Medihelp MedVital Elect Plan
Overall, Medihelo MedVital Elect Plan starts from R1,776 per month. The plan covers several benefits such as consultations, medication and emergencies. MedVital Elect Plan offers mobile apps for both Android and IOS.
Medihelp MedVital Elect Plan Overview
👉 The Medihelp MedVital Elect medical aid plan is one of 11, starting from R1,776, and includes several core benefits, day-to-day benefits, added insured benefits, unlimited PMB medicine, additional GP consultations, childbirth, and more.
👉 Gap Cover is not available on the Medihelp MedVital Elect Plan. However, Medihelp offers 24/7 medical emergency assistance. According to the Trust Index, Medihelp has a trust rating of 4.2.
Medihelp MedVital Elect Plan Contributions 2024
| 💻 Main Member | 👤 +1 Adult Dependent | 👶 +1 Child Dependent |
| R1,776 | R1,290 | R696 |
Medihelp MedVital Elect Plan vs. Similar Plans from other Medical Schemes
| 1️⃣ Medihelp MedVital Elect | 2️⃣ KeyCare Start Regional | 3️⃣ Bankmed Basic | |
| Prescribed Minimum Benefits (PMB) | ✔️ | ✔️ | ✔️ |
| Screening and Prevention | ✔️ | ✔️ | ✔️ |
| Medical Savings Account | ❌ | ❌ | ❌ |
| Maternity Benefits | ✔️ | ✔️ | ✔️ |
| Pre- and Postnatal Care | ✔️ | ✔️ | ✔️ |
| Chronic Conditions | ✔️ | ✔️ | ✔️ |
| Home Care | ❌ | ✔️ | ✔️ |
| Oncology Cover (Maximum ZAR) | R242,000 | Up to 100% of the Discovery Health Rate (DHR) | Up to 100% of the cost at a DSP, 100% of the scheme rate at a non-DSP |
| Extended Cover for Oncology | ❌ | ❌ | ❌ |
| Hospital Cover | Unlimited | Network Hospital in the member’s region only – Unlimited | Unlimited |
| Optometry Benefit | ❌ | ✔️ | ✔️ |
| Dentistry Benefit | ❌ | ✔️ | ✔️ |
| Advanced Dentistry | ❌ | ❌ | ❌ |
| Internal Prosthesis | ❌ | ❌ | ❌ |
| External Prosthesis | ✔️ | ❌ | ✔️ |
| Mental Healthcare Program | ✔️ | ✔️ | ✔️ |
| Diabetes Care Program | ❌ | ✔️ | ✔️ |
| HIV Care Program | ❌ | ❌ | ✔️ |
| Cardio Care Program | ❌ | ❌ | ✔️ |
| Spinal and Neck program | ❌ | ✔️ | ✔️ |
| Disease Prevention Program | ❌ | ✔️ | ✔️ |
| Cover for Covid-19 and other diseases (WHO Outbreak Benefit) | ✔️ | ✔️ | ✔️ |
| Annual Limit | None | Unlimited Hospital Cover | Unlimited |
| Above Threshold Benefit (ATB) | ❌ | ❌ | ❌ |
| International Cover | Scheme Tariff | ❌ | Members pay costs and claim back |
| Main Member Contribution | R1,776 | R930 – R2,190 | R1,230 – R2,356 |
| Adult Dependent Contribution | R1,290 | R930 – R2,190 | R920 – R1,773 |
| Child Dependent Contribution | R696 | R560 – R670 | R309 – R593 |
| Gap Cover | ❌ | ✔️ | ❌ |
MedVital Elect Plan Benefits and Cover Comprehensive Breakdown
MedVital Elect Day-to-Day Benefits
➡️ Covered up to 100% of the Medihelp Tariff (MT).
➡️ There is a limit of R1,400 dedicated to day-to-day for the main member and R2,700 for the main member plus dependents.
Consultations
➡️ GP appointments and follow-up appointments
➡️ Specialists (35 percent co-payment if not referred by a network primary care physician or not pre-authorized)
➡️ Telemedicine, virtual consultations, and visits from nurses at network pharmacies.
➡️ Pharmacies providing primary care and emergency units, including primary care drug therapists, in terms of consultations and follow-ups.
➡️ Physiotherapy, including material and treatment.
Medication
➡️ The medication is obtained through the Medihelp Preferred Pharmacy Network and prescribed or given by a physician.
➡️ Acute and non-PMB chronic medication and self-medication, including emergency room drugs and immunizations.
➡️ Generic medicine – 100% of the MMAP Original medicine if no generic equivalent – 80% of the MT.
➡️ 70% of the MMAP comprises original medication taken willingly when a generic alternative is available.
➡️ Homeopathy, naturopathy, and osteopathy account for 25% of the possible daily benefit.
MedVital Elect Benefit Table
| Additional GP Consultation | A beneficiary’s Pap smear, mammography, prostate test, FOBT, or bone mineral density test activates a family consultation benefit. |
| R475 for Self-Medication | After a beneficiary claims the combo health screening (blood glucose, cholesterol, BMI, and blood pressure measurement) at a preferred pharmacy clinic, the family will receive R475 for non-prescribed medicine. |
| PMB Chronic Medicine | • Pre-approval and registration on Medihelp’s PMB drug management program is required. • Covered up to 100% of the MT. • Unlimited cover • Formulary and DSPs apply, or a 60% co-payment will apply. |
| Oxygen | • Covered out-of-hospital. • Subject to pre-approval and clinical protocols and must be prescribed by a medical doctor. • Covered up to 100% of the MT. • Unlimited cover. • 20% co-payment if this benefit is not pre-approved before treatment. |
| Dentistry under conscious sedation in the dentist’s rooms | • Impacted tooth extraction (3rd molars covered on the dentist’s account) • Covered up to 100% of the MT. • If not pre-approved, a 20% co-payment applies. |
| Dental procedures performed under general anesthesia in a MedVital Elect Network Day facility | • Impacted tooth extraction (3rd molars covered on the dentist’s account) • Covered up to 100% of the MT. • Member is responsible for the first R3,700 per admission. • If not pre-approved, a 20% co-payment applies. • There is a 35% co-payment if the procedure is not performed in the Medihelp day procedure network. |
| Services in and out of the hospital, including fitting, cost of repairs, maintenance, spares, accessories, and adjustments on the following: • Stoma Components • Incontinence Products/Supplies | • Unlimited Cover. • Covered up to 100% of the MT. |
MedVital Elect Emergency Benefits
👉 A medical emergency is a sudden and unexpected occurrence that necessitates quick medical or surgical treatment to safeguard a patient’s health.
👉 Failure to offer medical or surgical treatment would result in severe impairment of bodily functioning or severe dysfunction of a bodily organ or portion or jeopardize the individual’s life.
👉 Netcare 911 is the designated service provider for Medihelp’s emergency transport services, and you must contact them in an emergency. Phone 082 911.
👉 Furthermore, you may also seek assistance at the nearby hospital’s emergency room. However, the following conditions apply:
➡️ Emergency admissions must be reported to Medihelp on the following business day by calling 086 0200 678.
➡️ If you visit an emergency facility but are not hospitalized, the care you receive will be covered by your regular plans.
➡️ Facilities costs are not included.
| In the Beneficiary’s Country of Residence (RSA, Lesotho, Eswatini, Mozambique, Namibia, Zimbabwe, Botswana), including road and air transport. | • Unlimited Cover. • Covered up to 100% of the MT. • If not pre-approved, a 50% co-payment applies. |
| Outside the beneficiary’s Country of Residence | Road Transport • Covered up to 100% of the MT. • If not pre-approved, a 50% co-payment applies. • Limited to R2,320 per case. Air Transport • Covered up to 100% of the MT. • If not pre-approved, a 50% co-payment applies. • Limited to R15,400 per case. |
MedVital Elect Added Insured Benefits
➡️ With a strong emphasis on preventative care, early diagnosis of potential health problems, and maternity benefits and childcare, these benefits are offered annually in addition to your insured benefits unless otherwise specified.
➡️ Protocols and item codes may be applicable.
➡️ Members can look for network provider information on Medihelp’s website or app using the provider search option.
➡️ You can also sign up for HealthPrint, a free online health and fitness program offered by Medihelp, to activate the specified benefits.
| Benefit | Age, Gender, Frequency, and Additional Information | |
| Mammogram | • For women 40 – 75 years old. • Every two years. • A medical doctor must request it. | |
| Pap Smear | • For women 21 – 65 years old. • Every three years. • A medical doctor must request it. | |
| Flu Vaccines | • Once yearly. • It must be done at network pharmacy clinics. | |
| Contraceptives | Oral, injectable, or implantable contraceptives • Female beneficiaries up to 50 years. • Covered up to R150 per month and up to R1,950 per beneficiary. Intra-uterine devices for women up to 50 years • Every 60 months. • Covered up to R2,150 per beneficiary. | |
| Child Benefits | • Babies <2 years receive two additional visits to a general practitioner, pediatrician, or ear, nose, and throat specialist. However, a network Physician reference is not required to see these specialists. • In network pharmacy clinics, the full series of regular child immunizations are covered for up to seven years. • Vaccination of children against influenza at network pharmacy clinics. | |
| Routine Screening and Immunization | • A combo test, including blood glucose, cholesterol, BMI & blood pressure measurement. • Individual tests, including blood glucose or cholesterol. • HIV testing, counselling & support • A tetanus vaccine • A flu vaccination • Two HPV vaccinations for girls and boys between 10 – 14 years or three between 15 – 26 years | |
| Men’s Health | • A prostate test (PSA level) requested by a physician for men aged 40 to 75. • A flu vaccination administered at network pharmacies. | |
| Screening and Immunization for beneficiaries 45> | • An FOBT test for recipients 45-75 years • Women aged 65 and older can access one bone mineral density test every two years if requested by a physician. • A Pneumovax vaccine on a 5-year cycle for each 55-year-old with asthma or COPD who is registered. | |
| Wellness Support | • This benefit covers back therapy at a DBC facility as an alternative to surgery for eligible patients. Moreover, treatment is a precondition for spinal surgery. • One dietitian consultation each registered HealthPrint member whose BMI is greater than 30 and whose BMI was determined by a BMI test. • An oncology schedule is provided in conjunction with Independent Clinical Oncology Network oncologists (ICON) • HIV programme • Presented in partnership with LifeSense Disease Management | |
| Care Extender Benefit | Additional GP visit • Once your increased insured benefits pay for a Pap smear, mammography, prostate test, FOBT, or bone mineral density test, the family will receive a one-time GP visit benefit. • Test protocols will apply to this benefit. Self-Medication (R475) • Once your enhanced insured benefits pay for a combo health screening (blood glucose, cholesterol, BMI, and blood pressure), the family will receive a one-time R475 for self-medication. |
Medihelp MedVital Elect Plan Exclusions and Waiting Periods
Medihelp MedVital Elect Exclusions
👉 As medical research advances, new medical services are introduced each year. However, Medihelp covers life-saving medical treatment first.
👉 The Medical Schemes Act requires medical schemes to cover the diagnostic, treatment, and care costs of the mandated minimum benefits (PMB) without co-payments or limits.
👉 Furthermore, services must follow legislation’s PMB treatment algorithms and Medihelp’s managed healthcare guidelines, which may include pharmaceutical formularies.
👉 Medihelp will cover the cost of a substitute treatment if a protocol or formulary drug is ineffective or hazardous. However, the Medihelp MedVital Elect plan excludes several items, including but not limited to the following (the full list for MedVital Elect is available here)
➡️ Infertility treatment other than that specified in the Medical Schemes Act of 1998 Regulations.
➡️ Treatment of alcoholism and drug abuse, as well as services rendered by institutions registered per the Prevention and Treatment for Substance Abuse Act 70 of 2008 or other institutions whose services are similar, unless otherwise specified in the Regulations to the Medical Schemes Act of 1998.
➡️ Therapy for impotence
➡️ The artificial insemination of a human, as defined in section 61 of the National Health Act of 2003.
➡️ Immunizations (including immunization processes and materials) required by an employer, excluding flu vaccinations and routine childhood immunizations.
➡️ Workout, counseling, and rehabilitation regimens
➡️ Services provided by social workers and counselors who are not qualified clinical psychologists Expenses of home visits and home programs
➡️ When only housing and basic care services are provided.
➡️ All operations and services are excluded except for removing impacted teeth (3rd molars – dentist’s account solely for certain item codes).
➡️ Dentures made of plastic
➡️ Snoring aids
➡️ Mouthguards
➡️ Blood pressure apparatus
➡️ Commode
➡️ Raised toilet seat
➡️ Hospital beds for home usage
➡️ Vision-improving devices
➡️ Mattresses and cushions
➡️ Bras without external breast prosthesis
➡️ Where the reason for hospitalization is dental fear or anxiety; Where there are many hospitalizations; Where the sole reason for hospitalization is to acquire a sterile facility; The cost of dental materials for procedures conducted under general anaesthesia.
Medihelp MedVital Elect Waiting Periods
👉 During waiting periods, members are eligible for membership but not for benefits. For example, Medihelp could implement either a general or condition-specific waiting period as follows:
➡️ The general waiting period is up to three months from the date of membership. During this time, you will not be eligible for benefits other than the minimum prescribed benefits (PMB). During this waiting period, the Scheme will not pay any claims you file.
➡️ From the day you join, a condition-specific waiting period of up to 12 months applies. During this period, you will not be eligible for benefits related to a specific ailment for which you get medical advice, a diagnosis, care, or treatment (this excludes PMB).
Our Verdict on The MedVital Elect Plan
👉 The Medihelp MedVital Elect Plan is one of their medical plans that offers a comprehensive range of benefits at an affordable price.
👉 This plan includes in-hospital and out-of-hospital benefits such as general practitioner visits, specialist consultations, and chronic medication cover. In addition, the Medihelp MedVital Elect Plan also offers emergency medical services, basic dentistry, and maternity benefits.
👉 One of the main advantages of this plan is that it offers members access to a wide network of healthcare providers, including hospitals and doctors.
👉 However, one drawback is that certain benefits are subject to limits and co-payments, which can increase out-of-pocket expenses for members.
👉 Overall, the Medihelp MedVital Elect Plan is a solid medical plan option for individuals and families looking for comprehensive healthcare coverage at an affordable price.
👉 MediHelp has the following 11 plans to choose from
Frequently Asked Questions
What is Medihelp MedVital Elect Plan?
It is a medical plan offered by Medihelp, a South African medical scheme that provides comprehensive healthcare cover to its members.
What benefits are covered under the Medihelp MedVital Elect Plan?
The plan covers a range of in-hospital and out-of-hospital benefits, including general practitioner visits, specialist consultations, chronic medication cover, emergency medical services, basic dentistry, and maternity benefits.
Can I choose my own healthcare provider under this plan?
Yes, the Medihelp MedVital Elect Plan offers access to a wide network of healthcare providers, including hospitals and doctors. However, there are co-payments involved when you use non-DSP providers and facilities.
Is there a limit to the benefits covered under Medihelp MedVital Elect Plan
Yes, certain benefits are subject to limits and co-payments, which can increase out-of-pocket expenses for members.
Can I add dependents to my Medihelp MedVital Elect Plan?
Yes, the plan allows members to add dependents such as spouses, children, and other family members.
How do I make a claim under the Medihelp MedVital Elect Plan
Members can submit claims online or through the Medihelp mobile app. Alternatively, claims can be submitted through a paper-based form on the Medihelp website.
Does Medihelp MedVital Elect Plan cover pre-existing medical conditions?
Yes, pre-existing medical conditions are covered after a waiting period of up to 12 months, subject to certain conditions.
Is emergency medical transportation covered under Medihelp MedVital Elect Plan?
Yes, the Medihelp MedVital Elect Plan covers emergency medical transportation, such as ambulance services, in and outside South Africa. However, certain limits and co-payments apply.
Can I use the Medihelp MedVital Elect Plan for dental treatment?
Yes, dental treatment is covered, but it is limited to impacted tooth extractions.
Does the Medihelp MedVital Elect Plan cover alternative therapies?
Medihelp MedVital Elect covers limited alternative therapies.
Are prescription glasses covered under this plan?
No, prescription glasses and contact lenses are not covered under the Medihelp MedVital Elect Plan.
Can I change my Medihelp MedVital Elect Plan during the year?
Yes, members can change their plans during the annual open enrollment period. Furthermore, members can change during certain life events such as marriage or childbirth.
Does this plan cover medical treatment received outside of South Africa?
Yes, the Medihelp MedVital Elect Plan includes cover for emergency medical treatment received outside of South Africa, subject to certain conditions.
Is there a waiting period before I can use my Medihelp MedVital Elect?
Yes, a waiting period of up to three months applies to certain benefits such as hospitalization and major medical procedures.
