5 Best Medical Insurance Plans in South Africa

 

The 5 Best Medical / Health Insurance Plans in South Africa revealed.

 

We tested them side by side and verified their options.

This is a complete guide to the best medical insurance plans in South Africa.

 

In this in-depth guide you’ll learn:

 

• ☑️ What is a Medical / Health  Insurance Plan?
• ☑️ How do you find affordable medical / health insurance plans in South Africa?
• ☑️ How to choose the best affordable medical / health insurance plan for your needs?
• ☑️ How to compare medical insurance plans against each other?
• ☑️ How to sign up with your ideal medical insurance plan?
• ☑️ What is the best way to sign up for medical insurance plan for the first time?
• ☑️ Medical Aid vs Medical Insurance.
• ☑️Short Term Medical Insurance vs Long Term Medical Insurance.

 

 

So if you’re ready to go “all in” with medical insurance plans, this guide is for you.

 

Let’s dive right in…

 

 

Best Medical Insurance Plans (2025)

 

🩺 Medical Aid	✔️ Offers Medical Insurance Plan?	⚕️ Plan Offered	👉 Sign Up
1. Dischem Health Insurance	Yes	MyHealth Plus Plan	👉 Apply Now
2. Discovery Health	Yes	Discovery FlexiCare Plan	👉 Apply Now
3. OnePlan Health Insurance	Yes	Professional	👉 Apply Now
4. MediHelp	Yes	Savings Plan	👉 Apply Now
5. FedHealth	Yes	flexiFED Savvy	👉 Apply Now

 

 

5 Best Medical Insurance Plans (2025)

 

1. Dischem Health Insurance – Overall, Best Medical Insurance Plan in South Africa
2. Discovery Health – Top Value-Based Healthcare Medical Insurance
3. Oneplan Health Insurance– Best Provider of Low-Cost Medical Assistance
4. Medihelp – Free Online Platform to Stay Healthy
5. Fedhealth – Top Customization Medical Insurance in South Africa

 

 

 

 

Understanding medical insurance plans for South Africans

 

 

👉 Private health insurance in South Africa is thriving despite continued discussions about establishing a public health insurance fund.

 

👉 Until the National Health Insurance (NHI) is fully in place, working citizens of our wonderful country should do what they can to avoid the already-stretched-thin public healthcare system in favour of the more efficient private sector.

 

👉 It’s vital to purchase a health insurance policy that actually pays for all of the services it advertises it will. Before settling on a health insurance provider, it’s wise to arm yourself with some basic knowledge.

 

👉 Having health insurance protects you financially in the event of an accident or illness, and it also offers you daily benefits.

 

👉 Cash reimbursements or lump sum payments are made to clients on a daily basis for the length of time they spend in the hospital, up to the policy’s maximums for both the insured event and the policy year.

 

👉 Under most policies, hospitalisation costs, including as those associated with childbirth, emergency room visits, intensive care unit stays, and the treatment of terminally ill patients, are covered by your health insurance provider if you are younger than 65 years old.

 

👉 Hernias, appendicectomies, gall bladder problems, kidney stones, hysterectomies, and many other similar illnesses are all covered by health insurance.

 

👉 After a patient is admitted to the hospital, these insurances pay out a predetermined benefit. The specified benefit is intended to offset non-medical expenses, such as lost wages, and has nothing to do with the cost of medical care itself.

 

👉 What this implies is that instead of compensating the hospital for the service you received, your health insurance company will pay out a set amount determined by the policy you have. Think of it like homeowner’s insurance: if your house floods and you lose everything inside, you’ll get back the amount you insured your stuff for, not the amount it would cost to replace them.

 

👉 This is due to the fact that medical insurance is offered by for-profit businesses, who employ underwriting and actuarial expertise to foresee the likelihood of future claims.

 

👉 They are not required to take in any given applicant, and they can indefinitely exclude out those with certain diseases. They are also exempt from making any payments towards the insured sum, even if the actual cost is higher.

 

📢 Complete below form and receive a free, no obligation quote

 

 

 

Health insurance benefits

 

 

👉 Health insurance premiums are not uniform across the board because they are based on a number of characteristics unique to each client.

 

👉 When compared to medical aid plans, health insurance provides its clients with either a daily Rand value or an annual maximum for hospitalisations. Similar to other insurance policies, your medical insurance premiums may increase at any time of the year if you file a claim.

 

👉 There is, however, an advantage to possessing both. When you have medical aid, you don’t have to worry about costs associated with hospitalisation, chronic illness, or meeting your daily health care needs below the minimum required by law.

 

👉 On the other hand, health insurance will cover lost wages and other expenses in the event of hospitalisation. Other costs associated with your hospital stay are also covered. It’s like having any other type of insurance: ideally, you won’t have to use it, but if the time comes, it’s great to know you have it.

 

📌 READ: What Is the Difference Between Medical Aid and Medical Insurance

 

 

5 Best Known Medical Insurance Plans

 

 

👉 The best health insurance providers in South Africa will be detailed below. Coverage from these companies is trustworthy and reasonably priced.

 

👉 We’ll go over the many programmes they offer, the services they provide, and the prices they demand. We will also supply full contact information.

 

👉 We’ve compiled a list of the best health insurance companies in South Africa and explained why we prefer them.

 

 

1. DisChem Health Insurance

 

 

 

Overview

 

Medical Insurance powered by Dis-Chem Health, insured by Centriq Insurance.

 

✅ Overall, this Medical Insurance is trustworthy and comprehensive. It offers cover for day-to-day medical costs such as consultations with a private doctor (GP), medication, dentistry, eye exams, maternity care, health screenings and more.

 

✅ The MyHealth Core plan is an entry-level Day-to-Day Cover policy that provides coverage for a broad spectrum of health problems from R469 per month. You will have access to private doctor visits, nursing, pharmacy-based care, dentistry, eye exams, spectacles and frames in addition to both over-the-counter and prescription medicine.

 

• You can go to the doctor up to four times per year, but you must visit a doctor that is part of the Prime Cure Network. To find a doctor closest to you, go to the Dis-Chem Health website and click on Find a Doctor. You can also use the Dis-Chem Health app and search for a provider using your location.

 

• Before your 3rd and 4th visit to the doctor, you need to call Dischem Health on 0861 029 892 to get Pre-authorisation for the visit to be covered. Minor Treatments like stitches, biopsies and wound care are included in the visit if they are on the approved list of procedures Dischem health cover.

 

✅ The MyHealth Plus Plan is a more comprehensive health insurance option that gives you unlimited access to doctors, dentists and specialists from R649 per month.

 

• You can go to the doctor whenever you are not feeling well, but you must visit a doctor that is part of the Prime Cure Network. To find a
  doctor closest to you, go to the Dis-Chem Health website and click on Find a Doctor. You can also use the Dis-Chem Heath app and search for a provider using your location.

 

• Before your 4th visit to the doctor, and every visit thereafter, you need to call Dischem Health on 0861 029 892 to get Pre-authorisation for the visit to be covered. Minor Treatments like stitches, biopsies and wound care are included in the visit if they are on the approved list of procedures Dischem Health cover.

 

✅ Enjoy coverage for Doctor (GP) visits to Prime Cure network doctors, virtual GP consults, specialists, nurse and wellness clinic visits, health screenings, and medication to name a few.

 

✅ With Dis-Chem Health Accident Cover, look after your family in the case of an accidental emergency, heart attack or stroke from R206/month for adults and R114/month for children. You are covered for an unlimited number of Emergency Department
visits at hospitals in the Prime Cure Network should you suffer a Medical Emergency.

 

• Note: Your cover will end when you are Discharged from the Emergency Department or when your R20 000 limit is reached, whichever occurs first.

 

✅ Included are emergency casualty visits, hospitalisation for accidents in a private hospital, ambulance services and emergency stabilisation. The Extended Accident cover is more comprehensive and gives you greater levels of cover from R237/month for adults.

 

✅ You can choose to also add the Medical Emergency Illness Buy-Up for an additional R64 per adult and R39 per child.

 

✅ You can also add Lifestyle Benefits for an additional R55/month. Benefits include: family, legal and financial counselling as well as extra by Dis-Chem rewards programme.

 

📌 You might consider Dischem Health Insurance from R206 per month

 

 

How Much Are Momentum Health Monthly Premiums?

 

• ✅ The MyHealth Core plan is an entry-level Day-to-Day Cover policy from R469 per month.
• ✅ The MyHealth Plus Plan is a more comprehensive health insurance from R649 per month.
• ✅ With Dis-Chem Health Accident Cover from R206/month for adults and R114/month for children.
• ✅ The Extended Accident cover is more comprehensive and gives you greater levels of cover from R237/month for adults.
• ✅ You can choose to also add the Medical Emergency Illness Buy-Up for an additional R64 per adult and R39 per child.
• ✅ You can also add Lifestyle Benefits for an additional R55/month.

 

 

What Is the Waiting Period for Dischem Health’s Benefits?

 

 

MyHealth Core Plan:

• 📌 1-month general waiting period on new policies where no claims will be covered
• 📌 6-month waiting period for chronic medication if you have HIV and Diabetes Mellitus (type 2)
• 📌 No general waiting period will apply to a newborn child or Eligible Spouse if you add them to your Policy within 90 days from the birth or marriage date. No general waiting period will apply to an Eligible Child if you add them within 90 days from the date of activation of the Policy.

 

MyHealth Plus Plan:

• 📌 A six-month waiting period before starting chronic medication if you have HIV and type 2 diabetes
• 📌 A one-month general waiting period before starting a new policy during which no claims will be paid
  If you add a newborn child or eligible spouse to your policy within 90 days of the date of birth or marriage, no general waiting period will be applicable.
• 📌 If you add an eligible child within 90 days of the policy’s activation date, there won’t be a general waiting period.

 

Accident Cover:

• 📌 No waiting periods apply to Accident Cover Policies.

 

 

👉 READ more about Dischem Health Waiting periods in this guide

 

 

When is Pre-Authorisation Required by Dis-Chem Health?

 

 

Pre-authorisation is required by Dis-Chem Health for the following:

 

✅ GP Visits: Dis-Chem Health covers four GP visits. Pre-authorisation from Ask A Doctor is needed from the 3rd GP visit

 

✅Acute medication: Pre-authorisation must be obtained for the prescribing Doctor visit for acute medication

 

✅ Dental:

• For dental cover, pre-authorisation is needed for four or more repairs to teeth, or five or more composite fillings per Family Per Annum
• Cover for emergency root canal during Office Hours for pain and sepsis only.
• Pre-authorisation is needed for five or more dental extractions

 

✅ Pre-Authorisation is needed from the third oral radiography X-ray.

 

✅ Glasses: Pre-authorisation is needed for the glasses benefit

 

✅ X-rays and scans: Pre-authorisation with Ask A Doctor is needed from the third Doctor visit for tests on X-rays and scans

 

✅ Blood tests: Pre-authorisation with Ask A Doctor is needed from the 3^rd

 

Pre-authorization with Dis-Chem Health is typically required for certain medical services or treatments that are considered non-routine, elective, or costly.

 

Pre-authorization ensures that the healthcare services or treatments you plan to receive are covered by your medical scheme. Without pre-authorization, you risk facing unexpected out-of-pocket expenses for services that may not be covered.

 

Pre-authorization often involves a review of your medical condition and proposed treatment plan by healthcare professionals. This process helps ensure that you receive the most appropriate and effective care for your health needs, promoting better treatment outcomes.

 

Failure to obtain authorization from Dis-Chem Health when required can have several consequences:

• ✅ Out-of-Pocket Expenses
• ✅ Reduced Coverage
• ✅ Disputes and Appeals

 

 

👉 READ more about the Pre-authorisation required by Dis-Chem Health

 

 

Dischem Health Contact Details

 

Medical Insurance: The Medical Insurance department at Dis-Chem Health oversees the operations and requirements related to the medical insurance plans offered by the scheme. These include sales, customer support, family, legal and financial counselling, and Netcare emergency.

 

✅ Call:

• Sales: 0861 029 892
• Customer Support and General Enquiries: 0861 029 892
• Family, Legal or Financial Counselling: 0861 635 766
• Emergency (Netcare911): 082 911

 

✅ Email:

• Sales: [email protected]
• Customer Support and General Enquiries: [email protected]
• Family, Legal or Financial Counselling: None
• Emergency (Netcare911): None

 

❌ WhatsApp: None

 

❌ Fax: None

 

✅ Mobile App: Available on Apple Store, Google Play and AppGallery

 

✅ Website enquiry: https://dischemhealth.co.za/contact/

 

 

2. Discovery Health

 

 

 

Overview

 

👉 Discovery Medical Health is a non-profit organisation governed by the Medical Schemes Act 131 of 1998, as amended, and governed by the Council for Medical Schemes (CMS). It is a recognised open medical scheme that anybody can join, according to the Scheme rules.

 

👉 The Scheme is owned by its members, and its operations are overseen by an independent Board of Trustees (the Trustees or the Board). Via a formal contractual arrangement, the Scheme outsources its administration and managed care functions to Discovery Health (Pty) Ltd.

 

👉 Value-based healthcare is one of the Scheme’s strategic focuses. Their approach, which puts their members at the centre of care, reimburses providers based on health outcomes rather than just the volume of services they give.

 

👉 It provides members with access to programmes and providers dedicated to continual quality improvement.

 

👉 With several quality of care programmes and innovations, which are constantly reviewed by the Scheme on an ongoing basis, Discovery Health seeks to guarantee that our members have access to the safest, most efficient, and effective healthcare accessible in South Africa.

 

👉 The Scheme also provides its members with information that is pertinent to their requirements.

 

 

Discovery Health Insurance

 

 

• ✅ Discovery Flexicare covers essential day-to-day medical expenses or the cost of specific medical procedures.

 

• ✅ Discovery Flexicare gives affordable medical insurance to more South Africans who are looking for cheaper options under R500. The Flexicare starts at R350 per month for a main Member and R469 for Flexicare Plus.

 

• ✅ Access to emergency medical services through Netcare 911 ambulance services.

 

• ✅ Transportation to an appropriate state hospital.

 

• ✅ And much more…. – Download the flexicare-retail-guide 2025 of Discovery for more information on the benefits.

 

 

	Flexicare benefits	Flexicare plus benefits
Unlimited GP consultations	Available with nurse referral	☑️
Unlimited nurse consultations	☑️	☑️
Medicine	☑️	☑️
X-rays	☑️	☑️
Flu vaccine	☑️	☑️
Eye care	❌	☑️
Dentistry	❌	☑️
Health Check	☑️	☑️
Maternity benefit	☑️	☑️
Blood tests	☑️	☑️
Procedures in GP rooms	☑️	☑️
HIV care	☑️	☑️
Private ambulance services	☑️	☑️
	R350pm	R469pm

 

 

How Much Are Discovery Medical Aid Monthly Premiums?

 

👉 Monthly premiums start from R350 per member for the FlexiCare Medical Insurance cover and goes up to R469 per member for the FlexiCare Plus Health Insurance Plan.

 

 

Flexible monthly premiums

Role	Flexicare	Flexicare plus	Trauma** R400,000	Trauma** R1,000,000	Vitality Active
Main member	R350	R469	R187	R262	R129
Spouse	R350	R434	R187	R262	R79
Adult	R350	R434	R187	R262	R79
Child*	R239	R249	R70	R116	R79

 

 

What Is the Waiting Period for Discovery Medical Aid’s Benefits?

 

👉 A waiting period means that you or your dependant(s) cannot claim for the associated healthcare services during the waiting period.

 

👉 Unless otherwise approved, the following waiting periods will apply. A 12-month, condition-specific waiting period may be applied for any condition (including chronic illnesses and HIV) that existed before the start date of the membership.

 

WAITING PERIOD DESCRIPTIONS

☑️ General waiting period
1-month general waiting period on all benefits

☑️ Radiology (X-rays) waiting period
1-month waiting period

☑️ Pathology (blood tests) waiting period
1-month waiting period

☑️ Dentistry waiting period
3-month waiting period

☑️ Optometry waiting period
3-month waiting period

☑️ Maternity waiting period
12-month waiting period

☑️ HIV waiting period
12-month waiting period

☑️ Chronic conditions waiting period
12-month waiting period

☑️ Over-the-counter medicine waiting period
1-month waiting period

☑️ Trauma Benefit waiting period
1-month waiting period

 

 

How to Claim for Discovery Medical Aid Benefits

 

✅ Flexicare is structured in such a way that you should not have to pay for services provided by healthcare providers in our networks. Flexicare will pay healthcare providers who are part of our approved networks directly.

 

MOTOR VEHICLE ACCIDENTS AND CLAIMS FROM THE ROAD ACCIDENT FUND

 

✅ You must send all enquiries about motor vehicle accidents and claims against the Road Accident Fund to Discovery Thirdparty Recovery Services. You can send an email to [email protected].

 

CLAIMS PAYMENT

 

✅ If the healthcare provider has already sent us the claim, you do not have to send us another copy.
If you paid for the services provided, you can submit your claims to Flexicare by email to [email protected].

 

Other ways:

 

👉 You can submit a claim fast and easily in the following ways:

➡️ Scan and upload your claims on the website.

➡️ Scan and email your claims to [email protected].

➡️ Use the Discovery app on your smartphone. If the claim has a QR code, scan the QR code or alternatively take a photo of the claim from within the app.

➡️ You can also submit your claims by post.

 

 

Discovery Medical Aid Contact Details

 

GENERAL ENQUIRIES, CHRONIC ILLNESS BENEFIT AND CLAIM ENQUIRIES

✅ Telephone: 0860 44 47 79
✅ Email: [email protected]
✅ You can email administration enquiries and withdrawal requests to [email protected] or action these changes on the Discovery website.

 

COMPLAINTS

✅ Email: [email protected]
If you still have concerns, you can contact Discovery’s Group
Compliance at:
✅ Email: [email protected]

 

HIV

✅ Email: [email protected]

 

HOSPITAL PREAUTHORISATION

✅ Telephone: 0860 44 47 79

 

USSD SERVICES

You can use our USSD service to confirm your policy number, find your allocated GP or get benefit information. To access this service you can dial: *120*DISCO# or *120*34726#

Note: You must access the USSD menu using the same
cellphone number that we have on record for you.

 

Postal:

PO Box 784262,

Sandton,

2146

Phone: 0860 99 88 77

 

 

3. OnePlan Health Insurance

 

 

Overview

 

☑️ Individuals and families can select from affordable medical insurance plans provided by Oneplan Health Insurance, an innovative and customer-centric healthcare solution. Oneplan’s approach to health / medical insurance differs from conventional medical aid programs in providing a more flexible and cost-effective way of accessing healthcare.

 

☑️ One of the distinguishing characteristics of Oneplan is its extensive selection of health insurance plans, which accommodate a variety of budgets and healthcare requirements.

 

☑️ Furthermore, Oneplan’s plans range from hospitalization coverage to comprehensive health insurance with additional dental and routine care benefits. One plan’s unique selling proposition is the ability to tailor plans to meet individual needs and budgets. Oneplan’s dedication to innovation and technology is a further one of its strengths.

 

☑️ For instance, the Oneplan app provides clients with a simple and convenient way to manage their policies and benefits, such as submitting claims and viewing available benefits.

 

Oneplan Health Insurance – Advantages over Competitors

 

Provides affordable medical coverage with various plans, including the Oneplan Core Plan, Oneplan Blue Plan, Oneplan Professional Plan, and Oneplan Executive Plan.

 

• ✅ Offers comprehensive medical cover, including hospitalization and day-to-day benefits, as well as dental, optical, maternity, and chronic medication benefits.
• ✅ Provides access to a network of healthcare providers, including general practitioners, dentists, and optometrists.
• ✅ Offers a range of benefits to suit different budgets and medical needs, making it accessible to a wide range of customers.
• ✅ Allows for easy claim submissions through the Oneplan Health App, reducing the administrative burden on customers.
• ✅ Provides excellent customer service with knowledgeable consultants who are patient in explaining policy details and answering customer queries.

 

Offers a range of value-added benefits, such as cashback on healthy food purchases and discounts on gym memberships, to encourage healthy living.

 

 

How Much Are OnePlan Health Insurance Monthly Premiums?

 

🟥 Family Dynamic	1️⃣ Core Plan	2️⃣ Blue Plan	3️⃣ Professional Plan	4️⃣ Executive Plan
🟧 Single Member	R500	R1000	R1,465	R1,975
🟨 Single Insured +1 Child	R875	R1,625	R2,340	R2,895
🟩 Single Insured +2 Children	R1,205	R2,220	R3,065	R3,725
🟦 Single Insured +3 Children	R1,505	R2,795	R3,705	R4,380
🟪 Single Insured +4 Children	R1,775	R3,360	R4,345	R5,020
🟥 Couple	R1000	R1,980	R2,795	R3,505
🟧 Couple Insured +1 Child	R1,350	R2,570	R3,415	R4,345
🟨 Couple Insured +2 Children	R1,665	R3,035	R3,970	R5,160
🟩 Couple Insured +3 Children	R1,955	R3,470	R4,515	R5,775
🟦 Couple Insured +4 Children	R2,240	R3,885	R4,990	R6,405

 

 

What Is the Waiting Period for OnePlan Health Insurance Benefits?

 

The waiting period is a specific duration that must pass before certain benefits of your health insurance policy become effective. This period is put in place by insurers to prevent immediate claims for pre-existing conditions and to manage the risk of new enrolees.

 

With OnePlan, this waiting period is designed to ensure the sustainability of the plan while providing members with access to quality healthcare services. The duration and conditions of the waiting period can vary based on the type of coverage you select and your health history.

 

This guide will help you understand the specifics of OnePlan’s waiting period, ensuring you have a clear understanding of when and how you can start using your health insurance benefits to their fullest extent.

 

 

When is Pre-Authorisation Required by OnePlan?

 

 

OnePlan requires pre-authorisation for several specific medical services to ensure that the treatments are covered under the policy and deemed medically necessary. Here are the main instances where pre-authorisation is necessary:

• 📌 Specialist Consultations
• 📌 Hospital Admissions
• 📌 Advanced Diagnostic Procedures
• 📌 Elective Surgeries
• 📌 Chronic Medication
• 📌 Certain Therapies

 

👉 Learn more about the OnePlan Authorisation Process

 

 

OnePlan Health Insurance Contact Details

 

When contacting OnePlan, you can use the following methods depending on your needs:

 

 

 

General Contact:

• ☑️ Call: 010 0010 141 (Monday to Friday, 8:00 – 17:00; Saturday, 8:00 – 12:00)
• ☑️ Email: [email protected]
• ☑️ WhatsApp: 083 794 5452 (Available during business hours)
• ☑️ Website Enquiry: Use the web chat feature or request a call back via the “Contact Us” section on the OnePlan website
• ☑️ Mobile App: Access support through the OnePlan app, available on both iOS and Android platforms

 

 

Health Insurance:

The Health Insurance department at OnePlan handles a range of services related to their health insurance products.

• ☑️ Call: 010 0010 141

 

 

Email:

• ☑️ Customer Care: [email protected]
• ☑️ Maternity Pre-birth & Specialist Authorisation: [email protected]
• ☑️ Hospital Claims: [email protected]
• ☑️ Hospital Authorisation & Admission: [email protected]
• ☑️ Day-to-Day Claims: [email protected]

 

 

4. Medihelp

Overview

👉 Medihelp’s main objective as a self-administered medical aid is to serve its members by meeting their healthcare needs.

👉 Medihelp welcomes all South Africans, whether you are a student, a new employee wishing to join a medical aid for the first time, a company owner searching for a good healthcare plan for your employees, or the head of a family with growing medical needs.

 

Medihelp Health Insurance

👉 Medihelp only provides four plans. Prices vary depending on what you want from your plan, but they all start at a stupidly low price. Everything on the website is quite simple. It’s simple to sort through your alternatives and make a decision.

👉 The student plan, their most basic plan, starts at just under R600 and covers day-to-day expenses as well as chronic illnesses and hospital visits. Extras, such as screenings and pregnancy care, are available for a fee.

👉 The comprehensive plan begins at less than R3000 and includes GP and specialist appointments, dental and optometrist treatment, hospital expenditures, and maternity and infant care. There is also a hospital plan that covers limited daily expenses in addition to hospital bills, as well as a savings plan in which your savings account pays day-to-day expenses.

👉 Medihelp is a fantastic, free online platform that assists users in staying healthy. You can examine your health data, register for free sporting events, join a weight-loss programme, or enjoy a pregnancy and infant programme here.

 

How Much Are Medihelp Medical Scheme’s Monthly Premiums?

👉 Medihelp monthly premiums range from R756.00 pm for the student hospital plan, R1 254.00 pm for the Vital Plan, R2 310.00 pm for the Savings plans, and R2 394.00 pm for Comprehensive plans.

 

What Is the Waiting Period for Medihelp Benefits?

👉 Depending on the medical aid scheme you join, the average waiting period for NetCare benefits is three months. Pre-existing conditions have a 12-month waiting period.

 

How to Claim Benefits from Medihelp Medical Scheme

👉 Members can submit claims using one of the following:

👉 Doctors and healthcare practitioners usually submit claims for their services directly to Medihelp on your behalf, but some healthcare practitioners require you to pay their accounts first and then claim a refund from Medihelp.

👉 To ensure that your claim is valid according to the Medical Schemes Act and Medihelp’s Rules, please ensure that the following details appear on the printed account:

• ➡️ Your membership number and correct dependant code (e.g. “01” for the principal member)
• ➡️ The member’s name and surname
• ➡️ The name, surname and date of birth of the patient
• ➡️ Medihelp Medical Scheme – not “Private” (this has tax implications)
• ➡️ The healthcare practitioner’s name and practice number
• ➡️ Your proof of payment (attached)
• ➡️ The amount you have paid
• ➡️ The amount charged per item
• ➡️ The relevant codes such as ICD-10, NAPPI and item codes
• ➡️ The date on which the service/procedure was rendered/performed

 

Medihelp Medical Scheme Contact Details

086 0100 678

[email protected]

 

 

5. Fedhealth

Overview

👉 Fedhealth has been servicing the medical needs of South Africans since its inception in 1936. Much has changed throughout the years, but their dedication to providing low-cost, high-quality medical treatment has not.

👉 Fedhealth continues to operate as a cooperative run by and for its members, and as such is always looking for new ways to meet its members’ health-care requirements in an ever-changing world.

👉 Fedhealth places a premium on customization, so as a member, you may have a say in the type of healthcare coverage you receive. Fedhealth, as a membership organisation, prioritises its members’ needs.

👉 Because of the Scheme’s strong financial position, it has been able to keep its AA- Global Credit Rating for the past 14 years while also providing for its members in times of need by setting aside more than the statutory 25% reserve.

👉 Fedhealth is well-known for its unique Risk-based awards, which extend members’ regular advantages even further.

👉 Examples include free upgrades at any time of year within 30 days of a big life change, decreased prices for children with dependents up to the age of 27, and no limits on the number of network doctor’s appointments.

 

Fedhealth Health Insurance

👉 Fedhealth offers seven packages ranging in price from roughly R1000 to R10,000. Fortunately, four of these ideas are less than R2000. Their most basic plan includes some tests, hospital visits, 26 chronic diseases, basic contraception, and maternity and newborn care.

👉 The most expensive plan includes coverage for 68 chronic conditions, immunisations, a plethora of test choices, and a high payment rate. The flexiFED 2 and 3 plans also include some excellent maternity alternatives.

👉 All packages include a MediTaxi service to transport you to follow-up treatments (in specific regions) and a paediatric help line.

👉 Fedhealth has exceptional customer service statistics: their claim turnaround time is 5 days, their average call waiting time is 8 seconds, and 90% of queries are handled on the first contact, according to their website.

 

How Much Are Fedhealth Medical Scheme Monthly Premiums?

👉 The monthly premiums for the salary-banded myFED option is from R 1 275 per month for the main member. The maxima PLUS extensive medical cover will cost 13 122 per month per the main member.

 

What Is the Waiting Period for Fedhealth Benefits?

👉 The general waiting period for Fedhealth benefits is usually three months, depending on the medical aid scheme you join. The waiting period for pre-existing conditions is 12 months.

 

How to Claim Benefits from Fedhealth Medical Scheme

👉 Members can submit claims using one of the following:

• ➡️ In the Fedhealth Family Room,
• ➡️ Through a WhatsApp service
• ➡️ On the Fedhealth Member phone App
• ➡️ You may also email, fax or post the claims to email: [email protected], fax: (011) 671 3842 or post to Private Bag X3045, Randburg, 2125.

 

Fedhealth Medical Scheme Contact Details

Flora Centre Shop 21 and 22

Corner Conrad street and Ontdekkers Rd

Florida Glen

Johannesburg

Phone: 0861 116 016

 

 

Frequently Asked Questions

How does health insurance work in South Africa?

Health insurance covers hospitalization as well as day-to-day expenses. A predefined set amount is paid out to the client in the form of a daily cash-back or payment per insured event, with a maximum amount per event and an annual limit amount.

 

Is it better to pay for health insurance?

Paying for your own health insurance coverage is a new experience for many young individuals, and it may appear to be unimportant. Nevertheless, the exact opposite is true. One of the most important components of any financial plan is adequate health insurance.

 

What is the difference between medical aid and health insurance?

Although a medical aid plan provides more comprehensive coverage, it typically does not cover personal accident disability or limb loss. That is what health insurance does. It may also include death and funeral coverage, which is not provided by medical aid systems.

 

What happens if you don’t have health insurance and you have to go to the hospital?

You will be responsible for the entire amount and must work out a payment plan with the hospital. Try asking for charitable care alternatives or discounts to help cover some of the costs.

 

What are the advantages of private health insurance?

Private health insurance has several advantages, including access to private hospital rooms, lower wait times, and the option to choose your chosen doctor.

 

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