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Medihelp Necesse R11000 and over 2017

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Type of Medical Aid Plan: 
Capitation
Medical Aid Year: 
2017
Income Level: 
11 001 and more
In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
Hospital Rate of Payment: 
100% of scheme rate
Hospitals: 

Network hospitals

Upfront Payments to hospitals: 

None

Casualty / Emergency Visits: 
No Benefit
Specialists: 
100% of scheme rate
Other healthcare professionals eg. Physio, Occupational, Dietician: 
100% of scheme rate R8 500 per family per year
Radiology and pathology: 
100% of scheme rate R23 300 per family per year
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
No Benefit
MRI and CT scans: 
100% of scheme rate R14 200 per family per year
ICU and High Care: 
100% of scheme rate
Dialysis: 
100% of scheme rate PMB only
Organ Transplants: 
100% of scheme rate
Oncology / Cancer: 
100% of scheme rate DSP ICON
Neck and Back Operations: 
No Benefit
Joint Replacements: 
No Benefit
Prosthesis: 

PMB ONLY

Medical and Surgical Appliances: 
Sub-limits apply subject to scheme protocols
Maternity Confinements: 
100% of scheme rate R22 700 for elective caesarean section
In Hospital Dentistry: 
PMB only
Take home Medicine: 
100% of scheme rate R320 per admission
Rehabilitation, Hospice and Step-down facilities: 
Subject to pre-authorisation and prescribed by a medical doctor
Treatment for Mental Health: 
Subject to pre-authorisation and prescribed by a medical doctor
HIV / AIDS: 
Antiretroviral therapy and treatment by DSP (Disc-Chem Direct)
Ambulance Service: 
Netcare 911
International Travel Benefit: 
No Benefit
Day-to-day benefits
GP consultations: 

100% of scheme rate 9 consultations per beneficiary per year

Specialist consultations: 

100% of scheme rate if referred by your network doctor M = R2 800 per year M+ = R3 900 per year

Acute medicine: 

Dispensed by a dispensing Necesse network GP (included in the consultation fee) - 100% of scheme rate

Over-the-counter (OTC) Medicine: 

Self-medication obtained from a network pharmacy - 100% scheme rate R100 per event R260 per beneficiary per year

Optometry benefits: 
100% of scheme rate per beneficiary per 24 month cycle
Basic dentistry: 
100% Denis rate 1 routine check-up, fillings, extractions, scale and polish, 2 root canals, Plastic dentures
Specialised Dentistry: 
No Benefit
Orthodontics: 

No Benefit

MRI and CT Scans (Out of Hospital): 
100% of scheme rate R14 200 per family per year
Radiology and Pathology: 
100% of scheme rate
Pregnancy benefits: 
Subject to GP consultation limit, 2 Gynaecologist consultations, two 2D scans
Physiotherapy and Occupational Therapy day to day: 
M = R1800 M+ = R2800 per year, must be requested by a network doctor
Chronic Conditions
Provider: 
MobileMeds
Chronic Conditions: 

26 Conditions on Chronic Disease List. PMB only

Additional Chronic Conditions: 
No Benefit
Preventative Care Benefits
Preventative Benefits: 

Health tests: Blood glucose, Cholesterol, HIV, Pap smear, Mammogram, Prostate test, Bone density test - One per beneficiary per year. Immunisation: Flu vaccine, Tetanus vaccine - One per beneficiary per year. Back treatment programme. HealthPrint wellness programme.

Total Contributions
Total Contribution Main Member: 
1932.00
Total Contribution Adult: 
1506.00
Total Contribution Child*: 
834.00
Necesse 11 001 and more
Risk Contributions
Risk Contribution Main Member: 
1932.00
Risk Contribution Adult: 
1506.00
Risk Contribution Child: 
834.00
Benefit: 
Subject to pre-authorisation, DSP (ICON), protocols and registration on the Medihelp Oncology Management Programme - 100% of the cost.
How many times per annum do you and your dependants visit a doctor?: 
9
How much do you spend on Acute medication per annum?: 
Less than R 1000
How much do you spend on Chronic medication per annum?: 
R1000 - R4999
Will you or any of your dependants require specialised Dentistry: 
No