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Medshield MediValue Prime Medical Aid Plan

Overall, the Medshield MediValue Prime Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and hospitalization alternatives to up to 3 Family Members. The Medshield MediValue Prime Medical Aid Plan starts from R2,736 ZAR.

👤 Main Member Contribution	R2,736
👥 Adult Dependent Contribution	R2,388
🍼 Child Dependent Contribution	R771
🌎 International Cover	Only Organ Transplants
📉 Annual Limit	Unlimited Hospital Cover
🏥 Hospital Cover	Unlimited
💶 Prescribed Minimum Benefits	☑️ Yes
💻 Screening and Prevention	☑️ Yes
💙 Medical Savings Account	None
🔁 Gap Cover	None

Medshield MediValue Prime Plan – 11 Key Point Quick Overview

☑️ Medshield MediValue Prime Plan Overview
☑️ Medshield MediValue Prime Plan Contributions
☑️ Medshield MediValue Prime Plan Benefits and Cover Comprehensive Breakdown
☑️ Medshield MOM Program and Benefits
☑️ MediValue Prime SmartCare Services and Benefits
☑️ MediValue Prime Wellness Benefits
☑️ MediValue Prime COVID-19 Benefits and Access to Care
☑️ MediValue Prime Plan Exclusions and Waiting Periods
☑️ Medshield MediValue Prime Plan vs. Similar Plans from other Medical Schemes
☑️ Our Verdict on The MediValue Prime Plan
☑️ MediValue Prime Plan Frequently Asked Questions

Medshield MediValue Prime Plan Overview

The Medshield MediValue Prime medical aid plan is one of 11, starting from R2,736 and Prescribed Minimum Benefits (PMB), no overall annual limit on in-hospital treatment and services, hospitalization alternatives (allied healthcare services), and more. Gap Cover is not available on the Medshield MediValue Prime Plan. However, Medshield offers 24/7 medical emergency assistance. According to the Trust Index, Medshield has a trust rating of 4.1.

Medshield MediValue Prime Plan Contributions

👤 Main Member	👥 +1 Adult Dependent	🍼 +1 Child Dependent
R2,736	R2,388	R771

Medshield MediValue Prime Plan Benefits and Cover Comprehensive Breakdown

MediValue Prime 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.

MediValue Prime Major Medical Benefits In-Hospital

🔍 Overall Annual Limit	There is no overall annual limit. Members must use the Prime Hospital Network.
🏥 Hospitalization	Unlimited cover. Subject to the relevant Management Healthcare Program. Pre-approval is needed for specialist services. Must use the Prime Hospital Network.
📌 Surgical Procedures	Unlimited cover.
📍 Medicine upon discharge	Limited to R500 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 R32,970 limit per family yearly, subject to the hospitalization limit. DSPs must be used, or a 25% co-payment will apply for using a non-MediValue Prime Network Hospital. Terminal care is limited to R13,715 per family per year and is subject to the annual limit.
☑️ General, Medical, and Surgical Appliances	Limited to R2,955 per family yearly. Pre-authorization is required. Only DSP, Network Providers, or Preferred Providers can be used.
✅ 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 but subject to PMB and PMB level of care. Subject to pre-authorization and the relevant Managed Healthcare Program. Clinical Protocols will apply.
🅱️ 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.
🩸 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.
👩‍⚕️ Medical Practitioner Consultations and Visits during hospital admission	Clinical Protocols apply. Unlimited cover.
😴 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. 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. 25% co-payment for using a non-MediValue Prime 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.
🌎 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. The Preferred Provider Network applies. 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. Subject to the hospitalization limit and then the daily limit unless pre-approved for PMBs and PMB level of care.
🦾 Internal Prostheses and Devices	Subject to pre-authorization by the relevant Managed Healthcare Program. Only for surgically implanted devices. Limited to R35,510 per family yearly. 25% co-payment unless related to PMB. Unlimited with PMB and PMB treatment. Hips and knees sub-limit: R35,510 per beneficiary (subject to PMB and PMB level of care).
🦵 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. Unlimited, but PMB and PMB level of care applies.
📌 Long Leg Callipers	Unlimited, but PMB and PMB level of care applies.
📈 Basic Radiology	Unlimited cover. Must form part of the authorized event. Clinical protocols will apply.
📉 Specialized Radiology	Limited to R10,340 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.
📊 CT Scans, MUGA Scans, MRI Scans, Radio Isotope Studies	Subject to the Specialised Radiology Limit. Clinical protocols will apply.
📍 CT Colonography (Virtual colonoscopy)	There is no co-payment on this benefit. Clinical protocols apply.
✳️ 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 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.
⬇️ Non-Surgical Procedures and Tests	Unlimited cover.
🧠 Mental Health	Unlimited cover but subject to the PMB and PMB level of care. 25% upfront co-payment for non-Compact Network Hospitals. Employ one DSP for PMB and non-PMB admissions.
💉 Rehabilitation for Substance Abuse	Unlimited but subject to PMB and PMB level of care.
👨‍⚕️ Consultations and Visits, Procedures, Assessments, Therapy, Treatment, or Counselling	Unlimited but subject to PMB and PMB level of care.
1️⃣ HIV and Aids	According to the Managed Healthcare Protocols. Pre-authorization and Managed Healthcare Program registration are required.
2️⃣ Anti-retroviral and related medicines	Voluntary out-of-formulary or PMB medication from a non-DSP supplier requires a 35% upfront co-payment.
3️⃣ HIV/AIDS-related Pathology and Consultations	Voluntary out-of-formulary or PMB medication from a non-DSP supplier requires a 35% upfront co-payment.
4️⃣ 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.

MediValue Prime Oncology Benefits

1️⃣ Oncology Limit	Unlimited cover. Subject to PMB and PMB level of care. 40% co-payment upfront when using a non-DSP.
2️⃣ Active Treatment (Includes Stoma Therapy, Incontinence Therapy, and Brachytherapy)	Subject to the Oncology Limit. ICON Standard Protocols apply.
3️⃣ Oncology Medicine	Subject to the Oncology Limit. 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.
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	Pre-authorization is required from the Oncology Managed Healthcare provider. Clinical Protocols will apply.
8️⃣ Vitreoretinal Benefit	Limited to R40,000 per family yearly. Clinical protocols apply.
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 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.

MediValue Prime Chronic Medicine Benefits

🅰️ Using a MediValue Prime Chronic Network Pharmacy from Rand one	Exclusive to PMB. Medicines will be approved according to the Medshield Formulary, with coverage from Rand one. Use of a non-MediValue Prime Chronic Network Pharmacy will incur an upfront co-payment of 35%.
🅱️ Supply of Medication (One month in advance)	Exclusive to PMB. Medicines will be approved according to the Medshield Formulary, with coverage from Rand one. Use of a non-MediValue Prime Chronic Network Pharmacy will incur an upfront co-payment of 35%.

MediValue Prime Chronic Disease List

✅ 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

and many more.

MediValue Prime Dentistry Benefits

🦷 Basic Dentistry	Limited to R2,425 per family yearly.
🏥 In-Hospital	Subject to the basic dentistry limit. After that, it is subject to the day-to-day limit. 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.
🚑 Out-of-Hospital	Subject to the basic dentistry limit. After that, it is subject to the day-to-day limit. 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 R6,995 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 R1,800 co-payment is required for wisdom teeth extraction in a Day Clinic. An upfront co-payment of R4,000 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. An R1,800 co-payment is required for wisdom teeth extraction in a Day Clinic. An upfront co-payment of R4,000 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.
📌 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	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 R7,880 per family yearly.

MediValue Prime 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.

🤰 Antenatal Consultations	Six 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 Test	One per pregnancy.
📍 Confinement In-Hospital	Unlimited cover. Must use the Prime Hospitalisation Network.
👨‍⚕️ Delivery by a Family Practitioner or Medical Specialist	Unlimited cover. Must use the Prime Hospitalisation Network.
💙 Confinement in a registered birthing unit or out-of-hospital	Unlimited cover Must use the Prime Network.
🔁 Delivery by a registered Midwife or a Practitioner	Covered up to 200% of the Medshield Private rates (only for a registered Midwife).
🛁 Hire of a water bath and oxygen cylinder	Unlimited cover.

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.

MediValue Prime 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 Consultations – Infections of the chest and upper respiratory tract, urinary tract, eyes, ears, etc.
✅ Chronic Consultations – Medication and refills for hypertension, diabetes, excessive cholesterol, etc. Then, members are advised to utilize the Medshield Chronic Medication Courier Service DSP to have their chronic medication delivered directly to their home or place of business.

🅰️ 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.

MediValue Prime Day-to-Day Benefits

📌 Day-to-Day Limits	Limited to the following: Main Member – R6,330 Main Member +1 – R7,920 Main Member +2 – R8,490 Main Member +3 – R9,885 Main Member +4> – R10,935
📍 Family Practitioner (FP) Consultations and Visits Out-of-Hospital FP consults and visits are available in person, over the phone, and remotely. Each beneficiary is required to select one Family Practitioner from the Family Practitioner (FP) Network. From Rand one, the FP Network is applicable.	A maximum of 2 Family Practitioners (FP) from the Medshield FP Network can be nominated by each beneficiary. Subject to your nominated Family Practitioner’s daily limit.
☑️ Non-Nominated FP/Emergency visits	Limited to two visits per family. Included in the day-to-day limit.
✅ Additional FP Consultations and visits to a nominated provider	This benefit is only active once your daily limit has been exhausted. There is a limit of 2 visits per beneficiary from the OAL after daily limits are depleted. This benefit is subject to the Medshield FP Network.
🔎 Extended FP visits for emergency and chronic FP consultations	Registration in the Disease Management Program is required. Pre-approval is needed. Chronic Disease List and Clinical Protocols Apply. Unlimited cover if the daily limit and Care Plan FP visits have been depleted. Members must use a nominated FP on the Medshield network. There is a limit of one FP consultation per beneficiary.
👨‍⚕️ Medical Specialist Consultations and Visits	Two visits per family per year are included in the OAL. Once these visits have been used, the benefit is limited to the day-to-day limit.
⚠️ Casualty and emergency visits	Subject to the day-to-day limit.
💊 Acute Medicine	Subject to the daily limit.
👩‍⚕️ Pharmacy Advised Therapy (PAT)	Subject to the day-to-day limit. Limited to R250 per script and one script per beneficiary daily.
🤓 Optometry	Subjected to applicable Optometry Managed Healthcare Program and Procedures. One set of Optical Lenses and a frame or contact lenses per beneficiary every two years. Benefit determined by the Optical Service Date Cycle.
👁️ Optometric Refraction Eye Tests	One test per beneficiary per 24-month optical cycle. Subject to the OAL.
👁️‍🗨️ Spectacles or Contact Lenses (Single Vision Lenses, Bifocal Lenses, Multifocal Lenses, Contact Lenses)	Subject to the OAL and Optical Limit.
📖 Reading Glasses	There is a limit of R190 per beneficiary. Subject to 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 overall annual limit, 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. Only covered when referred by a Network GP.
📊 Specialized Radiology	Limited to R10,340 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.
☑️ 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 R2,000 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	Members must use the Medshield Specialist Network. Limited to (and included in) the day-to-day limit.
🩺 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.

Read more about the Top 100 Medical Aid Questions

MediValue Prime 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 R445 per family yearly. Once this limit is reached, payment is made from the day-to-day limit.
📍 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.
☑️ 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. There is no benefit after that.
📈 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.
🚩 PSA Screening for Male Beneficiaries	Subject to the OAL.
🔎 Tuberculosis Test	One test per beneficiary.
✔️ Mammogram (Breast Screening)	One screening per female beneficiary 40>

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)
💚 6 Years	Polio Diphtheria and Tetanus (DT)

MediValue Prime Ambulance and Emergency Services

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

Subject to pre-approval by the supplier of Ambulance and Emergency Services.
Air Evacuation necessitates scheme approval.
Applying Clinical Procedures.

MediValue Prime Prescribed Minimum Benefits

Medshield members are entitled to coverage for 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.

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 MediValue Prime 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 MediValue Prime Option Payment for PMB conditions	The Day-to-Day limit on your benefit option or plan is a risk allocation made available to members. As a result, a PMB will pay from your Day-to-Day limit until it is empty, then pay from Risk until the services on your Care Plan have been used. Suppose you require additional services that are not included in your Care Plan. In that case, you and your treating provider must complete a new PMB Application form.
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. MediValue Prime covers either a PCR or an antigen test, but not both.

MediValue Prime COVID-19 Benefits and Access to Care

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).

MediValue Prime Plan Exclusions and Waiting Periods

MediValue Prime Exclusions

MediValue Prime does not cover the following:

Primary (milk) teeth root canal treatment
Procedures for direct and indirect pulp capping
From a metal base to full dentures, including laboratory fees
Acrylic with a high impact
Gold, precious metal, semi-precious metal, and platinum foil prices
Fees for laboratory delivery.
Equipment, devices, and procedures that have not been scientifically proven or are not acceptable
Chair backrests and seats
Bandages and dressings (except for medicated dressings and dressings used during a procedure or treatment)
Beds, mattresses, pillows, and bed skirts
Cardiac assist devices, such as Berlin Heart (unless PMB level of care, in which case DSP applies)
Unless otherwise specified, diagnostic kits, agents, and appliances (excluding diabetic accessories) (unless PMB level of care)
Toothbrushes that are powered by electricity
Ionisers and air purifiers; humidifiers

and many more. A full list of Exclusions will be supplied.

MediValue Prime Waiting Periods

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:

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 will apply.

Medshield MediValue Prime Plan vs. Similar Plans from other Medical Schemes

🔎 Medical Aid Plan	🥇 Medshield MediValue Prime	🥈 GEMS Ruby	🥉 Bestmed Rhythm 2
👤 Main Member Contribution	R2,736		R2,100
👥 Adult Dependent Contribution	R2,388		R1,996
🍼 Child Dependent Contribution	R771		R1,264
🌎 International Cover	Only Organ Transplants	Scheme Rate	R500,000 – R3 million
📉 Annual Limit	Unlimited Hospital Cover	Unlimited	Several limits and sub-limits

Our Verdict on The MediValue Prime Plan

Medshield MediValue Prime is a medical aid plan offered by Medshield Medical Scheme in South Africa. This plan is designed to provide members with a balance between affordability and comprehensive coverage. The MediValue Prime Plan offers extended day-to-day benefits, including dentistry, optometry, prescribed medication, and additional in and out-of-hospital treatments and services. One of the main benefits of the MediValue Prime Plan is the extended day-to-day benefits. This includes specialized dentistry, such as root canals and orthodontics, and optometry benefits, including eye tests, frames, and lenses. The plan also covers prescribed medication, which can be expensive without medical aid. Additionally, eligible female members can receive mammograms as part of the plan’s preventative care benefits.

Another benefit of the MediValue Prime Plan is additional in and out-of-hospital treatments and services. This includes cover for chronic medication, HIV/AIDS treatment, and maternity benefits. The plan also covers specific procedures and treatments excluded from other medical aid plans, such as homeopathy and acupuncture. However, the MediValue Prime Plan does have some drawbacks of which members must be aware. Firstly, the plan does not include a savings account, meaning members are responsible for paying for day-to-day expenses out of their own pocket.

Additionally, the plan requires co-payments for specific procedures and treatments, which can be costly for members who require frequent medical care. The plan also has very tight limits on certain treatments, which can lead to out-of-pocket expenses for members. Overall, the Medshield MediValue Prime Plan is a good option for those seeking a balance between affordability and comprehensive coverage.

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

MediValue Prime Plan Frequently Asked Questions

Does MediValue Prime offer maternity benefits?

Yes, MediValue Prime offers maternity benefits, including antenatal care, delivery options, and post-partum care.

What are the vision care benefits covered by Medshield?

Medshield covers a range of vision care benefits, including eye exams, prescription glasses, and reading glasses.

Can MediValue Prime cover advanced dentistry procedures such as dental implants?

Yes, MediValue Prime does cover advanced dentistry procedures such as dental implants, root canal treatment, and orthodontic treatment.

Does Medical Aid cover braces in South Africa?

Yes, braces are covered by most Medical Aid schemes in South Africa. However, the type of coverage and costs will depend on the specific Medical Aid scheme and plan.

Can I rent crutches through Medshield?

Medshield does offer medical equipment rentals, including crutches, walkers, and knee scooters.

Does MediValue Prime cover hearing aids?

Yes, MediValue Prime does cover hearing aids, including digital hearing aids, Bluetooth hearing aids, and invisible hearing aids.

How often should I have an eye exam under Medshield?

You can have an eye test done once every two years.

Does Medical Aid in South Africa cover cosmetic dentistry?

Most Medical Aid schemes in South Africa do not cover cosmetic dentistry procedures such as teeth whitening or veneers.

Can I get reimbursed for orthodontic treatment under Medshield?

Yes, Medshield offers orthodontic benefits that can cover a portion of the cost of braces or clear aligners.

Does Medical Aid cover hearing aid batteries in South Africa?

Most Medical Aid schemes in South Africa do not cover hearing aid batteries, as they are consumables.

Can I get a referral to an obstetrician through Medshield?

Yes, Medshield can provide referrals to obstetricians as part of their maternity benefits.

What types of orthodontic treatment are covered by MediValue Prime?

MediValue Prime covers a range of orthodontic treatment options, including braces, clear aligners, retainers, and other appliances.

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.