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MEDIHELP Necesse R11 001+ 2019

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Medical Aid Year: 
2019
In Hospital Benefits
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

Choose any hospital

Upfront Payments to hospitals: 

Back and neck fusion: R7,400 co-payment
In-hospital dentistry for children younger than 5yrs and removal of impacted teeth: R820 co-payment
Specialised radiology (MRIs and CT Scans): R1,100 co-payment
Gastroscopy and Colonoscopy:
in doctor's rooms: no co-payment
in day hospital: R2,000 co-payment
in-hospital: R3,050 co-payment
Co-payments paid by you or your gap cover

Casualty / Emergency Visits: 
From day-to-day benefits
Specialists: 
Up to 100% scheme rate You or gap cover pay the balance, if any
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Professional services for up to 30 days after discharge following hospital admission: speech therapy, occupational therapy and physiotherapy. R1,750 per person and R2,400 per family
Radiology and pathology: 
You or your gap pay R1,050 co-payment In and out of hospital
Dialysis: 
unlimited
Organ Transplants: 
unlimited
Oncology / Cancer: 
R300,000 per family per year for non-PMB cases PMBs covered in full
Prosthesis: 

Most non-PMB sublimits are increased by gap cover, if authorised by medical aid
EVARS prosthesis: R124,000
Vascular/cardiac prosthesis: R53,100
Health-essential functional prosthesis: R58,800. This includes non-PMB hip, knee and shoulder replacements
Wear and tear for hip and knee prosthesis: Subject to DSP if PMB, otherwise R18,600 for hospital and components
Intra-ocular lenses: R3,950 per lens, 2 lenses per beneficiary per year and subject to health-essential functional prosthesis benefit (above)
Prosthesis with reconstructive or restorative surgery, (in and out of hospital) or external breast prostheses, (in and out of hospital): R9,150 per family per year
Cochlear implants: R99,800 per person
Artificial eyes: R7,500 per person, every 3 years
Artificial limbs: R6,000 per person, every 3 years

Medical and Surgical Appliances: 
R6,000 per family every 3 years, paid by scheme
In Hospital Dentistry: 
Maxilo-facial surgery: 100% scheme rate
Take home Medicine: 
R350 per admission
Medical Aid Plan Name Term: 
Any