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MEDIMED MEDISAVE MAX R10,001 to R18,000 2019

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Medical Aid Year: 
2019
In Hospital Benefits
Hospital Rate of Payment: 
Unlimited
Specialists: 
Unlimited Paid at 200% of the MEDIMED Scheme Tariff
Other healthcare professionals eg. Physio, Occupational, Dietician: 
R4,000 per family
Radiology and pathology: 
Unlimited
MRI and CT scans: 
Unlimited
Dialysis: 
R200,000 per family
Organ Transplants: 
Combined limit with Dialysis
Oncology / Cancer: 
R400,000 per family Authorised through ICON
Neck and Back Operations: 
Spinal Fusion R25,000 per family
Prosthesis: 

INTERNAL PROSTHESIS
PRE-AUTHORISATION REQUIRED

R40,000 per family
Sub-limits:
Ÿ Spinal Fusion R25,000 per family
Ÿ Intra-occular lenses R2,500 per
lens
Ÿ Mesh R7,000 per family

EXTERNAL PROSTHESIS
PRE-AUTHORISATION REQUIRED

R6,000 per family

Medical and Surgical Appliances: 
R6,000 per family
In Hospital Dentistry: 
R12,000 per beneficiary Limited to impacted wisdom teeth and children under 12 years
Rehabilitation, Hospice and Step-down facilities: 
R15,000 per beneficiary
Treatment for Mental Health: 
R6,000 per beneficiary paid at 100% Thereafter paid at 70% Overall maximum of R12,000 per family
HIV / AIDS: 
Unlimited Subject to managed care protocols
Ambulance Service: 
Unlimited Preferred provider ER24 24 hour contact number 084 124
Day-to-day benefits
GP consultations: 

Certain authorised procedures done in the provider's rooms will be paid
from the in-hospital benefit. Please contact the customer care team to
establish whether a planned procedure qualifies to be paid from this
benefit

Specialist consultations: 

Certain authorised procedures done in the provider's rooms will be paid
from the in-hospital benefit. Please contact the customer care team to
establish whether a planned procedure qualifies to be paid from this
benefit

Acute medicine: 

100% of MEDIMED Scheme Tariff

Over-the-counter (OTC) Medicine: 

Limited to R160 per prescription up to a maximum of R1,600 per family.

Optometry benefits: 
R3,500 per beneficiary to a max of R7,000 per family. Benefits every 2nd year.
Basic dentistry: 
100% of MEDIMED Scheme Tariff
Specialised Dentistry: 
100% of MEDIMED Scheme Tariff
MRI and CT Scans (Out of Hospital): 
100% of MEDIMED Scheme Tariff
Radiology and Pathology: 
100% of MEDIMED Scheme Tariff
Pregnancy benefits: 
2 Pre-natal visits · 2 2D scans · 1 Paediatrician visit · 1 maternity bag per pregnancy · Antenatal vitamins (R60 per month for 9 months payable from Acute Benefit)
Physiotherapy and Occupational Therapy day to day: 
100% of MEDIMED Scheme Tariff
Chronic Conditions
Chronic Conditions: 

SUBJECT TO PRE-AUTHORISATION

EXTERNAL PROSTHESIS
PRE-AUTHORISATION REQUIRED
PRESCRIBED MINIMUM BENEFITS
PSYCHIATRIC HOSPITALISATION
PRE-AUTHORISATION REQUIRED
Includes hospitalisation and doctor's
costs
BASIC RADIOLOGY
SPECIALISED RADIOLOGY
PRE-AUTHORISATION REQUIRED
In and out of hospital
DELIVERY
(In and out of hospital)

R6,000 per family
Unlimited at DSP
R6,000 per beneficiary paid at 100%
Thereafter paid at 70%
Overall maximum of R12,000 per
family
Unlimited
Overall maximum of R20,000 per
family
In Hospital
Obstetrician/Gynaecologist funded at
200% of Medimed Scheme Tariff.
Home Delivery
Registered Midwife funded at 100% of
Medimed Scheme Tariff.
Limited to R3 000 per pregnancy.
(If not hospitalised)

HIV and AIDS
OXYGEN

Unlimited
Subject to managed care protocols
R6,000 per family
Paid at 100% of the MEDIMED
Scheme Tariff
The Medisave Max option has no overall annual limit. All benets are paid up to the MEDIMED Scheme Tariff.

IN-HOSPITAL BENEFITS AND MAJOR MEDICAL EXPENSES
Medisave Max

CHRONIC DISEASE LIST
CONDITIONS

100% up to the momTYB Chronic
Drug Amount (CDA)

EXTENDED CHRONIC
CONDITIONS

100% of the momTYB Chronic Drug
Amount (CDA)
R3,500 per beneficiary
Overall maximum of R7,000 per family

Preventative Care Benefits
Preventative Benefits: 

Cover for flu vaccinations, pap smear,
mammogram or breast scan, bone density
scan, prostate test, cholesterol test, blood
sugar test, dental consultation and HIV
test
R1,500 per beneficiary
Up to a maximum of R3,000 per family

Total Contributions
Total Contribution Main Member: 
3350.00
Total Contribution Adult: 
3350.00
Total Contribution Child*: 
590.00
Medisave Max R10,001 to R18,000
Risk Contributions
Risk Contribution Main Member: 
3350.00
Risk Contribution Adult: 
3350.00
Risk Contribution Child: 
590.00
Medical Aid Plan Name Term: 
Any