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MEDIMED ALPHA 2019

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Medical Aid Year: 
2019
In Hospital Benefits
Hospital Rate of Payment: 
Unlimited
Specialists: 
Unlimited Paid at 100% for PMB's Paid at 75% of the MEDIMED Scheme Tariff for non-PMB's
Other healthcare professionals eg. Physio, Occupational, Dietician: 
R4,500 per family 60% of MEDIMED Scheme Tariff In and out of hospital
Radiology and pathology: 
Unlimited Paid at 100% for PMB's Paid at 75% of the MEDIMED Scheme Tariff for non-PMB's
Dialysis: 
R100,000 per family
Organ Transplants: 
Combined limit with Dialysis
Oncology / Cancer: 
R200,000 per family Authorised through ICON
Neck and Back Operations: 
Spinal Fusion R23,000 per family
Prosthesis: 

INTERNAL PROSTHESIS
PRE-AUTHORISATION REQUIRED

R40,000 per family
Paid at 100% of the MEDIMED Scheme
Tariff
Sub-limits:
Ÿ Spinal Fusion R23,000 per family
Ÿ Intra-occular lenses R2,500 per lens
Ÿ Mesh R7,000 per family

 

EXTERNAL PROSTHESIS
PRE-AUTHORISATION REQUIRED

R6,500 per family
Paid at 100% of the MEDIMED Scheme
Tariff

Medical and Surgical Appliances: 
APPLIANCES PRE-AUTHORISATION REQUIRED R4,000 per family Nebulisers and glucometres limited to R500 per appliance Paid at 60% of the MEDIMED Scheme Tariff
In Hospital Dentistry: 
R12,000 per family Doctor and related costs paid at 75%/60% of the MEDIMED Scheme Tariff Limited to impacted wisdom teeth and children under 12 years
Rehabilitation, Hospice and Step-down facilities: 
R5,000 per family
Treatment for Mental Health: 
R6,500 per family paid at 100% Thereafter paid at 75% Overall maximum of R12,000 per family
HIV / AIDS: 
Unlimited Subject to managed care protocols
Day-to-day benefits
GP consultations: 

Unlimited
Paid at 100% for PMB's
Paid at 75% of the MEDIMED Scheme
Tariff for non-PMB's

Specialist consultations: 

Unlimited
Paid at 100% for PMB's
Paid at 75% of the MEDIMED Scheme
Tariff for non-PMB's

Acute medicine: 

R3,500 per beneficiary up to a
maximum of R8,000 per family
Paid at 60% of the MEDIMED Scheme
Tariff

Over-the-counter (OTC) Medicine: 

R120 per prescription up to a
maximum of R1200 per family. Subject
to the Acute Medication benefit limit.
Paid at 60% of the MEDIMED Scheme
Tariff

Optometry benefits: 
One optometric examination per beneficiary per year. Paid at 100% of the MEDIMED Scheme Tariff
Basic dentistry: 
Unlimited Paid at 60% of the MEDIMED Scheme Tariff
Specialised Dentistry: 
R5,000 per beneficiary up to a maximum of R10,000 per family Paid at 60% of the MEDIMED Scheme Tariff
Radiology and Pathology: 
Unlimited Paid at 75% of the 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 at 60%)
Chronic Conditions
Chronic Conditions: 

CONDITIONS

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

EXTENDED CHRONIC CONDITIONS 75% of the momTYB CDA (Chronic

Drug Amount)
R3,000 per beneficiary
Overall maximum of R6,000 per family

Preventative Care Benefits
Preventative Benefits: 

Cover for flu vaccinations, pap smear,
mammogram or breast scan, bone
density scan, prostate test, cholesterol,
one dental consult, test, blood sugar
test and HIV test
R1,400 per beneficiary
Up to a maximum of R2,800 per family
Paid at 100% of the MEDIMED Scheme
Tariff

Total Contributions
Total Contribution Main Member: 
1130.00
Total Contribution Adult: 
1130.00
Total Contribution Child*: 
450.00
Alpha
Monthly Medical Savings
Savings Child*: 
450.00
Savings Adult: 
1130.00
Savings Main Member: 
1130.00
Medical Aid Plan Name Term: 
Any