Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
100% of the Medical Tariff in any private hospital. Pre-authorisation and protocols apply.
Upfront Payments to hospitals:
PROCEDURE-SPECIFIC DEDUCTIBLES
Back and neck fusion – member pays the first R9 500 per admission.
Endoscopic procedures – Gastroscopy, colonoscopy, arthroscopy and sigmoidoscopy.
- In a day clinic – member pays the first R2 550.
- In hospital – member pays the first R3 550.
- Doctor’s rooms – 100% of the MT (gastroscopy or colonoscopy).
PRE-AUTHORISATION IS IMPORTANT
Always pre-authorise services such as hospitalisation, emergency transport and oxygen to prevent a deductible.
Casualty / Emergency Visits:
Unlimited cover for trauma that necessitates hospitalisation in the case of motor vehicle accidents, stab wounds and similar trauma.
Other healthcare professionals eg. Physio, Occupational, Dietician:
Up to 30 days after discharge for speech therapy, occupational therapy and physiotherapy. Member = R1 700 per year, Member+ = R2 300 per year.
Radiology and pathology:
100% of the MediHelp Tariff.
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
In hospital – member pays the first R3 550.
MRI and CT scans:
Subject to pre-authorisation. MRI and CT imaging 100% of the Medihelp tariff – Unlimited Member pays the first R1 550 per examination. Angiography – 100% of the Medihelp tariff.
Dialysis:
Renal dialysis, Pre-authorisation and protocols apply.
Organ Transplants:
Prescribed minimum benefits – 100% of the cost.
Oncology / Cancer:
Prescribed minimum benefits– 100% of the Medihelp tariff Non-Prescribed minimum benefits – R100 000 per family per year.
Neck and Back Operations:
Back and neck fusion – member pays the first R9 500 per admission.
Take home Medicine:
100% of the MediHelp Tariff. Savings account.
Rehabilitation, Hospice and Step-down facilities:
Hospice services and sub-acute care facilities as an alternative to hospitalisation. Pre-authorisation and protocols apply.
Treatment for Mental Health:
Subject to pre-authorisation, services rendered in an approved/ network hospital/facility and prescribed by a medical doctor. 100% of the MediHelp Tariff. R22 100 per beneficiary per year (maximum R30 300 per family per year.
HIV / AIDS:
HIV counselling and testing – Unlimited.
Ambulance Service:
Netcare 911. RSA, Lesotho, Swaziland, Mozambique, Namibia and Botswana Subject to pre-authorisation and protocols. Transport by road/air. 100% of the MediHelp Tariff. Unlimited.
International Travel Benefit:
EMERGENCY TRANSPORT SERVICES (Netcare 911). Outside beneficiary’s country of residence, Transport by road, 100% of the MT R1 900 per case, Transport by air, 100% of the MT R12 400 per case.
