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 R500 000 per beneficiary up to a maximum of R1 000 000 for a family for non-PMB treatment with limits, at 100% of the Medshield Rate;
VERY BASIC OPTION

Provider

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

Chronic

26 PMB's at DSPs

Out of Hospital Benefits

Saving / Day to Day / OHEB

LIMIT OF R2 500 PER FAMILY:
Member: 8 visits
Member + 1: 9 visits
Member + 2: 11 visits
2 out of network visits per family thereafter a 40% co-payment will apply

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 post natal visits

Contributions

Contributions

Member: R1 332
Adult: R1 332
Per Child: R342

 

 

 

 

 

 

 

 


Finding it difficult to make sense of all this? Not to worry, you can:

Finding it difficult to make sense of all this? Not to worry, you can:

Get free quotes & medical aid advice