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Medihelp Unify 2017

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Type of Medical Aid Plan: 
New Generation
Medical Aid Year: 
2017
In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
100% of scheme rate
Hospitals: 

100% of the cost Unlimited

Upfront Payments to hospitals: 

Specific procedure co-payments apply of between R1 500 and R 9000.

Specialists: 
100% of scheme rate
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Savings account.
Radiology and pathology: 
100% of scheme rate
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
Covered at 100% of the scheme rate. Member pays the first R3 400 per admission
MRI and CT scans: 
100% of scheme rate pays the first R1 500 per examination.
ICU and High Care: 
100% of scheme rate
Dialysis: 
100% of scheme rate
Organ Transplants: 
Subject to pre-authorisation and clinical protocols, PMB only 100% of the cost.
Oncology / Cancer: 
100% of scheme rate DSP: ICON
Neck and Back Operations: 
100% of scheme rate subject to R9000 co-payment per admission
Joint Replacements: 
PMB's Only
Prosthesis: 

All hospital admissions and prostheses are subject to pre-authorisation, protocols and case management. See brochure for full details. Benefits not applicable to wear and tear. PMB's only.

Medical and Surgical Appliances: 
Savings account
Maternity Confinements: 
100% of scheme rate
In Hospital Dentistry: 
No Benefit
Take home Medicine: 
Savings account
Rehabilitation, Hospice and Step-down facilities: 
Subject to pre-authorisation and prescribed by a medical doctor unlimited 100% of scheme rate
Treatment for Mental Health: 
Subject to pre-autorisation prescribed by a medical doctor R21 000 per beneficiary per year. Maximum R28 750 per family per year
HIV / AIDS: 
100% of scheme rate
Ambulance Service: 
Netcare 911
International Travel Benefit: 
No benefit
Day-to-day benefits
GP consultations: 

Subject to savings

Specialist consultations: 

Subject to savings

Acute medicine: 

Subject to savings

Over-the-counter (OTC) Medicine: 

Subject to savings

Optometry benefits: 
Subject to savings
Basic dentistry: 
Subject to savings
Specialised Dentistry: 
Subject to savings
Orthodontics: 

Subject to savings

MRI and CT Scans (Out of Hospital): 
100% of scheme rate subject to R1500 co-payment
Radiology and Pathology: 
Subject to savings
Pregnancy benefits: 
Subject to savings
Physiotherapy and Occupational Therapy day to day: 
Subject to savings
Chronic Conditions
Provider: 
Any pharmacy
Chronic Conditions: 

26 Conditions on Chronic Disease List

Preventative Care Benefits
Preventative Benefits: 

One test per beneficiary per year. Blood glucose, cholesterol, HIV - voluntary counselling and testing. Clicks and Dis-Chem clinics only. Back treatment programme.

Total Contributions
Total Contribution Main Member: 
1944.00
Total Contribution Adult: 
1602.00
Total Contribution Child*: 
588.00
Unify
Annual Medical Savings Account
Annual Medical Savings Main Member: 
5832.00
Annual Medical Savings Adult: 
4824.00
Annual Medical Savings Child*: 
1800.00
Monthly Medical Savings
Savings Child*: 
150.00
Savings Adult: 
402.00
Savings Main Member: 
486.00
Risk Contributions
Risk Contribution Main Member: 
1944.00
Risk Contribution Adult: 
1602.00
Risk Contribution Child: 
588.00
Principal Member Risk: 
1458.00
Principal Member Savings: 
486.00
Principal Member Total: 
1944.00
Per Adult Dependent Risk: 
1200.00
Per Adult Dependent Savings: 
402.00
Per Adult Dependent Total: 
1602.00
Child dependant Risk: 
438.00
Child dependant Savings: 
150.00
Child dependant Total: 
588.00
Benefit: 
Subject to pre-authorisation and registration on the Medihelp Oncology Management Programme. Protocols and DSP (ICON) apply.
How many times per annum do you and your dependants visit a doctor?: 
15
How much do you spend on Acute medication per annum?: 
More than R 5000
How much do you spend on Chronic medication per annum?: 
More than R 5000
Will you or any of your dependants require specialised Dentistry: 
No