Medshield - MediPhila Medical Aid Plan

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


Network of Mediphila hospitals

GP's & Specialists

GP's & Specialists: Subject to OAL
Radiology & Pathology: Subject to option rules
Oncology limit: PMB Treatment
Organ Transplants: PMB Treatment
Dialysis: PMB Treatment
Internal Prosthesis: PMB Treatment
Mental Health: PMB's


26 PMB's at DSPs

Out of Hospital Benefits

Saving / Day to Day / OHEB


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



Member: R1 851

Adult: R1 851

Per Child: R477









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