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Medimed is based in the Eastern Cape and has its origins in large employers who previously ran their own risk pools.
Its delivery arrangements include a capitated managed care model where comprehensive cover is purchased from the local IPA's (Independent Practice Associations) and free choice.
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Medisave Max
- General Overview
The Medisave Max option provides comprehensive healthcare cover at the Medimed Scheme tariff. This option offers unlimited cover for hospital admissions at any private hospital in terms of specific clinical guidelines and protocols with generous limits for certain benefits . The Chronic Medication Benefit provides cover for all PMB’s (Prescribed Minimum Benefits) plus an extra R3, 000 per beneficiary and R6, 000 per family for additional chronic conditions. Day-to-Day Benefits are covered from the Savings Account (25% of your monthly contribution) and thereafter automatically from the Elective Benefit (R4, 000 per beneficiary and R8, 000 per family), offering you the flexibility of managing your own out of hospital costs.
Detailed benefit guides as well as the
Scheme rules are available on the web site. Should you use a broker they can also assist in the explaining of the way the options work and how these options compare to other schemes.
- Benefits and Rates (pdf)
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| Medisave Standard
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Managed Care
- General Overview
The Managed Care Option provides extensive cover for hospitalisation through the preferred providers: Mercantile Hospital and Cuyler Clinic. In addition unlimited cover for primary healthcare is provided through a committed network of General Practitioners (GP’s). These networks were initially structured around the Nelson Mandela Metropole (Port Elizabeth, Uitenhage and Despatch), but can also be extended to other areas upon application. Medication is covered in full in accordance with a medication formulary, for both acute and chronic conditions. The Chronic Medication Benefit is authorised for the 26 Prescribed Minimum Benefit Conditions (PMB’s). The GP doctor networks manage your heallthcare to ensure that you have benefits for the full year.
Detailed benefit guides as well as the
Scheme rules are available on the web site. Should you use a broker they can also assist in the explaining of the way the options work and how these options compare to other schemes.
- Doctor Network
- Benefits and Rates (pdf)
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Alpha
- General Overview
The Alpha Option is the co-payment option offered by Medimed, providing full cover for hospital costs and 100% cover at the Medimed Scheme tariff for doctor costs in-hospital related to PMB (Prescribed Minimum Benefit) admissions. Doctor costs for non-PMB admissions and out of hospital are covered at 75% of the Medimed Scheme tariff. Acute medication, dentistry and auxiliary costs are paid at 60% of the Medimed Scheme tariff. There are limits on certain benefits and members are required to pay out of hospital costs up-front and claim a refund from the Scheme.
Detailed benefit guides as well as the
Scheme rules are available on the web site. Should you use a broker they can also assist in the explaining of the way the options work and how these options compare to other schemes.
- Benefits and Rates (pdf)
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| What is high blood pressure? |
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| Your blood pressure is the force exerted by your heart, against the resistance created by the arteries, to keep blood flowing throughout the body. Your blood pressure is high (hypertension) when the force is excessive. |
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| What are PMB’s? |
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| PMB’s are a set of defined benefits in the Medical Schemes Act (The Act) aimed at ensuring that all medical scheme members have access to certain minimum health services. They ensure cover for costs related to the diagnosis, treatment and care of : Any medical condition which meets The Act’s definition of an emergency, a limited set of 270 medical conditions and 25 chronic conditions defined in the Chronic Disease Listing (CDL). |
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