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%

     

    Medshield Medicore Benefits and Rules

    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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