Medshield Medical Scheme 2017 Benefits and Contributions Adjustments
PremiumPlus OPTION Comprehensive cover Unlimited In-Hospital benefits Personal savings account
Premium Plus OPTION General, Medical and Appliances
The limit has been increased to R5 350 per family
Refractive Surgery
Limit increased to R 15 400 per family
Prosthesis and Devices Internal
Increased to R53 500 per family
Specialised Radiology (In and Out of Hospital)
Increased to R21 550 per family
Chronic Medicine Pharmacy Advised Therapy
Limit increased to R11 910 per beneficiary and R23 815 per family Limit increased to R185 per script
Optical Readers
Increased to R140 per beneficiary
Flu Vaccination
Increased to R 85 per beneficiary
Adult Vaccination
Increased to R1 280 per family
Human Papillomavirus (HPV)
1 per female beneficiary
Birth Control
Increased to R140 per female beneficiary
Premium Plus OPTION Dentistry benefits restructured as follows for simplicity: Basic Dentistry In-Hospital
Unlimited. Medshield Private Rates (up to 200%)
Basic Dentistry Out-of-Hospital
Subject to Personal Savings Account. Threshold and Above Threshold apply R15 000 per family per annum
Specialised Dentistry
Wisdom Teeth and Apicectomy
Dental Implants
Orthodontic Treatment
Subject to the Specialised Dentistry Limit. Medshield Private Rates (up to 200%) Subject to the Specialised Dentistry Limit. Medshield Private Rates (up to 200%) Subject to the Specialised Dentistry Limit.
Crowns, Bridges, Inlays, Mounted Study Models, Subject to Personal Savings Account. Partial Metal Base Dentures and Periodontics Threshold and Above Threshold apply Maxillo-Facial and Oral Surgery R15 900 per family per annum. Extended Benefit Cover (up to 200%)
Premium Plus OPTION Threshold Benefit – Out-ofHospital
Member R12 730 Adult Dependant R11770 Child Dependant R2 350 Member R4 280 Adult Dependant R3 210 Child Dependant R2 140
Above Threshold Benefit
PREMIUM PLUS Principal Member
R4 284
SAVINGS (INCLUDED IN PREMIUM) R1 071
Adult Dependant
R3 909
R978
R792
R198
Child
MONTHLY PREMIUM
MediBonus OPTION Cover at the Hospital of member’s choice Comprehensive cover Range of Out-Of Hospital benefits
MediBonus OPTION Non-PMB Internal Prosthesis and Internal Devices
Reduced co-payment to 20%
General, Medical and Appliances
The limit has been increased to R11 500 per family
Refractive Surgery
Limit increased to R 15 400 per family
Prosthesis and Devices Internal
Increased to R40 660 per family
Specialised Radiology (In and Out of Hospital)
Increased to R18 030 per family
Chronic Medicine
Limit increased to R11 910 per beneficiary and R23 815 per family M0 R9 300 M+1 R13 040 M+2 R14 460 M+3 R15 930 M+4 R17 240
Day-to-Day Limits
MediBonus OPTION Pharmacy Advised Therapy
Optical Limit
Single member limit R725 Family limit R1 245 Script limit increased to R 185 per script Increased to R2 675 per beneficiary
Optical Readers
Increased to R140 per beneficiary
Flu Vaccination
Increased to R85 per beneficiary
Birth Control
Increased to R140 per female beneficiary
Adult Vaccination
Increased to R1280 per family
Human Papillomavirus (HPV)
1 per female beneficiary
MediBonus OPTION Dentistry benefits restructured as follows for simplicity: Basic Dentistry In-Hospital
Unlimited
Basic Dentistry Out-of-Hospital
Unlimited
Specialised Dentistry
R15 000 per family per annum.
Wisdom Teeth and Apicectomy
Subject to the Specialised Dentistry Limit.
Dental Implants
Subject to the Specialised Dentistry Limit.
Orthodontic Treatment
Subject to the Specialised Dentistry Limit.
Crowns, Bridges, Inlays, Mounted Study Models, Subject to the Specialised Dentistry Limit. Partial Metal Base Dentures and Periodontics Maxillo-Facial and Oral Surgery R15 900 per family per annum. Extended Benefit Cover (up to 200%)
MediBonus OPTION MEDIBONUS
MONTHLY PREMIUM
Principal Member
R4 119
Adult Dependant
R2 829
Child
R819
MediSaver OPTION Unlimited In-Hospital cover through the Medshield Hospital Network Freedom to manage their own Personal Savings for Out-of-Hospital benefits
MediSaver OPTION General, Medical and Appliances
The limit has been increased to R8 025 per family
Refractive Surgery
Limit increased to R7 500 per family
Prosthesis and Devices Internal
Increased to R37 450 per family
Specialised Radiology (In and Out of Hospital)
Increased to R15 880 per family
Pharmacy Advised Therapy
Script limit increased to R185 per script
Optical Readers
Increased to R140 per beneficiary
Flu Vaccination
Increased to R85 per beneficiary
Birth Control
Increased to R140 per female beneficiary
Adult Vaccination
Increased to R320 per family
Human Papillomavirus (HPV)
1 per female beneficiary
MediSaver OPTION Dentistry benefits restructured as follows for simplicity: Basic Dentistry In-Hospital
Subject to the Specialised Dentistry Limit
Basic Dentistry Out-of-Hospital
Subject to Personal Savings Account
Specialised Dentistry
R10 000 per family per annum
Wisdom Teeth and Apicectomy
Subject to the Specialised Dentistry Limit
Dental Implants
Subject to the Specialised Dentistry Limit
Orthodontic Treatment
Subject to Personal Savings Account
Crowns, Bridges, Inlays, Mounted Study Models, Subject to Personal Savings Account Partial Metal Base Dentures and Periodontics
Maxillo-Facial and Oral Surgery
R15 900 per family per annum
MediSaver OPTION MEDISAVER Principal Member
R2 571
SAVINGS (INCLUDED IN PREMIUM) R516
Adult Dependant
R2 151
R432
R615
R123
Child
MONTHLY PREMIUM
MediPlus OPTION Middle to Upper income earners Unlimited In-Hospital cover through the Medshield Hospital Network Comprehensive Out-of-Hospital benefits
MediPlus OPTION Non-PMB Internal Prosthesis and Internal devices
Reduced co-payment to 20%
General, Medical and Appliances
The limit has been increased to R7 490 per family
Refractive Surgery
Limit increased to R7 500 per family
Prosthesis and Devices Internal
Increased to R31 000 per family and application
Specialised Radiology (In and Out of Hospital)
Increased to R10 200 per family
Chronic Medicine
Limit increased to R5 385per beneficiary and R10 775 per family M0 R6 750 M+1 R9 420 M+2 R10 600 M+3 R11 910 M+4 R13 050
Day-to-Day Limits
MediPlus OPTION Pharmacy Advised Therapy
Optical Limit
Single member limit R535 Family limit R985 Script limit increased to R185 per script Increased to R1 765 per beneficiary
Optical Readers
Increased to R140 per beneficiary
Flu Vaccination
Increased to R85 per beneficiary
Birth Control
Increased to R140 per female beneficiary
Adult Vaccination
Increased to R320 per family
Human Papillomavirus (HPV)
1 per female beneficiary
MediPlus OPTION Dentistry benefits restructured as follows for simplicity: Basic Dentistry In-Hospital
Unlimited
Basic Dentistry Out-of-Hospital
Unlimited
Specialised Dentistry
R10 000 per family per annum
Wisdom Teeth and Apicectomy
Subject to the Specialised Dentistry Limit
Dental Implants
Subject to the Specialised Dentistry Limit
Orthodontic Treatment
Subject to the Specialised Dentistry Limit
Crowns, Bridges, Inlays, Mounted Study Models, Subject to the Specialised Dentistry Limit. Partial Metal Base Dentures and Periodontics Maxillo-Facial and Oral Surgery R12 985 per family per annum.
MediPlus OPTION MEDIPLUS
MONTHLY PREMIUM
Principal Member
R2 544
Adult Dependant
R1 797
Child
R558
MediCore OPTION Unlimited In-Hospital cover though the Medshield Hospital Network No Day-to-Day Benefits
MediCore OPTION Prosthesis and Devices Internal
Increased to R28 890 per family
Diagnostic Laparoscopy
Co-payment reduced to R2 000
Flu Vaccination
Increased to R85 per beneficiary
Birth Control
Increased to R140 per female beneficiary
Adult Vaccination
Increased to R320 per family
Human Papillomavirus (HPV)
1 per female beneficiary
Basic Dentistry (In-Hospital)
Unlimited
Maxillo-Facial and Oral Surgery
R10 000 per family per annum. Extended Benefit Cover (up to 200%)
MediCore OPTION MEDICORE
MONTHLY PREMIUM
Principal Member
R1 926
Adult Dependant
R1 623
Child
R438
MediValue OPTION Unlimited In-Hospital cover through the Medshield Hospital Network Limited Day-to-Day cover
MediValue OPTION General, Medical and Appliances
The limit has been increased to R2 140 per family
Specialised Radiology non-PMB co-payment
Co-payment reduced to 8%
Specialised Radiology (In and Out of Hospital)
Increased to R5 560 per family
Day-to-Day Limits
M0 R4 815 M+1 R5 240 M+2 R5 900 M+3 R6 860 M+4 R7 600 Increased to 3 per family
Specialist Visits Pharmacy Advised Therapy
Single member limit R400 Family limit R600 Script limit increased to R185 per script
MediValue OPTION Optical Limit
Increased to R1 550 per beneficiary
Optical Readers
Increased to R140 per beneficiary
Flu Vaccination
Increased to R85 per beneficiary
Birth Control
Increased to R140 per female beneficiary
Adult Vaccination
Increased to R320 per family
Human Papillomavirus (HPV)
1 per female beneficiary
MediValue OPTION Dentistry benefits restructured as follows for simplicity: Basic Dentistry In-Hospital (only for beneficiaries under the age of 6 years old) Basic Dentistry Out-of-Hospital Specialised Dentistry
R1 360 per family per annum. Subject to the Basic Dentistry Limit. Thereafter subject to Day-to-Day Limit Subject to the Basic Dentistry Limit. Thereafter subject to Day-to-Day Limit R5 000 per family per annum
Wisdom Teeth and Apicectomy
Subject to the Specialised Dentistry Limit.
Dental Implants
Subject to the Specialised Dentistry Limit.
Orthodontic Treatment
Subject to the Specialised Dentistry Limit.
Crowns, Bridges, Inlays, Mounted Study Models, Subject to Day-to-Day Limit. Partial Metal Base Dentures and Periodontics Maxillo-Facial and Oral Surgery R6 095 per family per annum.
MediValue OPTION MEDIVALUE
MONTHLY PREMIUM
Principal Member
R1 521
Adult Dependant
R1 323
Child
R414
MediPhila Low cost Option Unlimited In-Hospital cover through the MediPhila Hospital Network Unlimited GP visits
MediPhila OPTION Hospitalisation (Non-PMB Limit) Basic Dentistry
The limit has been increased to R500 000 per beneficiary and R1 000 000 per family Limit increased to R1 135 per family
Day-to-Day Limit
Increased to R2 500
General Practitioner Visits
Unlimited subject to pre-authorisation
Acute Medicine
Limit increased to R1 135 per family
Pharmacy Advised Therapy
Optical Limit
Single member limit R285 Family limit R395 Script limit increased to R60 per script Increased to R640 per beneficiary
Optical Readers
Increased to R140 per beneficiary
MediPhila OPTION Flu Vaccination
Increased to R85 per beneficiary
Birth Control
Increased to R96 per female beneficiary
Human Papillomavirus (HPV)
1 per female beneficiary
Basic Dentistry Out-of-Hospital Specialised Dentistry
R1 135 per family per annum Subject to Basic Dentistry R5 000 per family per annum
Subject to Specialised Dentistry Limit
Wisdom Teeth and Apicectomy
Maxillo-Facial and Oral Surgery
Limited to PMB only
MediPhila OPTION MEDIPHILA
MONTHLY PREMIUM
Principal Member
R1 041
Adult Dependant
R1 041
Child
R261
HIV/AIDS Cover 1 September 2016 - new HIV/AIDS treatment guidelines adopted by government Medshield has decisively dealt with the accompanying uncertainty regarding ‘test and treat’ approach Medshield already funds ‘test and treat’ - been factored into our 2017 benefit design
Contributing positively to a healthy nation In line with our vision and the Sustainable Development Goals set by the United Nations
Gap Cover Partnering with all our brokers by promoting GAP Cover products Assist members in overcoming payment shortfalls The biggest challenge facing the industry since the 2010 Court Ruling which nullified the Reference Price List Working hard with you to ensure readiness in 2017
Average Contribution increases for 2017
Portion of High Reserves used to fund part of benefit enhancements
9,6% Weighted Average contribution increase for 2017
Medshield • Complies with all statutory requirements • 50% solvency rate • AA-Global Credit Rating for 10 consecutive years
Thank you