Medihelp MedElect: in-and-out of hospital benefits (2025) (2025)

January 9, 2025

What's on this page:

Terminology:

PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

Monthly Costs (2025)

Medihelp:MedElect (2025 prices)
	Main member:	Adult member:	Child member:
Total Cost pm:	R3,126	R2,448	R1,014 Pay for all children
Savings (per year):	No savings account option on this plan The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account	Main= R6,400 Main+1= R9,500 Main+2= R11,600 Main+3= R12,700 Main+4+= R7,750
Children Rates:	Up to age 26yrs Pay for all children

In-hospital Procedures (2025):

Medihelp: MedElect
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	100% scheme rate
Hospital Choice:	Network hospital Day procedure: Network Day hospital
Penalty for using other hospital:	non-network hospital : 35% penalty Use of non-Day hospital: 35% penalty
Co-payments:	Spinal Column surgery: R18,000 co-payment Endoscopic procedures, in day hospital (all scopes): R5,300 co-payment Dental procedures: R2,260 co-payment Specialized radiology: R1,300 - R1,900 co-payment Prostatectomy: R8,000 co-payment Hysterectomy and Endometrial Ablation: R8,000 co-payment Note: A co-payment is a fee your medical aid can insist you pay, regardless of how much the doctor/charges. It's not the same as an "excess" payment (which is when a doctor charges more than the medical aid rate). If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here There might be other co-payments if you don't use a DSP, especially if you are being treated for a PMB or when buying medicine.
Specialised Radiology:	MRI and CT scan: R22,000 per family with a R1,900 co-payment, in or out of hospital
Scopes:	Endoscopic Procedures: R5,000 copayment
Supplementary Services: (Physio, etc)	PMBs only Physio and OT: R2,200 per person and R3,450 per family, in and out of hospital
Transplants:	PMBs only Cornea implants: R35,900 per implant
Dialysis:	Scheme rate, in and out of hospital
Exclusions:	NB: See scheme's rules for all exclusions. All schemes have plenty!
Alternatives to hospitals:	Hospice as an alternative to hospitalisation: Covered Subacute care as an alternative to hospitalisation: Covered Private Nursing as an alternative to hospitalisation: Covered Palliative care: R21,700 per family
Casualty/ER:	From day to day benefit
Other:	Speech therapy, OT and physio, post hospital care: R2,300 per person and R3,000 per family Wound care: R4,285 per family
PMBs= Prescribed Minimum Benefits (more info) \| DSP= Designated Service Provider

Out-of-hospital Procedures (2025):

Medihelp: MedElect

Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated

	Main Member:	Adult:	Child:
Savings (per year):	No savings account option on this plan The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account	Main= R6,400 Main+1= R9,500 Main+2= R11,600 Main+3= R12,700 Main+4+= R7,750

PMBs out of hospital:

All schemes must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
This can include consults with specialists, blood or other tests, radiology and medicine
PMB benefits must never be paid from your savings account
Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
See our Guide to PMBs for more information.

GP consultations:

Network GPs:
- Main: R2,200
- Main + 1: R4,050
- Main +2+: R4,750
Above is shared with psychologist benefit
non-network GPs: R1,350 per person and R2,700 per family

Childcare:

Conservative dentistry, for under 18yrs
Paediatrician/GP/ENT: 2 consults, 0-2yrs
Immunisations: Covered, up to 7yrs
Flu shot: Covered

Specialists consultations:

R1,500 per family

From day to day benefit

Pathology:

R3,600 per family

From day to day benefit
Shared with standard radiology

General radiology:

R3,600 per family

From day to day benefit
Shared with pathology

Specialised radiology:

MRI and CT scan: R22,000 per family with a R1,300 co-payment, in or out of hospital

Scopes:

Endoscopic Procedures: R5,000 copayment

Supplementary Services: (Physio, etc)

Occupational and speech therapy: R2,500 per person and R3,900 per family
From day to day benefit

General Appliances:

Stoma components: Unlimited, paid by scheme
Otherwise, R1,150 per family, from day-to-day benefit

1.1. Hearing Aids:

From day-to-day benefit

1.2. Wheelchairs:

From day-to-day benefit

PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

Medication Benefit (2025):

Medihelp: MedElect

Assume scheme pays all these costs, unless otherwise stated

	Main Member:	Adult:	Child:
Savings (per year):	No savings account option on this plan The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account	Main= R6,400 Main+1= R9,500 Main+2= R11,600 Main+3= R12,700 Main+4+= R7,750

Chronic:

27 PMB conditions: Covered. You can see the full PMB list here.

Acute (prescribed) medication:

From day to day benefit

Main: R1,500
Main + 1: R2,500
Main +2+: R3,000

Over-the-counter:

Care extender benefit: R510 for over the counter meds once you complete a health screening
Otherwise: R500 per person and R2,000 per family
From day to day benefit

Birth Control:

Oral, injectable/implantable: R150 per month up to R2,100 per year
IUD: R2,400 every 5 years

On Discharge:

R420 per admission

Biological:

PMBs only

You can also:
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Find all other open medical aid plans here.

PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

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What does a “PMBs only” restriction mean?
In this case, the scheme will only pay for diagnosis, treatment and management of a claim for one of 270 pre-defined conditions (PMBs). Read more, and see full list of PMB conditions.

What does “From Risk” mean?
The scheme will pay for this claim from its own funds, not from your savings or other day-to-day benefits.

What is a DSP?
A Designated Service Provider. The scheme has a network of providers, and will often only pay claims in full if you use a DSP. If you choose another provider, you might have a co-payment, or even no cover.

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