan) notification from the Scheme after the healthcare provider claims with the ICD-code as authorized.
The Care Plan details and approves benefits like radiography, pathology, and doctors’ visits.
After using the Care Plan, the member and their treating provider must fill out a PMB Application form to seek clearance for further treatment.
If approved, a revised Care Plan will include the additional treatment.

MediBonus Option Payment for PMB conditions:

While the funds in members’ PMSA come directly from the members themselves, the Risk Pool is responsible for covering the expenses associated with the care outlined in the members’ Care Plans (OAL).
The Member may request that the Scheme reprocess claims for services previously paid for by the Member but are included in the Care Plan.
It should be emphasized that this only pertains to the services included in the finalized Care Plan.

271 DTP Conditions:

Members with DTP must complete a PMB application form with their doctor.
If they do not complete a PMB Application form, the Day-to-Day Savings will pay for treatment.
The Care Plan (treatment plan) will list the covered treatments for the condition after clinical assessment and approval.

COVID-19 as a PMB

Respiratory DTP PMB includes Covid-19.
After seeing a doctor, members might need a COVID-19 PCR or SARS-CoV-2 Antigen test.
According to the Plan Regulations, this benefit requires a doctor or nurse referral and payment.
MediBonus covers either a PCR or an antigen test, but not both.

MediBonus COVID-19 Benefits and Access to Care

COVID-19 PCR Test or Antigen Tests

The COVID-19 PCR Test or Antigen Tests have the following features and conditions:

The First COVID PCR or antigen test is covered in the Overall Annual Limit (OAL).
Depending on the option, the Second and subsequent tests are covered by daily limits or a medical savings plan. If these benefits are not available, members must pay for the tests.
The 2nd and subsequent positive PCR or Antigen tests are covered first from Day-to-Day benefit or Savings, then from OAL if PMB applies.
The pathology test will be reimbursed as a PMB by Risk after emailing the positive results to Medshield. Risk
Benefits require a PMB Application form, and Clinical Protocols apply.
Travel and non-symptomatic COVID-19 tests are excluded from this benefit.
Scheme risk gives members the Day-to-Day restriction. Therefore, PMB COVID-19 treatment will pay from a Day-to-Day benefit until it is gone and then from Risk (OAL).

MediBonus Plan Exclusions and Waiting Periods

MediBonus Exclusions

MediBonus does not cover some of the following:

Cosmetic crown and bridge procedures, as well as the accompanying laboratory fees
Crown and bridge procedures with minimal tooth structural loss and accompanying laboratory costs
Rehabilitation of the occlusion and the related laboratory expenditures
Provisional crowns, as well as the accompanying laboratory fees
Emergency crowns that are not inserted immediately to safeguard a tooth after an injury, as well as the related laboratory expenditures
Gold, precious metal, semi-precious metal, and platinum foil prices
Fees for laboratory delivery
Unless expressly authorized and unless PMB level of care, orthopedic shoes, and boots
TENS and APS pain relief machines
Stethoscopes
Procedures for sinus lift
When claimed in conjunction with impacted teeth, closing an oral-antral opening
Orthognathic (jaw correction) surgery, as well as any associated hospital expenditures and laboratory fees
Aortic stents are covered until the Prescribed Minimum Benefits level of care (DSP) is met
Peripheral vascular stents are covered unless the Prescribed Minimum Benefits level of care (DSP) is met
Mineral trioxide cost
Enamel micro-abrasion
Dental procedures or equipment that is not deemed clinically necessary or desirable by the applicable Managed Healthcare Program

MediBonus Waiting Periods

Often, there is a waiting period for pre-existing conditions. This is to prevent new members from abusing medical insurance for a brief period to finance pricey procedures and cancel their membership shortly after. According to the Medical Schemes Act No. 131 of 1998, the following waiting periods may apply:

A 3 (three) month general waiting time for all benefits.
A maximum 12 (twelve) month exclusion for a previous ailment.
A late joiner contribution penalty.

Medshield MediBonus Plan vs. Similar Plans from other Medical Schemes

🔎 Medical Aid	🥇 Medshield MediBonus	🥈 Profmed ProSecure Savvy	🥉 Momentum Extender
👤 Main Member Contribution	R7,587	R	R6,589
👥 Adult Dependent Contribution	R5,328	R	R4,997
🍼 Child Dependent Contribution	R1,578	R	R1,937
🌎 International Cover	Only Organ Transplants	R8 million	R9.01 million
🚑 Hospital Cover	Unlimited	Covers up to 100% of the negotiated tariff	Unlimited
💶 Prescribed Minimum Benefits	☑️ Yes	☑️ Yes	☑️ Yes
📉 Screening and Prevention	☑️ Yes	☑️ Yes	☑️ Yes
➡️ Oncology Cover	R552,925	R466,155	R500,000
💙 Maternity Benefits	☑️ Yes	☑️ Yes	☑️ Yes

Our Verdict on The MediBonus Plan

Medshield MediBonus is a comprehensive health insurance plan designed to cater to the healthcare needs of individuals and families. The plan offers a range of benefits, including unlimited private hospital coverage, chronic medication, and day-to-day medical expenses. MediBonus plan members have access to a broad network of healthcare providers and facilities, ensuring they receive quality medical care when needed. One of the significant advantages of the MediBonus plan is its unlimited hospital cover, which means that members do not have to worry about running out of funds during a hospital stay. The plan also covers the cost of chronic medication for 27 specified chronic conditions and an additional 44, ensuring that members receive the necessary treatment for their long-term health conditions.

MediBonus also covers day-to-day medical expenses, such as GP consultations, blood tests, X-rays, and medication. One of the drawbacks of the MediBonus plan is that it may not be suitable for individuals who do not require comprehensive medical coverage. The plan’s premium is higher than other plans offered by Medshield, making it less affordable for some individuals. Additionally, the plan does not cover some medical procedures available in other plans offered by Medshield. Compared to other plans offered by Medshield, the MediBonus plan offers more comprehensive medical coverage.

However, this also means it comes with a higher premium, making it less affordable for some individuals. For instance, the Medshield MediCore Plus plan offers more affordable premiums. Still, it covers hospitalization, chronic medication, and day-to-day medical expenses. However, it does not offer the same level of medical coverage as the MediBonus plan.

You might also like the following plans MedShield has to offer:

MediBonus Plan Frequently Asked Questions

What is Medshield MediBonus, and how does it work?

Medshield MediBonus is a comprehensive medical aid plan offered by Medshield Medical Scheme in South Africa. The plan provides members with cover for private hospitalization, chronic medication, and day-to-day medical expenses. Furthermore, members can access a network of healthcare providers and facilities, ensuring they receive quality medical care. The plan’s premium is based on the member’s income and the number of dependents covered.

What is covered under the Medshield MediBonus plan?

The MediBonus plan covers unlimited private hospitalization, chronic medication for 27 specified chronic conditions and an additional 44 conditions, and day-to-day medical expenses, such as GP consultations, blood tests, X-rays, and medication. In addition, the Medshield MediBonus plan also covers up to 200% of the extended cover benefit for specific treatments.

How much does the Medshield MediBonus plan cost?

MediBonus is R6,966 for the primary member, R4,893 per adult dependent, and R1,499 per child dependent. However, the plan’s premium is higher than other plans offered by Medshield, making it less affordable for some individuals.

What are the advantages of the Medshield MediBonus plan?

One of the significant advantages of the MediBonus plan is its comprehensive medical cover, which includes unlimited hospital cover, chronic medication, and day-to-day medical expenses. The plan provides members access to a network of healthcare providers and facilities, ensuring that they receive quality medical care no matter where they are in South Africa.

Are there any drawbacks to the Medshield MediBonus plan?

One of the drawbacks of the MediBonus plan is that it may not be suitable for individuals who do not require more affordable medical coverage. The plan’s premium is higher than other plans offered by Medshield, making it less affordable for some individuals. Additionally, the plan does not cover some medical procedures available in other plans offered by Medshield.

What other medical aid plans does Medshield offer?

Medshield offers a range of medical aid plans to cater to different healthcare needs and budgets. These plans include MediCore, MediSaver, MediValue, and MediPlus. Each plan has its own unique benefits and features, allowing members to choose the one that best suits their needs and budget.

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.