Medimed

Medimed Medical Scheme is based in the Eastern Cape and was conceptualized among many large employers who previously had to do their own health-risk management.

Medimed offers a range of healthcare benefits to its members, including comprehensive in-hospital cover, chronic medication management, and access to a network of healthcare providers.

The scheme also offers wellness programs and preventative care initiatives to help members maintain good health.

Administration and management of the scheme

The scheme follows a capitated management care model which means that it sources comprehensive medical aid cover from independent practice associations in its immediate area and operates on the concept of free choice.

Medimed offers its members a medical care model that comprises a variety of elements. The scheme’s employees are the primary beneficiaries of the plan. It also caters to retirees and their dependents.

Members regard the scheme as excellent value for money, as it offers a number of options that each has unique characteristics that set it apart from one another.

Leveraging technology for a streamlined claims process

Medimed uses technology and innovation to enhance its members' healthcare experience.

This includes an online member portal that allows members to manage their healthcare benefits and claims online. The scheme also uses electronic claims processing to streamline the claims process and reduce administrative costs

Why MediMed

• The scheme offers excellent value for money
• Plans have saving account options that enable you to manage your day-to-day healthcare optimally.
• Members are refunded weekly for up-front expenses, enabling them to keep control of their cash flow.

CSI initiatives focused on healthcare

Medimed is committed to supporting the communities it serves through various CSI initiatives.

This includes partnering with community organizations to provide healthcare services to vulnerable groups, supporting health research and development, and investing in healthcare infrastructure in underserved areas.

Medimed offers you a choice of four comprehensive medical plans tailored to your unique requirements.

Medisave Max

This plan offers complete cover at the set Medimed tariff structure.

• This plan covers all hospital admissions at any private hospital or medical center according to specified clinical guidelines and protocols.
• Cover is unlimited although generous limits apply to a number of specified benefits.
• This plan has a chronic medication benefit that includes prescribed minimum benefits as well as an additional R3 500 per beneficiary and R7 000 per family for chronic conditions.
• Medisave Max also includes a savings account (comprising a quarter of your monthly contribution) that covers day-to-day benefits. Thereafter, the Elective benefit (comprising R7 000 per beneficiary and R14  000 per family will kick in.

Medisave Standard

• This plan offers comprehensive hospitalization cover but benefit limits are slightly less on certain services than with the Max option.
• You get unlimited private hospital admissions in line with relevant clinical protocols.
• All your chronic medications are covered and an additional R 2 000 per beneficiary or      R 4 000 per family apply.
• Your day-to-day benefits are funded from the savings account (to the value of a quarter of your monthly contributions).
• Thereafter, your elective benefit of R 5 500 per beneficiary and R 11 000 per family will apply. This enables you to control your own out-of-hospital expenses.

The Medisave Essential Option

You get extensive hospitalisation cover through Merchantile Hospital and Cuyler Clinic, as well as access to a wide network of doctors. Although this network primarily functions in the Nelson Mandela metropole, you can apply to have it extended beyond these borders.

Chronic medication is fully covered according to a medication formula and includes 26 minimum benefit conditions. By managing your health care, the doctor networks ensure that your benefits last for the full year.

The Alpha Option

This option is in the form of a co-payment plan that offers full hospital cover, as well as 100% cover for in-hospital doctor services in accordance with prescribed minimum benefit (PMB) admissions.

• Other admissions and out-of-hospital are funded at 75% of the scheme tariff.
• You get a 60% benefit on chronic medication, dentistry services, and other secondary costs. Members have to pay for their hospital costs and then claim these expenses from the scheme.
• This option is the most cost-effective due to its low premiums.