Benefits - Medimed

Benefits	ALPHA Payment Plan	MEDISAVE ESSENTIAL Managed Care Plan	MEDISAVE STANDARD Savings Plan	MEDISAVE MAX Savings Plan

Benefits	ALPHA Co-Payment Plan	MEDISAVE ESSENTIAL Managed Care Plan	MEDISAVE STANDARD Savings Plan	MEDISAVE MAX Savings Plan
Hospitalisation
Pre-authorised Admissions	Unlimited pre-authorised admissions paid at 100% of Medimed Scheme Tariff. Member levy (25–40%) applicable for specialists and GPs. No levy applicable for valid PMB admissions.	Unlimited pre-authorised admissions paid at 100% of Medimed Scheme Tariff at preferred providers. In-hospital service providers paid at 100% of Medimed Scheme Tariff.	Unlimited pre-authorised admissions paid at 100% of Medimed Scheme Tariff. In-hospital service providers paid at 100% of Medimed Scheme Tariff.	Unlimited pre-authorised admissions paid at 100% of Medimed Scheme Tariff. In-hospital service providers paid at 100% / 200% of Medimed Scheme Tariff.
Major Medical Expenses
Specialist Procedures & Treatments	Paid at 100% of Medimed Scheme Tariff, subject to pre-authorisation and benefit limits. Dialysis Oncology HIV & AIDS Organ Transplants	Paid at 100% of Medimed Scheme Tariff, subject to pre-authorisation and benefit limits. Dialysis Oncology HIV & AIDS Organ Transplants	Paid at 100% of Medimed Scheme Tariff, subject to pre-authorisation and benefit limits. Dialysis Oncology HIV & AIDS Organ Transplants	Paid at 100% of Medimed Scheme Tariff, subject to pre-authorisation and benefit limits. Dialysis Oncology HIV & AIDS Organ Transplants
Chronic Medication
Chronic Drug Amount (CDA)	Paid at 100% up to the momTYB CDA Extended chronic benefit paid at 75% of the momTYB CDA, subject to benefit limit Subject to pre-authorisation	Paid at 100% up to the momTYB CDA Extended chronic benefit paid at 100% of the momTYB CDA, subject to benefit limit Subject to pre-authorisation	Paid at 100% up to the momTYB CDA Extended chronic benefit paid at 100% of the momTYB CDA, subject to benefit limit Subject to pre-authorisation	Paid at 100% up to the momTYB CDA Extended chronic benefit paid at 100% of the momTYB CDA, subject to benefit limit Subject to pre-authorisation
Out-of-Hospital Expenses
Day-to-Day Cover	Member levy (25–40%) applicable for out-of-hospital expenses All benefit costs less than R1,000 to be paid by the member and claimed back from Medimed Benefit limits apply	Selected GP is the “manager” of all healthcare requirements — unlimited cover Referral required from selected GP for medication, pathology, radiology and specialists Casualty, out-of-town GP, OTC medication, auxiliary and appliances paid from Medical Savings Account at 100% of Medimed Scheme Tariff	Benefits paid at 100% of Medimed Scheme Tariff Paid first from the Medical Savings Account, thereafter from the Elective Benefit GP and specialist consultations & procedures Pathology and radiology Basic and advanced dentistry Appliances (in and out of hospital, incl. hearing aids & crutches) — R4,000 per beneficiary / R8,000 per family Acute medication Optometry — R4,000 per beneficiary / R8,000 per family every 2nd year OTC medication — R160 per script, max R1,600 per family Auxiliary (psychology, physiotherapy, chiropractor)	Benefits paid at 100% of Medimed Scheme Tariff Paid first from the Medical Savings Account, thereafter from the Elective Benefit GP and specialist consultations & procedures Pathology and radiology Basic and advanced dentistry Appliances (in and out of hospital, incl. hearing aids & crutches) — R4,000 per beneficiary / R8,000 per family Acute medication & child immunization Optometry — R4,000 per beneficiary / R8,000 per family every 2nd year OTC medication — R160 per script, max R1,600 per family Auxiliary (psychology, physiotherapy, chiropractor)
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