Medshield MediBonus Medical Aid Plan (🇿🇦 2026)

  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 R9 015 ZAR.    

Medshield MediBonus - 14 Key Point Quick Overview

1. ☑️ Medshield MediBonus Overview
2. ☑️ Medshield MediBonus Plan Contributions
3. ☑️ Medshield MediBonus Plan Benefits and Cover Comprehensive Breakdown
4. ☑️ MediBonus Chronic Disease List
5. ☑️ MediBonus Dentistry Benefits
6. ☑️ MediBonus Maternity Benefits
7. ☑️ Medshield MOM Program and Benefits
8. ☑️ MediBonus SmartCare Services and Benefits
9. ☑️ MediBonus Prescribed Minimum Benefits
10. ☑️ MediBonus COVID-19 Benefits and Access to Care
11. ☑️ MediBonus Plan Exclusions and Waiting Periods
12. ☑️ Medshield MediBonus Plan vs. Similar Plans from other Medical Schemes
13. ☑️ Our Verdict on The MediBonus Plan
14. ☑️ MediBonus Plan Frequently Asked Questions

Medshield MediBonus Overview

The Medshield MediBonus medical aid plan is one of 10, starting from R9 015, 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 but you can get it from their partner, TRA. However, Medshield offers 24/7 medical emergency assistance. According to the Trust Index, Medshield has a trust rating of 2.4 from hellopeter.   MedShield has the following medical aid plans to offer:  

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

Medshield MediBonus Plan Contributions

   

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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 that can be delivered 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

   

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MediBonus Oncology Benefits

   

MediBonus Chronic Medicine Benefits

Members must use a DSP Provider on MediBonus

• ✅Limited to R19 250 per beneficiary and R38,500 per family per year.
• ✅Medications will be approved per the Medshield Formulary and will be available beginning with Phase One.
• ✅20% upfront co-payment for the use of out-of-formulary medicine and a 20% upfront co-payment for the use of a non-DSP.

Supply of Medication (One month in advance)

• ✅Limited to R19 250 per beneficiary and R38,500 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 48, including:

1. ☑️ Addison’s disease
2. ☑️ Asthma
3. ☑️ Bi-Polar Mood Disorder
4. ☑️ Bronchiectasis
5. ☑️ Cardiac failure
6. ☑️ Cardiomyopathy
7. ☑️ Chronic renal disease
8. ☑️ Chronic obstructive pulmonary disease
9. ☑️ Coronary artery disease
10. ☑️ Crohn’s disease
11.  ☑️ And many more....

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MediBonus Dentistry Benefits

   

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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.  

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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 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, 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.    

MediBonus Day-to-Day Benefits

 

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.    

Wellness Benefits – Child Immunisations

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

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 (Designated Treatment Pair) 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 Vccination

• ✅ Subject to Overall Annual Limit (OAL).
• ✅ Limited to Scheme Vaccination Formulary. Excludes consultation costs.

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

MediBonus Plan vs. Similar Plans from Other Medical Schemes

     

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 48o , 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 to read more about Best Medical Aid Schemes with Back and Neck Preventative Programmes in South Africa.

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?

MediBonus provides mature families and professionals with unlimited hospital cover in a hospital of their choice, with In-Hospital Medical  Practitioner consultations and visits paid at 200% Medshield Private Tariff, and the independence to manage daily healthcare expenses through a substantial Day-to-Day Limit.  

How much does the Medshield MediBonus plan cost?

MediBonus is R9 015  for the primary member, R6 330 per adult dependent, and R1,878 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 unique benefits and features, allowing members to choose the one that best suits their needs and budget.