Everything You Need to Know About Medshield Medical Aid
If you’ve been researching medical aid options in South Africa, chances are you’ve come across Medshield. As one of the largest open medical schemes in the country, Medshield provides coverage for hundreds of thousands of members. However, deciding whether Medshield is the right choice can be difficult without understanding what it offers. In this comprehensive guide, I’ll reveal all the important details about Medshield so you can make an informed decision.
What Plans Are Available?
Medshield offers a range of plan options to suit different needs and budgets. Their most popular plans fall under three categories:
- Core Series: Entry-level plans ideal for individuals on a budget. Offers basic coverage for day-to-day expenses.
- Delta Series: Mid-range plans that balance affordability with comprehensive benefits. Ideal for families.
- Comprehensive Series: High-end plans with generous coverage limits for specialized treatments. Suited for executives or those with complex medical needs.
Within each series, multiple plan options allow you to customize your benefits and premiums. All Medshield plans also offer cover for prescribed minimum benefits as required by law.
What Does Coverage Include?
Medshield plans provide coverage for a wide scope of medical expenses, including:
- Consultations with GPs and specialists
- Chronic medication for conditions like diabetes and hypertension
- X-rays, blood tests and other diagnostic tests
- Hospitalizations in private or public wards
- Surgeries performed in and out of hospital
- Emergency medical transport
- Dentistry including fillings, extractions and dental implants
- Optical care including lenses, frames and contact lenses
- Alternatives therapies like aroma and homeopathy
Certain health programs are also available for conditions like HIV/AIDS, maternity care and cancer treatment. Check plan details for covered benefits.
What Is the Medshield Network?
A key advantage of Medshield is access to their large provider network. Known as the Medshield Specialist Network, it comprises over 5000 GPās and specialists vetted for quality of care. Visits to network providers are covered in full, sparing you out-of-pocket costs.
The network offers national coverage with providers located countrywide. All major private hospitals also participate, giving members freedom to choose facilities near home or work. Using network providers guarantees speedy claims processing and approval too.
While some out-of-network use is allowed on higher plans, staying within the Medshield network is generally more cost-effective in the long run.
How Does Claims Processing Work?
Unlike some medical aids requiring upfront payments, Medshield has a direct payment system. This means the medical aid settles claims directly with providers instead of reimbursing members.
Swiping your membership card at the provider ensures all eligible costs are covered in line with your plan benefits. Minor co-payments may apply for some services but you avoid deposit payments used by other aids.
If claims are submitted correctly together with supporting documents, Medshield aims to process routine claims within a few days. More complex cases may take up to 30 days as required by law. You can track claims status online through your member profile.
Premiums – How Much Will It Cost?
Medshield premiums vary depending on your selected plan, the number of dependents covered, and annual medical inflation factors. However, here are a few examples of average 2023 monthly premiums:
- Individual on Core Saver Plus: R1980
- Family of 4 on Delta D: R6000
- Executive on MediValue Options: R8500
Remember these are only estimates – an authorized financial adviser can provide an accurate quote tailored to your needs. Generally, premiums increase yearly so budget for inflation-linked hikes too.
Additional Benefits and Extras
Aside from comprehensive healthcare coverage, Medshield offers value-added services at no extra cost:
- A user-friendly mobile app to find providers, view benefits and submit claims
- Access to Medshield’s 24/7 medical advice line for emergencies
- Chronic medicine deliveries with Medshield’s dispensing network pharmacies
- Wellness programs promoting prevention and healthy lifestyles
- Travel cover when outside South Africa
Finance options are also available to pay in monthly installments. You may qualify for rewards or benefits based on your medical scheme contributions history too.
An Option Worth Considering
In summary, Medshield is a solid choice and one of South Africa’s best known medical aid brands. Over the years I’ve been impressed by their high quality providers and administration. From personal experience, claims are handled smoothly and customer service is always attentive.
The wide range of plans and add-ons ensures Medshield can meet varying healthcare needs. Of course, no aid is perfect – some may find premiums pricey compared to budget options. But if you prioritize coverage over costs, Medshield is a very viable option in my opinion.
I hope this overview shed light on what Medshield offers. Their website also has useful tools to compare plans. Speak to an adviser for advice tailored specifically for you and your family’s medical scheme requirements.
Key Features of Medshield Medical Aid Plans
Plan | Maximum Medical Savings Accounts | Annual Threshold Level | Co-Payments |
---|---|---|---|
Core | R3 450 | R9 900 | 20% |
Core Saver | R6 000 | R13 700 | 30% |
Complete | R9 000 | R18 000 | 25% |
Comprehensive | R15 000 | No limit | 20% |
Priority | R20 000 | No limit | 15% |
FAQ
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What is Medshield?
Medshield is essentially a health insurance company that provides medical aid plans for individuals and families in South Africa. In basic terms, Medshield is there to help cover your medical costs if you end up needing healthcare.
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How does Medshield work?
Medshield operates pretty much like any other medical aid. You pay monthly premiums, and in return Medshield takes care of part or all of your medical bills if you have to see a doctor or require treatment. The plans have limits called “limits” on what procedures and services are covered.
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Who can join Medshield?
Anyone can apply to become a Medshield member. However, Medshield does have age limits – you usually need to be under 64 and must provide health info for themselves and any dependents to qualify. You should also be living and working in South Africa to enroll.
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What are the different Medshield plans?
Medshield offers a variety of medical aid options to choose between. The primary plans are Core, Comprehensive, and the newest is called the Core Saver Plan – which is allegedly kind of like a cheaper version of the Core plan. They vary based on things like monthly costs, what medications and procedures are included, and use of networks.
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How much does Medshield cost?
Monthly Medshield premium rates vary considerably based on the plan you pick and who you include on it – like yourself, spouse and/or kids. For a single adult, Core Saver begins at roughly R1,800, while more full-featured plans could be R2,500-R4,000. Rates also rise with age. So costs may seem slightly steep depending on your needs.
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Is Medshield worth it?
Most experts agree that having medical aid is a smart idea in South Africa to potentially save a ton of cash if major healthcare issues arise. Medshield specifically gets decent reviews regarding the quality of care provided by their networks. Some folks believe the premiums are reasonable compared to other medical aid societies too. But it’s tough to say if Medshield is absolutely “worth it” without looking closely at your specific needs and finances.