Add to compare Type of Medical Aid Plan:
Day to day Benefits:
GP SERVICES WITHIN THE NECESSE NETWORK
In Hospital Benefits Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Only in a network hospital 100% of the MediHelp Tariff – Unlimited (Subject to pre-authorisation, case management and protocols).
Hospitals:
Only in a network hospital
Upfront Payments to hospitals:
To avoid deductibles visit the Necesse network service providers, follow the correct pre-authorisation process and use the Necesse formularies.
Casualty / Emergency Visits:
Unlimited cover for trauma that necessitates hospitalisation in the case of motor vehicle accidents, stab wounds and similar trauma.
Specialists:
Includes all specialist services (consultations, radiology, pathology at Lancet/PathCare, surgical and nonsurgical procedures). Member = R2 950 per year. Member+ = R4 100 per year.
Other healthcare professionals eg. Physio, Occupational, Dietician:
R8 950 per family per year. Must be referred by the attending medical doctor.
Radiology and pathology:
(Lancet/PathCare Only). R27 700 per family per year.
MRI and CT scans:
Services requested by a specialist on referral by a network GP. MRI and CT imaging (subject to pre-authorisation) and angiography 100% of the Medihelp Tariff. R15 000 per family per year.
HIV / AIDS:
One test per beneficiary per year requested by a Necesse network GP. Post-exposure prophylaxis in the event of sexual assault or accidental exposure to HIV.
Ambulance Service:
Netcare 911. Transport by road or air within the borders of South Africa 100% of the Medihelp Tariff – Unlimited (Pre-authorisation and protocols apply).
Day-to-day benefits GP consultations:
GP SERVICES WITHIN THE NECESSE NETWORK
Specialist consultations:
Includes all specialist services (consultations, radiology, pathology at Lancet/PathCare, surgical and nonsurgical procedures).
Acute medicine:
Acute medicine obtained from a dispensing Necesse network GP (formulary applies).
Over-the-counter (OTC) Medicine:
Self-medication obtained from a network pharmacy.
Optometry benefits:
BASIC OPTOMETRY. Preferred Provider Negotiators network applies. Benefits per 24-month cycle: 1 composite examination. Spectacles: R200 for a frame, 1 pair of standard clear Aquity lenses, Contact lenses – R450.
Basic dentistry:
Conservative dental services. Subject to the managed care protocols of the Designated service provider and services rendered by a Designated service provider network dentist.
Specialised Dentistry:
This option does not cover these benefits.
Orthodontics:
This option does not cover these benefits.
MRI and CT Scans (Out of Hospital):
Services requested by a specialist on referral by a network GP. MRI and CT imaging (subject to pre-authorisation) and angiography 100% of the Medihelp Tariff. R15 000 per family per year.
Radiology and Pathology:
100% of the Medihelp Tariff (subject to a list of codes, referal by a Necesse network GP and protocols apply).
Pregnancy benefits:
2 per beneficiary per year: Gynaecologist consultations (subject to referral by a Necesse network GP and pre-authorisation) & 2D-sonars.
Physiotherapy and Occupational Therapy day to day:
Member = R1 900 per year. Member+ = R2 950 per year.
Chronic Conditions Provider:
Designated service providers & specialist network apply.
Chronic Conditions:
100% of the cost for 270 – Prescribed minimum benefits and 26 chronic conditions.
26 chronic conditions on the Chronic Diseases List.
1. Addison’s disease
2. Asthma
3. Bipolar mood disorder
4. Bronchiectasis
5. Cardiac failure
6. Cardiomyopathy
7. Chronic obstructive pulmonary disease (COPD)
8. Chronic renal disease
9. Coronary artery disease
10. Crohn’s disease
11. Diabetes insipidus
12. Diabetes mellitus type 1
13. Diabetes mellitus type 2
14. Dysrhythmia
15. Epilepsy
16. Glaucoma
17. Haemophilia A and B
18. Hyperlipidaemia
19. Hypertension
20. Hypothyroidism
21. Multiple sclerosis
22. Parkinson’s disease
23. Rheumatoid arthritis
24. Schizophrenia
25. Systemic lupus erythematosus (SLE)
26. Ulcerative colitis
Preventative Care Benefits Preventative Benefits:
HEALTH TESTS
IMMUNISATION
These benefits are not available if you have been registered for a chronic/PMB condition as it is no longer considered as preventive care and may be linked to a specific age/gender/item code.
Total Contributions Total Contribution Main Member:
Total Contribution Adult:
Total Contribution Child*:
MediHelp Necesse R5 001 – R7 000
Risk Contributions Risk Contribution Main Member:
How many times per annum do you and your dependants visit a doctor?:
How much do you spend on Acute medication per annum?:
How much do you spend on Chronic medication per annum?:
Will you or any of your dependants require specialised Dentistry:
