πLadies can make use of our free Ovulation Calculator
Overall, the Medshield MediCore Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and comprehensive hospital cover to up to 3 Family Members. The Medshield MediCore Medical Aid Plan starts from R3 891 ZAR.
π Medical Aid Plan | π₯ Medshield MediCore |
π International Cover | Only Organ Transplants |
π€ Main Member Contribution | R3 891 |
π₯ Adult Dependent Contribution | R3 291 |
π Child Dependent Contribution | R897 |
π Annual Limit | Unlimited Hospital Cover |
πΆ Prescribed Minimum Benefits | β Yes |
βοΈ Home Care | βοΈ Yes |
βοΈ Chronic Conditions | β Yes |
β‘οΈ Maternity Benefits | βοΈ Yes |
The Medshield MediCore medical aid plan is one of 11, starting from R3 891,Β and includes comprehensive hospital cover, Virtual GP consultations, SmartCare benefits, a Medshield Mom maternity program, chronic medicine, ambulance services, and more.
Gap Cover is not available on the Medshield MediCore Plan. However, Medshield offers 24/7 medical emergency assistance. According to the Trust Index, Medshield has a trust rating of 4.1.
π Download the medicore_2025_benefit_guide
πMedShield has the following medical aid plans to offer:
π€ Main Member | π₯ +1 Adult Dependent | πΌ +1 Child Dependent |
R3 891 | R3 291 | R897 |
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π Overall Annual Limit | There is no overall annual limit. |
π Hospitalization | Unlimited cover. Subject to the relevant Management Healthcare Program. Pre-approval is needed for specialist services. |
βοΈ Extended cover | Covered up to 200% of specific services and procedures when a member is hospitalized. |
β Surgical Procedures | Unlimited cover. Extended cover up to 200%. |
π Medicine upon discharge | Limited to R500 per admission. Per the Maximum Generic Pricing of Medicine Price List and Medshield Formulary. |
π Hospitalisation Alternatives Physical Rehabilitation Sub-Acute Facilities Nursing Services Hospice Terminal Care | Clinical Protocols will apply. There is an R51,000 limit per family yearly, subject to the hospitalization limit. DSPs must be used, or a 30% co-payment will apply for using a non-MediCore Network Hospital. Terminal care is limited to R51,000 per family per year and is subject to the overall annual limit. |
βοΈ Oxygen Therapy Equipment | Unlimited cover but subject to PMB and PMB level of care. Subject to pre-authorization and the relevant Managed Healthcare Program. Clinical Protocols will apply. |
β οΈ Home Ventilators | Unlimited cover but subject to PMB and PMB level of care. Subject to pre-authorization and the relevant Managed Healthcare Program. Clinical Protocols will apply. |
π©Έ Blood, Blood Equivalents, and Blood Products | Unlimited cover. Subject to pre-authorization and the relevant Managed Healthcare Program. Must use the Prime Hospital Network. Clinical Protocols will apply. |
π °οΈ Medical Practitioner Consultations and Visits during hospital admission | Unlimited cover. Extended benefit cover is available up to 200%. |
π
±οΈ Sleep Studies Diagnostic Polysomnograms | Unlimited Cover Subject to pre-authorization by the relevant managed healthcare program. Clinical protocols will apply. |
π© CPAP Titration | Unlimited cover. Subject to pre-authorization by the relevant managed healthcare program. Clinical protocols will apply. |
β€οΈ 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. Service/treatment only from facilities in the Compact Hospital Network. Clinical protocols will apply Unlimited cover but subject to PMB and PMB level of care. 30% co-payment for using a non-MediCore Network Hospital. Limited to harvests in South Africa. Solid organ transplant donor work-up fees. No international donor search benefits. Bone marrow transplantation is confined to allogenic and autologous grafts from the South African Bone Marrow Registry. |
π International Corneal Grafts and Transplants | Limited to R51,900 per beneficiary. Subject to the OAL. Clinical protocols apply. |
β³οΈ Local Corneal Grafts and Transplants | Limited to R22,250 per beneficiary. Subject to the OAL. Clinical protocols apply. |
π Pathology and Medical Technology | Unlimited cover. The Preferred Provider Network applies. Must be part of an authorized event but excludes allergy and Vitamin D testing. |
𦡠Physiotherapy | Limited to R3,300 per beneficiary yearly. Once this is exhausted, the benefit is subject to the day-to-day limit unless specific authorization is obtained. Subject to the hospitalization limit and then the daily limit unless pre-approved for PMBs and PMB level of care. |
π¦Ύ Internal Prostheses and Devices | Subject to pre-authorization by the relevant Managed Healthcare Program. Only for surgically implanted devices. Limited to R42,000 per family yearly. 25% co-payment unless related to PMB. |
π 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 devices’ internal limit. There are no co-payments on external prostheses. R50 000 per family per annum. |
π Long Leg Callipers | Subject to prostheses and the device’s internal limit. There are no co-payments on external prostheses. |
π Basic Radiology | Unlimited cover. There is a limit of one bone densitometry scan allowed per beneficiary per year. Clinical protocols will apply. |
π Specialized Radiology | Limited to R12,000 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. |
π CT Scans, MUGA Scans, MRI Scans, Radio Isotope Studies | Subject to the Specialised Radiology Limit. Clinical protocols will apply. |
βοΈ CT Colonography (Virtual colonoscopy) | There is no co-payment on this benefit. Clinical protocols apply. |
β Interventional Radiology replacing Surgical Procedures | Unlimited cover, but clinical protocols apply. |
π Chronic Renal Dialysis Hemodialysis and Peritoneal Dialysis include the following: Material Medication Related Radiology and Pathology | Unlimited if PMB and PMB level of care are met. A non-DSP will incur a 35% upfront co-payment. Use of a DSP with Rand one for PMB admittance. |
π Non-Surgical Procedures and Tests | Unlimited cover. The extended cover offered up to 200%. |
π¨ββοΈ Procedures and Tests performed in the Practitionerβs rooms | There is no cover out-of-hospital. Unlimited cover. If the procedure is conducted in the Practitionersβ rooms, Medshield Private Rates pay up to 200%. |
π§ͺ Routine diagnostic Endoscopic Procedures performed in the Practitionerβs rooms | Unlimited cover. Medshield Private Rates cover up to 200% if the procedure is performed in the practitionerβs room. Co-payments do not apply for beneficiaries <8 years. |
π§ Mental Health | Unlimited cover but subject to the PMB and PMB level of care. 30% upfront co-payment for non-Compact Network Hospitals. DSP from Rand one applies for PMB and non-PMB admissions. There is a limit of R44,000 per family yearly. |
π Rehabilitation for Substance Abuse | There is one rehabilitation program available per beneficiary yearly. Subject to PMB and PMB level of care. |
π₯ Consultations and Visits, Procedures, Assessments, Therapy, Treatment, or Counselling in-hospital | Subject to the mental health limit. |
π Consultations and Visits, Procedures, Assessments, Therapy, Treatment, or Counselling out-of-hospital | Only PMBs are covered. |
1οΈβ£ HIV and Aids | According to the Managed Healthcare Protocols. Pre-authorization and Managed Healthcare Program registration are required. |
2οΈβ£ Anti-retroviral and related medicines | Voluntary out-of-formulary or PMB medication from a non-DSP supplier requires a 30% upfront co-payment. |
3οΈβ£ HIV/AIDS-related Pathology and Consultations | Voluntary out-of-formulary or PMB medication from a non-DSP supplier requires a 30% upfront co-payment. |
4οΈβ£ National HIV Counselling and Testing (HCT) | Voluntary out-of-formulary or PMB medication from a non-DSP supplier requires a 30% upfront co-payment. |
πΌ Infertility Interventions and Investigations | Clinical Protocols apply. Limited to interventions and investigations only. Pre-authorization and Managed Healthcare Program registration are required. |
π Oncology Limit | Unlimited cover. Subject to PMB and PMB level of care. 40% co-payment upfront when using a non-DSP. |
π Active Treatment (Includes Stoma Therapy, Incontinence Therapy, and Brachytherapy) | Subject to the Oncology Limit. ICON Standard Protocols apply. |
βοΈ Oncology Medicine | Subject to the Oncology Limit. ICON Standard Protocols apply. |
β Radiology and Pathology | Subject to the Oncology Limit. |
π PET and PET-CT | Limited to 1 Scan per family per annum. Subject to the Oncology Limit. |
π Integrated Continuous Cancer Care | Six visits per family per annum. Subject to the Oncology Limit |
π Specialized Drugs for Oncology, Non-Oncology, and Biological Drugs | Pre-authorization is required from the Oncology Managed Healthcare provider. Clinical Protocols will apply. Only PMBs are covered. |
π Vitreoretinal Benefit | Subject to pre-approval. Specialized Drugs Limit applies. |
βοΈ 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 R104,500 per family yearly and limited to (and included) in the hospitalization limit. Co-payments and prostheses limits will not apply for Breast Reconstruction. |
π °οΈ Using a MediCore Chronic Network Pharmacy from Rand one | Exclusive to PMB. Medicines will be approved according to the Medshield Formulary, with cover from Rand one. Use of a non-MediCore Chronic Network Pharmacy will incur an upfront co-payment of 35%. |
π ±οΈ Supply of Medication (One month in advance) | Exclusive to PMB. Medicines will be approved according to the Medshield Formulary, with cover from Rand one. Use of a non-MediCore Chronic Network Pharmacy will incur an upfront co-payment of 35%. |
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π¦· Basic Dentistry (Out-of-Hospital) | Unlimited |
π 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. Protocols and Medshield Dental Network apply. Compact Hospital Network services are required. |
π Maxillo-facial Surgery | 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 Compact Hospital Network. It might be subject to using the Medshield specialist network. Limited to R15,200 per family yearly. The extended benefit covers up to 200% (only for Maxillo-facial surgery) |
π©ββοΈ Antenatal Consultations | Six Consultations per pregnancy. It might be subject to the use of the Medshield Specialist Network. |
β€οΈ Antenatal Classes and Postnatal Midwife Consults | Four Visits per event. |
π Scans | Two 2D scans per pregnancy. |
π₯ Confinement In-Hospital | Unlimited cover. Extended Benefit covers up to 200%. Must use the Compact Hospitalisation Network. Using a non-DSP attracts a 25% upfront payment. |
π¨ββοΈ Delivery by a Family Practitioner or Medical Specialist | Unlimited cover. |
π€° Confinement in a registered birthing unit or out-of-hospital | Unlimited cover Extended Benefit cover of up to 200%. |
βοΈ Delivery by a registered Midwife or a Practitioner | Covered up to 200% of the Medshield Private rates (only for a registered Midwife). |
β Hire a water bath and oxygen cylinder | Unlimited cover. |
πPOLL: 5 Best Medical Aid/Insurance for Pregnancy
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.Β 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.Β 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.
πSome of the features and advantages include, but are not limited to, the following:
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.
πSmartCare services include the following:
βοΈ Pharmacy/clinic private nurse practitioner consultations | Unlimited cover. |
βοΈ 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. |
Medshieldβs 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 optionsβ 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.
π 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 R225 limit per prescription. Subject to Acute Medical Benefit Limit. Only relevant in the absence of intrauterine devices and alternatives. |
π COVID-19 Vaccines | Subject to the Overall Annual Limit. Protocols apply. |
π Flu Vaccines | One per beneficiary aged 18 or older is included in the Yearly limit. There is no benefit after that. |
β‘οΈ Pap Smear | One per female beneficiary. |
π 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>. |
βοΈ National HIV Counselling Testing (HCT) | One test per beneficiary. |
π©Ί HPV Vaccination | One course of two injections per female beneficiary between 9 to 13 years old. Subject to qualifying criteria. |
π§ͺ Tuberculosis Test | One test per beneficiary. |
This benefit and immunization program as per the Department of Health Protocols according to these age groups:
β€οΈ At Birth | Tuberculosis (BCG) Polio OPV |
𧑠6 Weeks | Polio (OPV) Diphtheria Tetanus, Pertussis (Whooping Cough) Hepatitis B Hemophilus Influenza B (HIB) Rotavirus Pneumococcal |
π 10 Weeks | Polio, Diphtheria, Tetanus, Pertussis (Whooping Cough) Hepatitis B Hemophilus Influenza B (HIB) Pneumococcal Rotavirus (Optional |
π 14 Weeks | Polio, Diphtheria Tetanus Pertussis (Whooping Cough) Hepatitis B Hemophilus Influenza B (HIB) Rotavirus Pneumococcal |
π 6 Months | Measles MV (1) |
π 9 Months | Measles, Pneumococcal, and Chickenpox CP |
β€οΈ 12 Months | Measles MV (2) |
𧑠15 Months | Chickenpox CP |
π 18 Months | Polio, Diphtheria, Tetanus, Pertussis (Whooping Cough) Measles Mumps and Rubella (MMR) |
π 6 Years | Polio Diphtheria and Tetanus (DT) |
πREAD more about medical insurance for children
A 24-hour Hotline will be available to members and their registered dependents. In addition, members can dial 086 100 6337 to reach the Ambulance and Emergency Services, provider.
π Medshield Emergency Medical Services | Subject to pre-approval by the supplier of Ambulance and Emergency Services. Air Evacuation necessitates scheme approval. Applying Clinical Procedures. |
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 Medshieldβs Designated Service Providers (DSPs) in compliance with the Scheme Rules.Β The Medical Schemes Act 131 of 1998 mandates that all medical plans must cover the costs associated with the following:
β 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 Specialistβs rate be paid at cost instead of the Scheme rate. |
β Out-of-Hospital treatment and managing PMBs | Members diagnosed with any 26 CDL conditions covered by Medshield and MediCore 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 doctorsβ 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. |
β MediCore Option Payment for PMB conditions | The costs of the treatments specified in the Care Plans are paid directly by Risk (OAL). Members who require further therapy must fill out a PMB application form. |
β 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. |
β 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. MediCore covers either a PCR or an antigen test, but not both. |
πMediCore does not cover the following:
Often, 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.
πAccording to the Medical Schemes Act No. 131 of 1998, the following waiting periods may apply:
π Medical Aid Plan | π₯ Medshield MediCore | π₯ Momentum Incentive | π₯ Bonitas Hospital Standard Plan |
π International Cover | Only Organ Transplants | R5 million | R2.5 million |
π€ Main Member Contribution | R3 891 | R3,060 – R5,457 | R3,252 ZAR |
π₯ Adult Dependent Contribution | R3 291 | R2,414 – R4,434 | R2,739 ZAR |
π Child Dependent Contribution | R897 | R1,174 – R2,128 | R1,236 ZAR |
π Annual Limit | Unlimited Hospital Cover | Unlimited Hospital Cover | Unlimited |
πΆ Prescribed Minimum Benefits | β Yes | βοΈ Yes | β Yes |
βοΈ Home Care | βοΈ Yes | β Yes | βοΈ Yes |
βοΈ Chronic Conditions | β Yes | βοΈ Yes | β Yes |
β‘οΈ Maternity Benefits | βοΈ Yes | β Yes | βοΈ Yes |
The Medshield MediCore Plan is a comprehensive in-hospital cover that offers extended benefits of up to 200% on certain treatments, oxygen therapy, alternative and allied healthcare services, GP, specialist consults, and more. The plan has several advantages, including excellent in-hospital cover, access to a wide range of medical services, and the flexibility to choose between healthcare providers. Moreover, it provides peace of mind for individuals requiring extensive medical treatment. However, the plan also has some drawbacks that potential policyholders should be aware of. One of the main drawbacks is that it does not offer any out-of-hospital benefits, meaning that individuals must pay out-of-pocket expenses for day-to-day medical treatment and services.
Additionally, the plan has strict conditions on treatments in-hospital, which may limit the treatment options available to policyholders. Furthermore, another drawback is that the plan does not offer a medical savings account, which can be helpful for individuals who want to manage their healthcare expenses. Overall, the Medshield MediCore Plan can be an excellent option for individuals seeking comprehensive in-hospital cover. However, potential policyholders should carefully consider the advantages and drawbacks of the plan before deciding. Additionally, individuals who require extensive out-of-hospital medical treatment may need to consider alternative healthcare plans that offer broader coverage.
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The Medshield MediCore Plan is a comprehensive medical cover that provides in-hospital cover, extended benefits cover, and access to various medical services.
The MediCore Plan covers in-hospital treatments, extended benefits cover specific treatments, oxygen therapy, alternative and allied healthcare services, GP and Specialist consults, and more.
The advantages of the MediCore Plan include excellent in-hospital cover, access to a wide range of medical services, and the flexibility to choose healthcare providers.
The drawbacks of the MediCore Plan include no out-of-hospital benefits, out-of-pocket expenses for day-to-day medical treatment and services, strict conditions on treatments in-hospital, and no medical savings account.
Yes, you can choose your healthcare provider under the MediCore Plan.
Yes, there is a waiting period of up to 3 months for specific treatments under the MediCore Plan.
Pre-existing conditions are not covered under the MediCore Plan for the first 12 months of membership.
Emergency medical treatment is covered under the MediCore Plan, subject to the terms and conditions of the policy.
Yes, you can add family members to your MediCore Plan at an additional cost.
Yes, you can upgrade or downgrade your MediCore Plan at any time, subject to the terms and conditions of the policy.
Yes, alternative and allied healthcare services are covered under the MediCore Plan, subject to the terms and conditions of the policy.
No, the MediCore Plan does not cover medical treatment outside South Africa.
Yes, MediCore offers basic dentistry but only in-hospital for beneficiaries <6 years and only for extensive dentistry.
Maternity cover is included in the MediCore Plan, subject to the terms and conditions of the policy.
You can claim the MediCore Plan by submitting a claim form and supporting documents to Medshield. The claim will be assessed and paid out subject to the terms and conditions of the policy.
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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