Medshield - MediPhila
Medshield Mediphilia is designed for low-income earners and comprises in-hospital and day-to-day benefits covered at network providers only. The plan provides unlimited hospital cover for Prescribed Minimum Benefits (PMBs) and generous limits, per beneficiary, for non-PMB treatment in hospital. Day-to-day benefits are paid from the out of hospital limit. These cover GP and specialists visits, acute medicines, casualty and emergency services, basic dentistry, optometry, radiology and pathology, up to prescribed limits.
In Hospital Benefits
| Overall Annual Limit |
Unlimited PMB treatment subject to sub-limits of R1000 000 per family for non-PMB treatment with limits, at 100% of the: (Medshield's Rate), VERY BASIC OPTION |
|---|---|
| Provider |
Network of Mediphila hospitals |
| GP's & Specialists |
GP's & Specialists: Subject to OAL |
| Chronic |
26 PMB's at DSPs |
Out of Hospital Benefits
| Saving / Day to Day / OHEB |
LIMIT OF R3 800 PER FAMILY Unlimited GP visits if pre-authorised. If not pre - authorised, visits are limited to 9 visits per family per year. 2 Out-of-Network visits per family per year. Thereafter a 40% co-payment will apply. Private Nurse Practitioners - Unlimited, but subject to the use of the SmartCare Network; Specialist Visit: 1 Visits per family per year (must be referred by network GP), thereafter subject to Day-to-Day Limit. Prescibed Medication: R1 650 per family per year and subject to Day-to-Day Limit, MediPhila Pharmacy Network and Basic Acute Formulary.; Basic Dentistry R1 700 per family per year. Subject to the Specialised Dentistry Limit.; Specialised Dentistry: R6 900 per family per year for Wisdom Teeth & Apicectomy. Services must be obtained from the MediPhila Hospital Network |
|---|---|
| Pooled Day to Day Benefit |
Some benefits are additional: ask for detailed quotes. |
| Threshhold / Safety Net |
Not applicable |
| Self-Payment Gap Before Threshold |
Not applicable |
| Above Threshold Limits |
Not applicable |
| Maternity Care |
6 consultations, 2 x 2D scans, 4 visits for post natal visits & antenatal |
Contributions
| Contributions |
Member: R1 851 Adult: R1 851 Per Child: R477
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