Medshield Medicore Benefits and Rules

Medshield Medical Aid is well established leading provider of medical aid services in South Africa. And Medshield Medicore is one of their flagship products.

The Medshield Medicore product provides unlimited hospitalisation with some In-Hospital procedures covered at 200% of the Medshield Private Tariff.

The plan does not include a saving account, making it more affordable and suitable for younger members.

Monthly contribution

The plan will cost R 1767 for the primary member, R 1488 for an additional adult and R 402 per child.

Major medical benefits In-Hospital

Overall annual limit                                         Unlimited

Extended benefit cover                                    Up to 200%, in-hospital, specific procedures/events only

Hospitalisation                                                  Unlimited. Use of Medshield Hospital Network. Clinical Protocols will apply. Pre-authorisation required.

Surgical procedures                                         Unlimited. Extended Benefit Cover of up to 200%

 

Medication on hospital discharge                  Max R300/admission. To be done on the day of discharge.

Hospital alternatives:                                       R30 000 per family per annum

Pre-authorisation required, only paid if immediately after an event. Clinical Protocols apply

 

 

More Medshield Medicore Benefits

Includes:

Home nursing

Physical Rehabilitation

Sub-Acute/step down facilities

Hospice

General surgical and medical appliances:       Unlimited, Pre-authorisation required. Clinical Protocols apply. PMBs only

Stoma Products/Incontinence Sheets for Stoma Therapy

CPAP equipment for Sleep Apnoea

Oxygen therapy equipment:                       Unlimited, Pre-authorisation required. Clinical Protocols apply. PMBs only.

Home ventilators:                                           Unlimited, Pre-authorisation required. Clinical Protocols

Blood, blood products or equivalents:  Unlimited, Pre-authorisation required. Clinical Protocols

Medical practitioner consultations:      Unlimited only when included in hospital event

Medical technology and pathology:       Unlimited only when included in hospital event

Physiotherapy:                                                 Unlimited only when included in hospital event

General radiology:                                          Unlimited, Pre-authorisation required. Clinical Protocols. 1 Bone Densitometry scan per member per year

Specialised radiology:                                   1 scan per family per year. Clinical Protocols apply. No co-payment applies for CT Colonography. Non-PMB 10% advance co-payment. Subject to Specialised Radiology Limit. Pre-authorisation required

 

And Yet More Medshield Medicore Benefits

Includes:

CT, MRI and MUGA scans as well as Radio isotope studies

Interventional Radiology used to replace surgery

HIV & AIDS                                                  According to Managed Healthcare Protocols. Pre-authorisation required

Includes:

HIV Counselling and Testing (HCT)

Anti-retroviral and related medicines

HIV/AIDS-related Pathology and Consultations

 

Mental Health:                                               R 30 000 per family per year

Pre-authorisation required

Medshield Hospital Network

Max 3 days if admission by GP

 

Maternity Benefits

Ante-natal consultations                                    6 Ante-Natal consultations per pregnancy.

Pregnancy-related scans and tests                   Two 2D Scans per pregnancy.

Confinement and post-natal consultations

Confinement in hospital                                                                            Unlimited

Delivery by a General Practitioner or Medical Specialist                    Unlimited

Confinement in a registered birthing unit or out of hospital              Unlimited

4 Post-Natal consultations per pregnancy

 

Oncology Benefits

 

Oncology limit                                                                                              PMBs Unlimited

 

Active Treatment: Brachytherapy, Stoma Therapy and Incontinence Therapy

Subject to ICON Standard Protocols and Oncology Limit

 

Oncology Medicine:

Subject to ICON Standard Protocols and Oncology Limit

 

Pathology and Radiology:                              Only oncology-related and part of the authorised event.

Subject to Oncology Limit.

 

PET and PET-CT:                                               Limited to 1 Scan per family per year.

Subject to Oncology Limit.

 

Dentistry benefits

Basic dentistry

In hospital                                                            Unlimited, Pre-authorisation required

Medshield Hospital Network.

Dental Protocols apply

Maxillo-facial and Oral surgery                       R10 000 per family per year

Dental Protocols apply

Only non-elective surgery                                Pre-authorisation required

Ambulance Services                                      Unlimited.

Clinical Protocols apply

Pre-authorisation required

 

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All info was correct at time of publishing