Overall, the Medshield MediSaver Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and a medical savings account for up to 3 Family Members. The Medshield MediSaver Medical Aid Plan starts from R5,376 ZAR.
| 👤 Main Member Contribution | R5 376 |
| 👥 Adult Dependent Contribution | R4 452 |
| 🍼 Child Dependent Contribution | R1 311 |
| 📊 Annual Limit | Unlimited Hospital Cover |
| 🔁 Gap Cover | None |
| 🌎 International Cover | Yes, subject to scheme tariff. |
| 🏥 Hospital Cover | Unlimited |
| ➡️ Oncology Cover | R428 000 |
| 🏠 Home Care | ☑️ Yes |
| 💙 Medical Savings Account | ✅ Yes |
The Medshield MediSaver medical aid plan is one of 10, starting from R5,376 and includes a medical savings account, unlimited in-hospital cover on the Compact Hospital Network, no overall annual limit, refractive surgery (including LASIK), and more.
Gap Cover is not available on the Medshield MediSaver 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:
| 👤 Main Member | 👥 +1 Adult Dependent | 🍼 +1 Child Dependent |
| R5 376 | R4 452 | R1 311 |
| 👤 Main Member | 👥 +1 Adult Dependent | 🍼 +1 Child Dependent |
| R9,672 Savings per year | R8,016 Savings per year | R2,364 Savings per year |
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Other channels allow patients to access advice and support outside of home visits.
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| 🔎 Overall Annual Limit | Unlimited |
| 🏥 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. Members must use the Compact Hospital Network. 30% upfront co-payment for the use of non-network hospital |
| 📍Surgical Procedures | Covered as part of an authorized event. Unlimited cover provided. |
| 💊 Medicine upon discharge | Limited to R800 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 R86,700 limit per family yearly, subject to the hospitalization limit. DSPs must be used, or a 30% co-payment will apply for using a non-MediSaver Network Hospital. Terminal care is limited to R57,500 per family per year and is subject to the overall annual limit. |
| 🩺 General, Medical, and Surgical Appliances | Limited to R12,850 per family per year. Pre-approval is required. Services must be obtained from a DSP, Network Provider, or Preferred Provider. |
| 🧪 Peak Flow Meters, Nebulizers, Glucometers, and Blood Pressure Monitors (needs motivation) | Limited to R950 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. Must use the Compact Hospital Network. 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. |
| 👁️🗨️ Refractive Surgery Includes the following: LASIK Radial Keratotomy Phakic Lens Insertion | Limited to R21,000 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. |
| ❤️ 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. Limited to R334 000 per family per annum. 30% upfront co-payment for the use of a non-Compact 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 R54 250 per beneficiary. Subject to the OAL. Clinical protocols apply. |
| 👁️ Local Corneal Grafts and Transplants | Limited to R23 250 per beneficiary. Subject to the OAL. Clinical protocols apply. |
| 📈 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. |
| 📉 Physiotherapy | Limited to R3 450 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. |
| 🦾 Internal Prostheses and Devices | Subject to pre-authorization by the relevant Managed Healthcare Program. Only for surgically implanted devices. Limited to R57,500 per family yearly. |
| 🦵 External Prostheses | Must be pre-approved. Treatment can only be obtained from a DSP, Network Provider, or Preferred provider. R100 000 per family per annum. The benefit includes Ocular Prostheses. Clinical protocols apply. Subject to prostheses and devices’ internal limit. There are no co-payments on external prostheses. |
| ⬇️ Long Leg Callipers | Subject to prostheses and devices’ internal limit. There are no co-payments on external prostheses. |
| 📍 Basic Radiology | Unlimited cover. Clinical protocols will apply. |
| 📌 Specialized Radiology | Limited to R25,600 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. |
| 1️⃣ CT Scans, MUGA Scans, MRI Scans, Radio Isotope Studies | Subject to the Specialised Radiology Limit. Clinical protocols will apply. |
| 2️⃣ CT Colonography (Virtual colonoscopy) | There is no co-payment on this benefit. Clinical protocols apply. |
| 3️⃣ Interventional Radiology replacing Surgical Procedures | Unlimited cover, but clinical protocols apply. |
| 4️⃣ Chronic Renal Dialysis Hemodialysis and Peritoneal Dialysis include the following: Material Medication Related Radiology and Pathology | Limited to R334,000 per family yearly. A non-DSP will incur a 35% upfront co-payment. Use of a DSP with Rand one for PMB and non-PMB. |
| 5️⃣ Non-Surgical Procedures and Tests | It must be as part of an authorized event. Members must use the Medshield Specialist Network. |
| 🧠 Mental Health | Limited to R53,800 per family per year in and out-of-hospital. 30% upfront co-payment for non-Compact Network Hospitals. DSP from Rand one applies for PMB and non-PMB admissions. |
| 💉 Rehabilitation for Substance Abuse | There is a limit of R19,350 per family yearly There is one rehabilitation program available per beneficiary yearly. Subject to PMB and PMB level of care. |
| 👨⚕️ 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 30% upfront co-payment. |
| 📌 HIV/AIDS-related Pathology and Consultations | Voluntary out-of-formulary or PMB medication from a non-DSP supplier requires a 30% upfront co-payment. |
| 📍 National HIV Counselling and Testing (HCT) | Voluntary out-of-formulary or PMB medication from a non-DSP supplier requires a 30% 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. |
| 1️⃣ Oncology Limit | Limited to R428,000 per family per year. |
| 2️⃣ Active Treatment (Includes Stoma Therapy, Incontinence Therapy, and Brachytherapy) | Subject to the Oncology Limit. ICON Standard Protocols apply. |
| 3️⃣ Oncology Medicine | Limited to R287,000 per family yearly. ICON Standard Protocols apply. |
| 4️⃣ Radiology and Pathology | Subject to the Oncology Limit. |
| 5️⃣ PET and PET-CT | Limited to 1 Scan per family per annum. Subject to the Oncology Limit. 25% upfront co-payment for the use of a non-DSP. |
| 6️⃣ Integrated Continuous Cancer Care | Six visits per family per annum. Subject to the Oncology Limit |
| 7️⃣ Specialized Drugs for Oncology, Non-Oncology, and Biological Drugs | 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. |
| 8️⃣ Vitreoretinal Benefit | Subject to pre-approval. Pre-authorisation is required for Vitreous and Retinal disorders. 40% upfront co-payment for non-PMB. Included in the Oncology Medicine Limit |
| 9️⃣ 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 R105,000 per family yearly and limited to (and included) in the hospitalization limit. Co-payments and prostheses limits will not apply for Breast Reconstruction. |
| ✅ Members must use a DSP Provider on MediSaver | Limited only to PMBs. Medications will be approved per the Medshield Formulary and will be available beginning with Phase one. Members must use a Medshield Pharmacy Network from Rand one. |
| ✅ Supply of Medication (One month in advance) | Limited only to PMBs. Medications will be approved per the Medshield Formulary and will be available beginning with Phase one. Members must use a Medshield Pharmacy Network from Rand one. |
and many more…
| 🅰️ 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. MediSaver members must use the Compact Hospital Network. |
| 🅱️ Basic Dentistry: Out-of-Hospital | 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 R16,700 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 R800 upfront co-payment is required for wisdom teeth extraction in a Day Clinic. An upfront co-payment of R3,500 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 R24,000 per family yearly. 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. |
| 🤰 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/3D or 4D scans per pregnancy. |
| 🧪 Amniocentesis Tests | One per pregnancy |
| 🏥 Confinement In-Hospital | Unlimited cover when using a Compact Network Hospital. |
| 👨⚕️ 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 Compact 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. |
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:
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SmartCare gives access to Videomed and telephone 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:
| 👨⚕️ Pharmacy/clinic private nurse practitioner consultations | Unlimited cover. |
| 👩⚕️ 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. |
| 📲 WhatsApp doc advice line | Unlimited cover. |
| 👩⚕️ General Practitioner (GP) Consultations and visits : out of hospital. | GP consultations and visits can be accessed in-person, telephonically or virtually. Use of the relevant GP Network applies. Subject to the Personal Savings Account. Threshold and Above Threshold Benefit apply. |
| 👨⚕️Virtual Care GP and Specialists consultation | 5 consultations per family, thereafter subject to the Personal Savings Account. |
| 💙 Additional GP consultation and visits. | 2 visits per beneficiary. |
| 🩺 Medical Specialist Consultations and Visits | Subject to the Personal Savings Account. |
| ⚠️ Casualty and emergency visits | Subject to the Personal Savings account. Facility fee, Consultations and Medicine. If retrospective authorisation for emergency is obtained from the relevant Managed Healthcare Programme within 72 hours, benefit will be subject to Overall Annual Limit. Only bona fide emergencies will be authorised. |
| 💊 Acute Medicine | Subject to the Personal Savings Account. |
| ✅ Pharmacy Advised Therapy (PAT) | Subject to the Personal Savings Account. 1 script per beneficiary per day. |
| 🤓 Optometry limit | R6 200 per beneficiary per 24 month Optical Service Date Cycle. 1 test per beneficiary per annum. |
| 🅰️ Optometric Refraction Eye Tests | One test per beneficiary per 24-month optical cycle. Subject to the OAL. Limited to the funds in the PMSA. |
| 👓 Spectacles or Contact Lenses (Single Vision Lenses, Bifocal Lenses, Multifocal Lenses, Contact Lenses) | Subject to the PMSA. 1 pair of Optical Lenses or Contact Lenses per beneficiary, every 24 months. Subject to the Optical Limit. |
| 👁️ Frame or lens enhancement | R3 900 per beneficiary included in the Optical Limit. |
| 📖 Reading Glasses | There is a limit of R220 per beneficiary. Subject to the PMSA. Must be supplied by a registered Optometrist, Ophthalmologist, Supplementary Optical Practitioner, or a registered Pharmacy. |
| 📈 Pathology and Medical Technology | Subject to the Personal Savings Account |
| 😷 Covid-19 PCR/Antigen Test | The 1st test is included in the PMSA, and subsequent tests provide no benefit unless the result is positive and subject to PMB. |
| ✳️ Physiotherapy, Biokinetics, and chiropractics | Subject to the Personal Savings Account |
| ☑️ Basic Radiology | Subject to the PMSA. 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. Only covered when referred by a Network GP. |
| ✅ Specialized Radiology | Limited to R25,600 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 Personal Savings Account. |
| 📍 Procedures and Tests performed in the Practitioner’s rooms | Unlimited cover. Unlimited, if procedure is done in the practitioner’s rooms. R1 500 upfront co-payment if procedure is done In-Hospital. No co-payment applicable In-Hospital for children 8 years and younger |
| ✔️ 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. There is an R1,500 upfront co-payment applicable if done In-Hospital. 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 R6,500 per family yearly. Included in the Mental Health Limit of R53 800 per family, In- and Out-of-Hospital. |
| Mental Health Medicine | Medicine Management of a specific non-CDL condition, in conjunction with Psychotherapy sessions. Subject to the relevant Managed Healthcare Programme. The Medicine Exclusion List and the Pharmacy Products Management Document are applicable. Levies and co-payments to apply where relevant. R5 850 per beneficiary. Subject to the medicine formulary and Chronic DSP from Rand one. 20% upfront co-payment will apply for the use of a non-DSP. |
| ➡️ Intrauterine Devices and Alternatives | 1 per female beneficiary. Includes all IUD brands up to and including the price of the Mirena device. Mirena/Kyleena device: 1 per female beneficiary every 5 years. Implanon: 1 per female beneficiary every 3 years. Nova T/Copper device: 1 per female beneficiary every 2 years |
| 💊 Additional Medical Services Including the following: Audiology Genetic Counselling Hearing Aid Acoustics Occupational Therapy Orthoptics Podiatry Speech Therapy and Private Nurse Practitioners Dietetics | Subject to the Personal Savings Account. |
| ❤️ Alternative Healthcare Service (Only applies to Acupuncturists, Homeopaths, Naturopaths, Osteopaths, and Phytotherapists) | Subject to the Personal Savings Account. |
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 R550 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 R235 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. |
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) |
| 💛 6 Years | Polio Diphtheria and Tetanus (DT) |
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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.
Medshield Emergency Medical Services
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:
| 1️⃣ 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. |
| 2️⃣ Out-of-Hospital treatment and managing PMBs | Members diagnosed with any 26 CDL conditions covered by Medshield and MediSaver 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. |
| 3️⃣ MediSaver 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. |
| 4️⃣ 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. |
| 5️⃣ 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. MediSaver covers either a PCR or an antigen test, but not both. |
Limited to Scheme Vaccination Formulary. Excludes consultation costs.
MediSaver does not cover some of the following:
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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.
According to the Medical Schemes Act No. 131 of 1998, the following waiting periods may apply:
| 🔎 Medical Aid | 🥇 Medshield MediSaver (2026) | 🥈 Bonitas BonSave Plan (2026) | 🥉 Discovery Health Classic Saver |
| 🌎 International Cover | Yes, Subject to scheme tariff. | R1,2m, Limited emergency cover for travel outside South Africa. | R5 million |
| 👤 Main Member Contribution | R5,376 | R4,047 | R3,910/month |
| 👥 Adult Dependent Contribution | R4,452 | R3,059 | R3,040/month |
| 🍼 Child Dependent Contribution | R1,311 | R1,211 | R930/month |
| 🔁 Gap Cover Option | None | Yes | Yes |
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💙 One of the main advantages of the MediSaver plan is its affordability. This plan offers comprehensive coverage at a reasonable cost, making it an excellent choice for individuals and families on a budget.
💙 The plan is also easy to understand and use, with specific benefits and no complicated exclusions. Members also have access to the Medshield App, which allows them to manage their benefits and claims on the go.
💙 One of the drawbacks of the MediSaver plan is that it may not be suitable for individuals who require extensive medical care. While this plan offers comprehensive cover for basic medical needs, it may not provide enough cover for more complex medical procedures.
💙 Overall, the MediSaver plan from Medshield is an excellent choice for individuals and families who require affordable basic medical coverage. With its comprehensive benefits, access to a network of healthcare providers, and easy-to-use features, this plan provides good value for money.
💙 However, it may not be suitable for those who require extensive medical care, as it has some limits on certain benefits.
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MediSaver is a medical aid plan offered by Medshield that provides affordable cover for basic medical needs, including in-hospital cover, chronic medication cover, and day-to-day benefits.
MediSaver is available to individuals and families looking for affordable basic medical coverage.
MediSaver is R5,376 for the main member, R4,452 per adult dependent up to 28 years, and R1,311 for child dependents 21 years and younger.
MediSaver includes unlimited in-hospital cover, chronic medication cover, day-to-day benefits, access to emergency medical services, cover for specialist consultations, and access to a network of healthcare providers.
The Medshield App is a mobile application that allows members to manage their benefits and claims on the go. Members can view their benefit balances, submit claims, and search for healthcare providers.
MediSaver covers pre-existing conditions, but there may be waiting periods before certain benefits become available.
MediSaver includes access to a network of healthcare providers. However, members can choose to see any healthcare provider outside the network. However, members may have to pay a co-payment for out-of-network healthcare providers.
Yes, Medshield MediSaver covers Optometry and Dentistry from certain day-to-day limits and the Personal Savings Account, depending on the benefit and treatment.
Members can submit claims using the Medshield App, online through the Medshield website, or by email, fax, or post.
Yes, there are waiting periods for certain benefits, including pre-existing conditions, maternity benefits, and dental and optical benefits.
Yes, members can upgrade or downgrade their plan during the allowed window, typically from November to December. However, dependents can be added at any given time.
MediSaver does include international travel insurance benefit to its members, subject to scheme tariff.
Yes, members can cancel their plan by giving written notice to Medshield. However, you will be expected to pay any monies (such as medical savings used) depending on when you cancel your plan.
Your plan may be suspended or canceled if you miss a premium payment. Therefore, keeping your premiums up to date is crucial to ensure that you have continuous coverage.
You can sign up for Medshield MediSaver by visiting their website, calling their customer service team, or completing an online application.
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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