Medshield Offers a Winning Hospital Aid Plan

Medshield premium plus hospital plan is a trusted name in South Africa having provided medical aid services since 1968. The Premium Plus plan is one of the most sought after medical aid policies.

Listed below are the features and benefits of this winning plan.

Medshield premium plus hospital plan

Medshield premium plus hospital plan

The Premium Plus product offers unlimited hospitalisation with many In-Hospital procedures covered at 200% of the Medshield Private tariff.

Monthly contribution

The plan will cost R3 777 (including R888 savings) for the main member, R3 444 (Including R810 savings) for an additional adult and R690 per child (including R172 savings)

Major benefits: In-Hospital:

Overall annual limit (OAL): Unlimited.

Extended benefit cover: Up to 200% applicable to specified procedures/services performed In-Hospital

Hospitalisation: Unlimited. Pre-authorisation required and clinical protocols are in place

Surgical procedures: Unlimited, with extended benefit cover of up to 200%

Medication on clinic discharge: R750 per admission, must be on the day of discharge.

Hospitalisation alternatives

Subject to pre-authorisation and only immediately after an event. Clinical protocols will apply. R100 00 per year per family. Includes:

  • Nursing services
  • Physical Rehabilitation
  • Hospice
  • Sub-Acute facilities
  • General, surgical and medical appliances: Pre-authorisation required R5000/family
  • Glucometers, Blood Pressure Monitors, Peak Flow Meters and Nebulisers (require motivation) R750 per member

Medshield premium plus hospital plan continued

The following are all subject to an appliance limit and Clinical Protocols will apply

  • Stoma Products/Incontinence Sheets for Stoma Therapy
  • Hearing Aids (including repairs)
  • Wheelchairs (including repairs)
  • CPAP equipment for Sleep Apnoea
  • Oxygen therapy equipment: Unlimited. Subject to pre-authorisation
  • Home ventilators: Unlimited. Subject to pre-authorisation
  • Blood, blood equivalents: Unlimited. Subject to pre-authorisation
  • Consultations and visits: Unlimited
  • Extended Benefit Cover of up to 200%
  • Must form part of authorised In-Hospital procedure
  • Refractive surgery: R14 400 per family per year
  • Pre-authorisation required
  • Pathology: Unlimited, clinical protocols apply
  • Physiotherapy: Unlimited, clinical protocols apply

Maternity Benefits

  • 12 Ante-Natal consultations per pregnancy included
  • Ante-natal classes: R500 per family.
  • Pregnancy scans and tests: Limit per pregnancy, 2 x 2D scans
  • Amniocentesis
  • Confinement/Post-natal consults: Pre-authorisation required
  • Confinement in hospital: Unlimited

 

Oncology benefits:

  • Oncology limit: Unlimited
  • .Treatment Including, Incontinence Therapy, Brachytherapy and Stoma Therapy
  • ICON Enhanced Protocols apply and Subject to Oncology Limit
  • Oncology Medication: R318 000 per family per year
  • Oncology related Radiology and Pathology Subject to Oncology Limit.

Dentistry Benefits

  • In hospital: Unlimited. Subject to pre-authorisation
  • Out of hospital: Medshield Private Rates of up to 200%
  • As per Dental Managed Healthcare Programme. Dental Protocols apply.
  • Enhanced dentistry: R15 000 per family per year. Subject to pre-authorisation. Medshield Private Rates of up to 200%
  • Orthodontic treatments: R15 000 per family per year. Subject to pre-authorisation. Medshield Private Rates of up to 200%
  • Maxillo-facial or oral surgery: R15 900 per family per year, Subject to pre-authorisation

Day-to-day benefits

  • General practitioner consultations: Paid from Personal Savings Account
  • Specialists consultations: Paid from Personal Savings Account
  • Medication: Paid from Personal Savings Account
  • Pathology: Paid from Personal Savings Account
  • Chiropractic, Physiotherapy, Biokinetics: Paid from Personal Savings Account
  • Threshold and above threshold benefits apply to all above

Wellness Benefits

  • Flu Vaccination: 1 per member 18+. Max of R80
  • Pap Smear: 1 per female member
  • Bone Density: 1 per member 50+ every three years.
  • Health Risk Assessment (Pharmacy or GP): 1 per member/year 18+
  • TB Test: 1 test per member
  • National HIV Counselling Testing (HCT): 1 test per member
  • Mammogram (Breast Screening): 1 per female member 40+ every two years.
  • Pneumococcal Vaccination: 1 per year, high-risk individuals and  member 60+
  • Birth Control (Oral Contraceptive): 1 month’s supply, maximum 12/year
  • Adult Vaccinations: R1 200 per family per annum.
  • Child Immunisations: As per Department of Health Protocol according to age

Ambulance service

 Emergency medical services: Unlimited. Pre-authorisation by Netcare 911 required and clinical Protocols apply.