MediCurve

2023 Benefit Guide

2023 Benefit Guide

Contents

4 About MediCurve
5 Information members should take note of
5 Online Services
6 Claims and Co-payments
7 Hospital-at-Home
8 In-Hospital Benefits
10 Dentistry Benefits
11 Oncology Benefits
12 Chronic Medicine Benefits
13 Applying for Chronic Medicine Benefits
14 Maternity Benefits
15 Medshield Mom
16 Out-of-Hospital Benefits
17 Family Practitioner Virtual Consultations
19 SmartCare
19 SmartCare Benefits
20 Wellness Benefits
21 Ambulance Services
21 Monthly Contributions
22 Prescribed Minimum Benefits (PMB)
25 COVID-19
27 Addendums
28 Exclusions
33 Contact details
33 Banking Details
33 Fraud

2
 MediCurve

Support. Care. Connection. Reliance. Trust. Happiness.

These are desired qualities in a partner for life. Qualities that define relationships forged between Medshield
and our members. A sense of comfort and knowing that your healthcare needs are covered.

Medshield stands at your side to help keep you healthy, offering support and assistance throughout every step
and stage of your life journey.

Live Assured knowing you are covered by Medshield - your trusted Partner for Life.

3
2023 Benefit Guide

MediCurve Benefit Option

You never know when you may require medical care or treatment and, most importantly, whether you will have funds
readily available to cover the costs. MediCurve provides the young and healthy with first time medical cover that fits
perfectly into their lifestyle.

This is an overview of the benefits

offered on the MediCurve option:

• A digital plan for the young,

carefree, healthy individual
• Easy online application process
• Submit your claims and manage your
health online via any mobile device
Ambulance Major Major
Medical
Medical Oncology • Unlimited Family Practitioner
Ambulance Oncology
Services Benefits
Benefits Benefits consultations including virtual,
(In-Hospital) Services Benefits
in-person, and Videomed and
(In-Hospital)
nurse-led SmartCare consultations.

This is an overview
of the benefits
offered
Family on the Chronic Maternity
Chronic Medicine MaternityWellness Dental
Wellness
Practitioner Medicine Benefits Benefits Benefits
MediPlus
Benefits option: Benefits Benefits Benefits Benefits

4
 MediCurve

IMPORTANT MEMBER INFORMATION

Information members should take note of:
Carefully read through this Guide and use it as a reference for more information on what is covered on the MediCurve option,
the benefit limits, and the rate at which the services will be covered:

1 2
Familiarise yourself with the
benefits offered on MediCurve, and nominate your Pre-authorise all hospital
Family Practitioner from the MediCurve Family admissions 72 hours
Practitioner Network.

3 4
If you do not obtain a pre-
Use the Medshield App authorisation or retrospective
to locate a MediCurve Hospital authorisation in case of an
Network for easy access emergency, you will incur a
percentage penalty

5 6
Pre-authorisation is not a guarantee The use of
of payment and Scheme Rules/ the Medshield
Protocols will be applied where Specialist Network
applicable may apply

Your cover for hospitalisation

7 8
Specialist services from treating/
includes accommodation,
attending Specialists are subject
theatre costs, hospital equipment,
to pre-authorisation referral from a
theatre and/or ward drugs,
nominated MediCurve Family
pharmaceuticals and/or
Practitioner (FP)
surgical items

Gap Cover
Gap Cover assists in paying for certain shortfalls not covered by the Scheme based on the Scheme Rules.
Assistance is dependent on the type of Gap Cover chosen. Medshield members can access Gap Cover through their Brokers.

Online Services Use these convenient channels to:

It has now become even easier to manage your healthcare! Access • View your membership card digitally
to real-time, online applications allow members to access their • View your monthly statements
medical aid information anywhere and at any time. • View your current claims
• Submit a new claim
1. The Medshield Login Zone on www.medshield.co.za • Submit a query
2. The Medshield Member App: Medshield’s Apple IOS app • Update your contact details
and Android app are available for download from the relevant • Access the document library
app store • View your authorisations
• Request a dental or hospital authorisation
3. The Medshield Short Code SMS check: SMS the word • Access your tax certificate and member certificate
BENEFIT to 43131 • Access the Provider Locator to search for healthcare
professionals or establishments
• View the Scheme Rules; and
• Access the Virtual GP Consultation platform

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2023 Benefit Guide

CLAIMS AND CO–PAYMENTS

Your claims will be covered as follows:

Medicines paid at 100% of the lower of the cost of the SEP of a Treatment and consultations will be paid at 100% of the negotiated
product plus a negotiated dispensing fee, subject to the use of the fee, or in the absence of such fee, 100% of the lower of the cost or
Medshield Pharmacy Network, relevant Chonic Medicine Networks and Scheme Tariff.
Managed Healthcare protocols.

The application of co–payments

The following services will attract upfront co-payments:

Voluntary use of a non-MediCurve Network Hospital 25% upfront co-payment

Voluntary use of a non-MediCurve Network Hospital - Organ, Tissue 25% upfront co-payment
and Haemopoietic stem cell (Bone marrow) transplant
Voluntary use of a non-MediCurve Network Hospital - Mental Health 25% upfront co-payment
Voluntary obtained out of formulary medication 35% upfront co-payment
Voluntary use of a non-DSP or non-MediCurve Network Pharmacy 35% upfront co-payment
Voluntary use of a non-DSP for chronic medication 35% upfront co-payment
Voluntary use of a non-DSP for HIV & AIDS related medication 35% upfront co-payment
Voluntary use of a non-DSP provider - Chronic Renal Dialysis 35% upfront co-payment
Voluntary use of a non-ICON provider - Oncology 40% upfront co-payment
Voluntary use of a non-MediCurve Family Practitioner 40% upfront co-payment
Dental Consultations R150 upfront co-payment
Optical Test R100 upfront co-payment
Optical Spectacles R100 upfront co-payment
Family Practitioner Consultations and Visits R100 upfront co-payment
Acute medicine per line item R10 upfront co-payment

In-Hospital and Day Clinic Procedural upfront co-payments for non-PMB

Endoscopic Procedures (Refer to Addendum B*) R2 000 upfront co-payment

Oral Surgery R4 000 upfront co-payment
Maxillo-facial Surgery R4 000 upfront co-payment
Impacted Teeth, Wisdom Teeth and Apicectomy R4 000 upfront co-payment
Wisdom Teeth extraction in a Day Clinic R1 800 upfront co-payment
Hysterectomy R5 000 upfront co-payment

Please note: Failure to obtain an authorisation prior to hospital admission or surgery and/or treatment (except for an emergency), will attract a 20% penalty,
in addition to the above co-payments.
*No In-Hospital Endoscopic procedural co-payment applicable for children 8 years and younger.

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 MediCurve

MEDSHIELD HOSPITAL-AT-HOME BENEFIT

All Medshield members are entitled to cover for Prescribed Minimum • Intravenous therapy
Benefits (PMBs), irrespective of your chosen benefit option. • In-person and virtual visits
Medshield’s Hospital-at-Home service, delivered by Quro Medical, • Skilled nursing
offers safe alternatives to hospitals as the centres of patient care and • Access to laboratory services, allied healthcare services
management. The Hospital-at-Home service gives members the option e.g. physiotherapy, and short-term oxygen
to receive active treatment for a specified period at home instead of a • Rapid response protocols – if a patient’s condition should
general hospital ward, without compromising on the quality of care. worsen during treatment, the clinical team from Quro
Medical will identify such changes and make the necessary
Hospital-at-Home will not replace the quality care that only a hospital arrangements, which may include an increase in visits, early
can provide, but should be seen as a complementary service in review by the treating doctor and, rarely, transfer to hospital.
specific instances. In fact, research shows that patients recover
better and faster in their own homes – resulting in improved health Benefits of Hospital-at-Home
outcomes and a more positive experience. Some patients are more • Faster recovery and a better healthcare experience
vulnerable to hospital-acquired infections and developing new health • Care tailored towards the member’s individual needs
complications. Therefore, they may benefit from receiving care at their • Recovery in a comfortable and familiar environment
home. Patients eligible for Hospital-at-Home are those who would • Fewer health complications and re-admission
usually need admission in a hospital general ward.
This service will be funded from members’ Alternatives to Hospital
Quro Medical works closely with each patient and his or her treating benefit in line with hospital benefit management protocols. At home
doctor to develop a personalised treatment plan that can be delivered treatment and monitoring is an alternative to a hospital admission
at home. During treatment, a patient’s medical needs may change and requires the consent of the patient. Members can either be
and, if necessary, treatment plans would be amended accordingly. referred to Quro Medical by their treating doctor, or they can request
The Quro Medical clinical team schedules regular home visits, daily this service from their doctor when general ward admission is
or more frequently, depending on individual need, to deliver the considered, or when they wish to be relocated to the home earlier
treatment and care required. Other channels are also available that during a hospital admission. Please note that this service needs
give patients access to advice and support outside of home visits. to be pre-authorised and approved through the hospital pre-
authorisation process by emailing preauth@medshield.co.za.
Elements of care provided through the
Hospital-at-Home service: This is just the latest innovation that the Scheme has added to
ensure our members always have access to safe, convenient and
• Your doctor can monitor your condition day and night using
quality care when they need it most.
digital technology. Additionally the service provides real-time
hospital-grade monitoring at home by continuously collecting
For more information, please call Hospital Benefit Management
vital sign data (usually monitored in the hospital) wirelessly and
on 086 000 2121 and follow the prompts.
automatically, and this data is closely monitored by a team of
healthcare professionals in a 24-hour medical command centre

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2023 Benefit Guide

MAJOR MEDICAL BENEFITS – IN-HOSPITAL

BENEFIT CATEGORY BENEFIT LIMIT AND COMMENTS

OVERALL ANNUAL LIMIT Unlimited.

HOSPITALISATION
Subject to pre-authorisation by the relevant Managed Healthcare Programme on Specialist services from treating/attending
086 000 2121 (+27 11 671 2011) and services must be obtained from the MediCurve Specialists are subject to pre-authorisation.
Hospital Network.
• Prescribed Minimum Benefits (PMB) Unlimited.
• Non-PMB 25% co-payment will apply for the use of a
non-MediCurve Network Hospital.
Clinical Protocols apply.

MEDICINE ON DISCHARGE FROM HOSPITAL Limited to R455 per admission.

Included in the Hospital benefit if on the hospital account or if obtained from a pharmacy on According to the Maximum Generic Pricing
the day of discharge. or Medicine Price List and Formularies.

ALTERNATIVES TO HOSPITALISATION R30 600 per family, subject to PMB and PMB level of care.
Treatment only available immediately following an event. Subject to pre-authorisation by the 25% co-payment will apply for the use of a
relevant Managed Healthcare Programme on 086 000 2121 (+27 11 671 2011). non-MediCurve Network Hospital.

Includes the following:

• Physical Rehabilitation
• Sub-Acute Facilities
• Nursing Services
• Hospice
• Terminal Care R12 660 per family per annum, subject to the Alternatives to
Clinical Protocols apply. Hospitalisation Limit.

BLOOD, BLOOD EQUIVALENTS AND BLOOD PRODUCTS Unlimited.

(Including emergency transportation of blood)
Subject to pre-authorisation by the relevant Managed Healthcare Programme on
086 000 2121 (+27 11 671 2011) and services must be obtained from the DSP or Network
Provider.
Clinical Protocols apply.

MEDICAL PRACTITIONER CONSULTATIONS AND VISITS Unlimited.

As part of an authorised event during hospital admission, including Medical and Dental Subject to pathology formulary list.
Specialists or Family Practitioners.

ORGAN, TISSUE AND HAEMOPOIETIC STEM CELL (BONE MARROW) Unlimited subject to PMB and PMB level of care.
TRANSPLANTATION 25% upfront co-payment for the use of a
Subject to pre-authorisation by the relevant Managed Healthcare Programme on non-MediCurve Network Hospital.
086 000 2121 (+27 11 671 2011) and services must be obtained from the MediCurve Organ harvesting is limited to the Republic of South Africa
Hospital Network. Work-up costs for donor in Solid Organ Transplants included.
No benefits for international donor search costs. Haemopoietic
Includes the following:
stem cell (bone marrow) transplantation is limited to allogenic
• Immuno-Suppressive Medication grafts and autologous grafts derived from the South African
• Post Transplantation Biopsies and Scans Bone Marrow Registry.

• Related Radiology and Pathology

Clinical Protocols apply.

PATHOLOGY AND MEDICAL TECHNOLOGY Unlimited.

As part of an authorised event, and excludes allergy and vitamin D testing.
Pathology Formulary applies.
Clinical Protocols apply.

PHYSIOTHERAPY R2 955 per beneficiary per annum, thereafter no benefit unless

As part of an authorised event. Subject to pre-authorisation by the relevant Managed specifically pre-authorised.
Healthcare Programme on 086 000 2121 (+27 11 671 2011).

PROSTHESIS AND DEVICES INTERNAL Unlimited subject to PMB and PMB level of care.
Subject to pre-authorisation by the relevant Managed Healthcare Programme on Use of a DSP applicable from Rand one. Sub-limit for
086 000 2121 (+27 11 671 2011) and services must be obtained from MediCurve Hospital hips and knees: R35 510 per beneficiary - subject to PMB and
Network. Preferred Provider Network will apply. PMB level of care.
25% co-payment for the use of a
non-MediCurve Network Hospital.

PROSTHESIS EXTERNAL Unlimited subject to PMB and PMB level of care.

Services must be pre-approved or pre-authorised by the Scheme on
086 000 2121 (+27 11 671 2011) and must be obtained from the DSP.
Network Provider or Preferred Provider.
Clinical Protocols apply.

8
 MediCurve

BENEFIT CATEGORY BENEFIT LIMIT AND COMMENTS

GENERAL RADIOLOGY Unlimited.

As part of an authorised event.
Clinical Protocols apply.

SPECIALISED RADIOLOGY R5 500 per family per annum In- and Out-of-Hospital.
Subject to pre-authorisation by the relevant Managed Healthcare Programme on
086 000 2121 (+27 11 671 2011) and services must be obtained from the DSP or Network
Provider.
Includes the following:
• CT scans, MUGA scans, MRI scans, Radio Isotope studies Subject to Specialised Radiology Limit.
• CT Colonography (Virtual colonoscopy) No co-payment applies to CT Colonography.
• Interventional Radiology replacing Surgical Procedures Unlimited.
Clinical Protocols apply.

CHRONIC RENAL DIALYSIS Unlimited subject to PMB and PMB level of care.
Subject to pre-authorisation by the relevant Managed Healthcare Programme on 35% upfront co-payment for the use of a non-DSP.
086 000 2121 (+27 11 671 2011) and services must be obtained from the DSP or Network Use of a DSP applicable from Rand one for PMB admission.
Provider.

Haemodialysis and Peritoneal Dialysis includes the following:

Material, Medication, related Radiology and Pathology.
Clinical Protocols apply.

NON-SURGICAL PROCEDURES AND TESTS Unlimited.

As part of an authorised event. The use of the Medshield Specialist Network may apply.

MENTAL HEALTH Unlimited subject to PMB and PMB level of care.

Subject to pre-authorisation by the relevant Managed Healthcare Programme on 25% upfront co-payment for the use of a
086 000 2121 (+27 11 671 2011). The use of the Medshield Specialist Network may apply. Up non-MediCurve Network Hospital.
to a maximum of 3 days if patient is admitted by a Family Practitioner. Use of a DSP applicable from Rand one for PMB admission.

• Rehabilitation for Substance Abuse Subject to PMB and PMB level of care.
1 rehabilitation programme per beneficiary per annum
• Consultations and Visits, Procedures, Assessments, Therapy, Treatment and/or Subject to PMB and PMB level of care.
Counselling

HIV & AIDS As per Managed Healthcare Protocols.

Subject to pre-authorisation and registration with the relevant Managed Healthcare Programme
on 086 014 3258 and must be obtained from the DSP.

Includes the following:

• Anti-retroviral and related medicines Out of formulary medication voluntarily obtained or PMB
• HIV/AIDS related Pathology and Consultations medication voluntarily obtained from a provider other than the
• National HIV Counselling and Testing (HCT) DSP will have a 35% upfront co-payment.
Courier DSP applies from Rand one.

INFERTILITY INTERVENTIONS AND INVESTIGATIONS Limited to interventions and investigations only.

Subject to pre-authorisation by the relevant Managed Healthcare Programme on Refer to Addendum A for a list of procedures and blood tests.
086 000 2121 (+27 11 671 2011) and services must be obtained from the DSP.
The use of Medshield Specialist Network may apply.
Clinical Protocols apply.

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2023 Benefit Guide

Dentistry Benefits
Provides cover for Dental Services according to the Dental Managed Healthcare Programme and Protocols.

BENEFIT CATEGORY BENEFIT LIMIT AND COMMENTS

BASIC DENTISTRY
According to the Dental Managed Healthcare Programme, Protocols and the Medshield Dental 1 Dental examination every 6 months with R150 upfront
Network. co-payment per beneficiary.

• Impacted Teeth, Wisdom Teeth and Apicectomy Subject to Overall Annual Limit.
Hospitalisation, general anaesthetics or conscious analgo sedation only for R1 800 upfront co-payment applies for wisdom teeth
bony impactions. Out-of-Hospital apicectomy of any permanent teeth only extraction performed in a Day Clinic.
covered in Practitioners’ Rooms. Subject to the Hospital Managed Healthcare R4 000 upfront co-payment applies if procedure is
Programme and pre-authorisation. Subject to the Dental Managed pre-authorised and done In-Hospital. No co-payment applies
Healthcare Programme, Protocols and the Medshield Dental Network. if procedure is done under conscious sedation in Practitioners’
Subject to pre-authorisation of general anaesthetic and conscious analgo rooms.
sedation, In- and Out-of-Hospital. No authorisation required for apicectomy,
removal of impacted teeth or wisdom teeth if done under local anaesthetic.

MAXILLO-FACIAL SURGERY R5 500 per family per annum,

AII services are subject to pre-authorisation by the relevant Managed Healthcare Programme subject to the Hospitalisation Limit.
on 086 000 2121 (+27 11 671 2011). R4 000 upfront co-payment applies if procedure is
Non-elective surgery only. pre-authorised and done In-Hospital.
According to the Dental Managed Healthcare Programme and Protocols.
Services must be obtained from the MediCurve Hospital Network. The use of the Medshield
Specialist Network may apply.

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 MediCurve

ONCOLOGY BENEFITS
For easy access to your Oncology benefits:

STEP STEP STEP

1 2 3

When diagnosed: Treatment Plan Authorisation:

Contact Medshield’s Your Oncologist will Once approved Medshield
Oncology Disease discuss your treatment will send authorisation to
Management team on plan and send to Medshield your ICON Oncologist and
086 000 2121 and you will for authorisation. you will receive a letter with
be provided with a list of the authorised treatment,
the ICON Oncology Group approved quantities and
practices in your area. Ask duration of the authorisation.
you doctor to refer you to
one of these Oncologists.

This benefit is subject to the submission of a treatment plan and registration on the Oncology Management Programme (ICON). You
will have access to post active treatment for 36 months.

BENEFIT CATEGORY BENEFIT LIMIT AND COMMENTS

ONCOLOGY LIMIT (40% upfront co-payment for the use of a non-DSP) Unlimited subject to PMB and PMB level of care.

• Active Treatment Subject to the Oncology Limit.

Including Stoma Therapy, Incontinence Therapy and Brachytherapy. ICON Standard Protocols apply.

• Oncology Medicine Subject to the Oncology Limit.

ICON Standard Protocols apply.

• Radiology and Pathology Subject to the Oncology Limit.

Only Oncology related Radiology and Pathology as part of an authorised event.

• PET and PET-CT Limited to 1 Scan per family per annum.

Subject to the Oncology Limit.

INTEGRATED CONTINUOUS CANCER CARE 6 visits per family per annum.

Social worker psychological support during cancer care treatment. Subject to the Oncology Limit.

SPECIALISED DRUGS FOR ONCOLOGY, NON-ONCOLOGY AND BIOLOGICAL DRUGS Subject to the Oncology Limit.
Subject to pre-authorisation on 086 000 2121 or (+27 11 671 2011).

• Vitreoretinal Benefit Subject to PMB and PMB level of care.

Vitreous and Retinal disorder. Subject to pre-authorisation.
Clinical Protocols apply.

BREAST RECONSTRUCTION (following an Oncology event) R94 105 per family per annum.
Subject to pre-authorisation by the relevant Managed Healthcare Programme on Co-payments and prosthesis limit as stated under Prosthesis is
086 000 2121 (+27 11 671 2011) and services must be obtained from the DSP or Network not applicable to Breast Reconstruction.
Provider. The use of the Medshield Specialist Network may apply.
Post Mastectomy (including all stages)
Clinical Protocols apply.

11
2023 Benefit Guide

CHRONIC MEDICINE BENEFITS

REGISTER EVALUATION

1 2
Your Doctor or Pharmacist Your medicine will be evaluated
should call Chronic Medicine in line with the Scheme Rules,
Management on 086 000 2120 Formularies and protocols. This option
(Choose relevant option) or email: covers medicine for all
medshieldauths@mediscor.co.za 26 PMB CDL’s.

NOTIFICATION

3
Your will receive notification once
registered. If more information is
required please ensure your Doctor
provides the required clinical
information.

5 4
DSP PHARMACY
Collect your medicine from a MediCurve SCRIPT
Chronic Network Pharmacy. The list is You will need a script from your Doctor
available via the App or the website. for the approved medicine.
online tools.

DO DON’T
Contact the Managed 35% Upfront co-payment
Healthcare Provider on will apply in the
086 000 2120 following instances:
(+27 10 597 4701). • Out-of-formulary
Always remember that medication voluntarily
Medication needs to obtained.
be obtained from a • Medication voluntarily
MediCurve Chronic obtained from a
Network Pharmacy. non-MediCurve Chronic
Network Pharmacy.

BENEFIT CATEGORY BENEFIT LIMIT AND COMMENTS

• The use of a MediCurve Chronic Network Pharmacy Limited to PMB only.

is applicable from Rand one. Medicine will be approved in line with the Medshield
• Supply of medication is limited to one month in advance. Formulary and is applicable from Rand one.
35% upfront co-payment for voluntary use of a
non-MediCurve Chronic Network Pharmacy.

12
 MediCurve

How to apply for your Chronic Medicine

If you have been diagnosed with a chronic condition you will Benefit Option by visiting www.mediscor.co.za/search-client-
require long-term medication. It is important to register your chronic medicine-Formulary/. If your medicine is not on the formulary for
medication so the payment of your medicine can be covered from your Benefit Option you can ask your doctor if there is an alternative
your Chronic Medicine benefit and not your Day-to-Day allocation or available that is on the formulary otherwise you will be liable for an
Savings. upfront co-payment.

Follow these easy steps:

STEP 1 STEP 3
Your doctor or Pharmacist can call Mediscor on You will receive a standard medicine authorisation and treatment
086 000 2120 (Choose option 3 and then option 1) letter once your application for chronic medication have been
or email medshieldauths@mediscor.co.za. processed.

You will need the following information: If your registration requires additional test results or a motivation,
you should follow up with your treating Doctor to provide this
• Membership details: Benefit Option name and your membership
information.
number

• Patient details: Name, Dependant code (on the back of your

membership card) and date of birth STEP 4
Take your script to the Chronic Medicine Designated Service
• Your Doctor’s details: Initials, surname and practice number
Provider (DSP) Network for your Benefit Option and collect your
• Diagnosis details: What chronic condition has been diagnosed medicine or have it delivered to your home.
and the ICD-10 code

• Prescribed medicine: Medicine name, strength and dosing

Chronic Medicine Authorisation Contact Centre hours
frequency
Mondays to Fridays: 07:30 to 17:00
If additional information or a motivation is required, we will contact
you and/or your treating doctor.

STEP 2
Your registration will be evaluated in line with the
Scheme Rules and Protocols by in-house qualified
and registered pharmacists and pharmacy assistants.

Your application will be processed according to the

formularies appropriate for the condition and Benefit Option.

Different types of formularies apply to the conditions

covered under the various Benefit Options. You can
check online if your medication is on the formulary for your

MEDICURVE CHRONIC DISEASE LIST

Addison’s disease Chronic obstructive pulmonary disease Epilepsy Parkinson’s disease
Asthma Coronary artery disease Glaucoma Rheumatoid arthritis
Bi-Polar Mood Disorder Crohn’s disease Haemophilia Schizophrenia
Bronchiectasis Diabetes insipidus Hyperlipidaemia Systemic lupus erythematosus
Cardiac failure Diabetes mellitus type 1 Hypertension Ulcerative colitis
Cardiomyopathy Diabetes mellitus type 2 Hypothyroidism
Chronic renal disease Dysrhythmias Multiple sclerosis

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2023 Benefit Guide

A Medshield complimentary baby bag can be requested during the 3rd trimester.
Kindly send your request to medshieldmom@medshield.co.za

Maternity Benefits
Benefits will be offered during pregnancy, at birth and after birth. Subject to pre-authorisation with the relevant Managed Healthcare
Programme prior to hospital admission. Benefits are allocated per pregnancy subject to the Overall Annual Limit, unless otherwise stated.

6 Antenatal 4 Visits per event

Two 2D Scans per pregnancy.
Consultations per pregnancy. For Antenatal Classes
& Postnatal Midwife One Amniocentesis test
The use of the Medshield Specialist per pregnancy.
Network may apply.
Consultations.

CONFINEMENT AND POSTNATAL CONSULTATIONS

25% upfront co-payment for the use of a non-DSP. Use of a DSP applicable from Rand on. Subject to pre-authorisation by the relevant Managed Healthcare
Programme on 086 000 2121 (+27 11 671 2011), and services must be obtained from the MediCurve Network.

• Confinement In-Hospital Unlimited.

• Delivery by a Family Practitioner or Medical Specialist Unlimited.
• Confinement in a registered birthing unit or Out-of-Hospital Unlimited.

– Delivery by a registered Midwife or a Practitioner Unlimited.

– Hire of water bath and oxygen cylinder Unlimited.
Clinical Protocols apply.

14
 MediCurve

Especially for Medshield MOMs

Motherhood is so much more than giving birth to a child. It’s loving and
knowing a soul before you even see it. It’s carrying and caring for a life
completely dependent on you for survival. It’s giving air to the lungs that
grew within you, and sight to the eyes that will look to you for answers to
life’s questions.

The Medshield MOM dedicated website will assist women on their journey
to motherhood, through all the various stages of pregnancy, birth and
postpartum, ensuring that parents and parents-to-be are aware of the
pregnancy-related benefits they enjoy as Medshield members.

The website, www.medshieldmom.co.za is an easy-to-use online resource

to access a hub of important content related to health, fitness, nutrition, the
body, motherhood, babies, toddlers and more, all suited to the pre- and
post-partum phases.

A guide
on your journey
from beginning
to end

Emails with updates

Advice formulated
on the size & development
by professionals
of your unborn child

Convenient, easily
accessible and reliable
pregnancy resources

Email reminders Endorsed by

to schedule ambassadors Toddler benefit which
appointments incorporates information relating
with your doctor to child immunisation, child
and to apply nutrition, a 24/7 nurse helpline
for hospital and digital/online child yoga.
pre-authorisations etc.

Moms may register and input the

particular week of their pregnancy
journey, and they will start receiving
content based on that specific time
frame and moving forward.

The Medshield MOM bags are locally

manufactured, using sustainable, recycled
material. These unique bags are packed with
fantastic Bennetts products for your little one.
Moms can get in touch with us during their third trimester to book a bag.
Medshield walks the pregnancy journey
Email medshielmom@medshield.co.za with your request, membership
alongside our moms. A health cover
number, contact details and delivery address.
partner that is committed to mom care
The Bennetts and Medshield MOM partnership also brings you and new life, ensuring that the next
incredible content and information to assist you along your journey. generation of South Africans are all born
healthy, happy and stay that way.

15
2023 Benefit Guide

Out-of-Hospital Benefits
Simplified Out-of-Hospital services subject to the Overall Annual Limit unless otherwise stated.

Unlimited Family Unlimited SmartCare

Practitioner Consultations
Consultations and Visits

Cover for Over the

Dental Counter Medicine
Benefits (Pharmacy Advised
Therapy)

Optical
Benefits

BENEFIT CATEGORY BENEFIT LIMIT AND COMMENTS

FAMILY PRACTITIONER CONSULTATIONS AND VISITS Unlimited.

FP consultations and visits can be accessed in-person, telephonically or virtually. R100 upfront co-payment per visit.

Each beneficiary must nominate ONE Family Practitioner from the MediCurve Family
Practitioner (FP) Network. The MediCurve FP Network is applicable from Rand one.

• Registered Chronic beneficiaries extended FP consultations and visits. 2 per beneficiary from the Overall Annual Limit. Subject to
Chronic Disease List applies. registering on the relevant Disease Management Programme.
The use of the MediCurve Family Practitioner Network applies.

NON-NOMINATED FAMILY PRACTITIONER (FP) CONSULTATIONS AND VISITS 2 visits per family per annum.
When you have not consulted your nominated FP. R100 upfront co-payment, thereafter an
additional 40% upfront co-payment will apply.

MEDICINES AND INJECTION MATERIAL

• Acute medicine R580 per family per annum.
Must be prescribed by the nominated FP and Medshield formularies apply. R10 upfront co-payment per medicine line item.
Subject to the use of the Medshield Pharmacy Network.
• Pharmacy Advised Therapy (PAT) R365 per family.
Limited to Schedules 0, 1 and 2 medicine advised and dispensed by a Pharmacist. The Limited to R105 per script,
use of the Medshield Pharmacy Network applies. 1 script per beneficiary per day.

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 MediCurve

Visit your Doctor without leaving your home!

VIRTUAL FAMILY How does it work?

PRACTITIONER CONSULTATION STEP 1
You can now consult with a qualified Family Practitioner (FP) via Click on the link on the Medshield home page at www.medshield.co.za
computer, smartphone or tablet from the comfort of your home or and follow the Virtual Family Practitioner Consultation link. (see
private space - all you need is an internet connection! image below)

Our partnership with Intercare gives all members reliable and secure You can also use the Medshield App. A SmartCare icon is available
access to video consultation with a FP through our Virtual FP under Member Tools. Select SmartCare and a new screen will open
Consultation portal on the home page of the Medshield website. with the Virtual Consultation link.

The Medshield Member App is available for download from the

relevant Apple IOS, Android or Huawei store.

STEP 2 STEP 4
Once you followed the link you need to enter the patient details on During the consultation the Family Practitioner might suggest a sick
a virtual form. After submitting the form a system check confirms note, or prescribe medicine and will email this to you to the address
that you are a valid member and that you have benefits available. you added in Step 2 on the Patient Detail form.
Your benefits is included in your Family Practitioner: Out-of-Hospital
benefits for your Benefit Option.
STEP 5
Please note that only scripts up to and including Schedule 4
STEP 3 medication may be e-mailed to a patient. Higher scheduled medicine
You will receive a SMS with an OTP on the number you have will only be accepted by pharmacies enabled with electronic
entered on the form. By entering the OTP, you consent to the Virtual scripting. The consulting Doctor can provide further guidance.
Consultation and you will be placed in a queue for the next available
Doctor to consult with you.

17
2023 Benefit Guide

Out-of-Hospital Benefits
BENEFIT CATEGORY BENEFIT LIMIT AND COMMENTS

OPTICAL LIMIT R895 per beneficiary every 24 months determined by optical

Subject to relevant Optometry Managed Healthcare Programme and Protocols. service date cycle.

• Optometric refraction (eye test) 1 test per beneficiary per 24 month optical cycle.
R100 upfront co-payment.

• Spectacles OR Contact Lenses R100 upfront co-payment.

Single Vision Lenses, Contact Lenses only. Subject to Optical Limit.
• Readers R190 per beneficiary.
If supplied by a registered Optometrist, Ophthalmologist, Supplementary Optical Subject to Optical Limit.
Practitioner or a registered Pharmacy.

PATHOLOGY AND MEDICAL TECHNOLOGY Subject to PMB.

Subject to the relevant Pathology Managed Healthcare Programme and Protocols.

COVID-19 PCR/Antigen Test 1st test included in Overall Annual Limit, thereafter no benefit
unless positive result which is then subject to PMB.

SPECIALISED RADIOLOGY Limited to R5 500 In- and Out-of-Hospital,

Subject to pre-authorisation by the relevant Managed Healthcare Programme on per family per annum.
086 000 2121 (+27 11 671 2011)

NON-SURGICAL PROCEDURES AND TESTS Subject to Overall Annual Limit if procedure is done in the
The use of the Medshield Specialist Network may apply. Practitioners’ rooms. R2 000 upfront co-payment if procedure
• Routine diagnostic Endoscopic Procedures in Practitioners’ rooms is pre-authorised and done In-Hospital. No co-payment
applicable In-Hospital for children 8 years and younger. Refer
to Addendum B for the list of services.

INTRAUTERINE DEVICES AND ALTERNATIVES 1 per female beneficiary.

Refer to Addendum B for the list of services. Includes consultation, pelvic ultra sound, Subject to the Overall Annual Limit. Includes all IUD brands up
sterile tray, device and insertion thereof, if done on the same day. Subject to the relevant to and including the price of the Mirena device. Mirena/Kyleena
clinical protocols. The use of the Medshield Specialist Network may apply. Procedure to be device: 1 per female beneficiary every 5 years. Implanon: 1 per
performed in Practitioners’ rooms. female beneficiary every 3 years. Nova T/Copper device: 1 per
female beneficiary every 2 years.
Only applicable if no contraceptive medication is used. On application only.

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 MediCurve

SmartCare provides access to Videomed, telephone and video consultation through specified
healthcare practitioners. SmartCare is an evolving healthcare benefit that is designed
around offering members the convenience of easy access to care.

SMARTCARE SERVICES:
Acute consultations: Chronic consultations:
Chest and upper respiratory tract infections, urinary tract infections, Medicine and repeat prescriptions for high blood pressure, diabetes,
eye and ear infections etc. high cholesterol etc. Members are then encouraged to use the
Medshield Chronic Medicine Courier Service DSP to deliver their chronic
medicine straight to their home or workplace.

Member visits Nurse confirms Full medical

1 SmartCare
supported
2 Medshield benefits. history and clinical
examination by
3
Pharmacy. registered nurse.

4
Recommends
Over-the-Counter
medicine.
or Nurse advises that
the member requires
a doctor consultation.
4
Nurse dials doctor on
Terms & Conditions Videomed and assist
• No children under the age of 2 may be seen doctor with medical
for anything other than a prescription for a
history, additional tests
routine immunisation
• No consultations related to mental health and examination. Doctor
• No treatment of emergency conditions generates script and
involving heavy bleeding and/or trauma sends script to printer
• No treatment of conditions involving sexual at Nurse’s station, while
assault
Nurse counsels the
• SmartCare services cannot provide Schedule
5 and up medication member.
• Over-the-Counter (OTC) and prescription
medication is subject to the Pharmacy
Advised Therapy Script Limit as per the
Scheme Rules and chosen benefit option
• Clinics trading hours differs and are subject Member collects
Member collects
5 Over-the-Counter
medication.
to store trading hours
medication from
dispensary. 5

SmartCare Benefits
BENEFIT CATEGORY BENEFIT LIMIT AND COMMENTS

PHARMACY/CLINIC PRIVATE NURSE PRACTITIONER CONSULTATIONS Unlimited.

The use of the SmartCare Pharmacy Network compulsory from Rand one.

NURSE-LED VIDEOMED FAMILY PRACTITIONER (FP) CONSULTATIONS Unlimited.

Subject to the use of the SmartCare Family Practitioner (FP) Network.

WHATSAPP DOC ADVICE LINE Refer to page 26.

Channel where members can communicate with a doctor to assess a patient for COVID-19.

19
2023 Benefit Guide

Wellness Benefits
Your Wellness Benefit encourages you to take charge of your health through preventative tests and procedures.
At Medshield we encourage members to have the necessary tests done at least once a year. Wellness Benefits are subject to
the use of Pharmacies that are included in your benefit options’ Pharmacy Network, available at www.medshield.co.za.

Unless otherwise specified, benefits are subject to the Overall Annual Limit, thereafter subject to the Day-to-Day Limit,
excluding consultations for the following services:

Test
Early Pro-active
Detection Management

BENEFIT CATEGORY BENEFIT LIMIT AND COMMENTS

Birth Control (Contraceptive Medication) Restricted to 1 month’s supply to a maximum of 13 prescriptions per annum per
Only applicable if no intrauterine devices and alternatives female beneficiary between the ages of 14 - 55 years old, with a script limit of R165.
are used. Subject to Acute Medicine Benefit Limit.

COVID-19 Vaccination Subject to the Overall Annual Limit. Protocols apply.

Flu Vaccination 1 per beneficiary 18+ years old, included in the Overall Annual Limit.
Thereafter no benefit.

Pap Smear 1 per female beneficiary.

Health Risk Assessment SmartCare Network 1 per beneficiary 18+ years old per annum.
• Cholesterol
• Blood Glucose
• Blood Pressure
• Body Mass Index (BMI)

National HIV Counselling Testing (HCT) 1 test per beneficiary.

✓ Log on to the Medshield App for a list of providers near you

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 MediCurve

Ambulance Services
You and your registered dependants will have access to a 24 hour Helpline. Call the Ambulance and Emergency Services
provider on 086 100 6337.

BENEFIT CATEGORY BENEFIT LIMIT AND COMMENTS

EMERGENCY MEDICAL SERVICES Unlimited.

Subject to pre-authorisation by the Ambulance and Emergency Services provider. Scheme
approval required for Air Evacuation.
Clinical Protocols apply.

Emergency Medically justified

24 Hour access
medical response transfers to special
to the Emergency
by road or air to scene care centres or
Operation Centre
of an emergency incident inter-facility transfers

Transfer from scene

to the closest, most
Telephonic
appropriate facility
medical advice
for stabilisation
and definitive care

Monthly Contributions
MEDICURVE OPTION PREMIUM

Principal Member R1 584

Adult Dependant R1 584

Child R1 584

21
2023 Benefit Guide

Prescribed Minimum Benefits (PMB)

Introduction
All Medshield members are entitled to cover for Prescribed Minimum Benefits (PMBs), irrespective of your chosen benefit
option. Medshield covers the cost of treatment for a PMB, provided that the services are rendered by a provider that is one
of Medshield’s Designated Service Providers (DSP) and according to the Scheme Rules.

This document provides detailed information on how Medshield cover PMBs, both if you are admitted to hospital (In-
Hospital) or receive treatment without being admitted to hospital (Out-of-Hospital).

Please note that PMBs have specific requirements according to the Scheme Rules, and these varies depending on your
chosen benefit option. It is therefore important that you take note of your benefit option and the PMB requirements
pertaining to your option, as detailed in this Guide.

What is a Prescribed Minimum Benefit (PMB)?

The Medical Schemes Act 131 of 1998 stipulates that all medical schemes have to cover the costs related to the diagnosis,
treatment and care of the following:
1. Any life-threatening medical emergency
2. A defined set of 26 Chronic Disease List (CDL) conditions
3. 271 DTP diagnoses.

The Council of Medical Schemes website at www.medicalschemes.co.za/resources/pmb/ provides the list of

conditions identified as Prescribed Minimum Benefits.

Explaining the various terms and what they mean when talking PMB’s
TERM DESCRIPTION AS IT RELATES TO PMBs

Care Plan A plan with details of approved treatment, Doctor visits, pathology, radiology etc. to treat your condition.
For the 26 CDL conditions a Care Plan is automatically generated when claiming. For the 271 DTP
you have to apply via completing the PMB application form, which is available on
www.medshield.co.za.
Important: If you need additional treatment or benefits than what is stipulated on the Care Plan, you need to
apply to the Scheme. (Please refer to the ‘Your Medshield Cover for PMB’ section of this document for more
details per benefit option).

CDL A defined list of 26/27 chronic conditions that we cover according to the Medical Schemes Act.
Chronic Disease List

Co-payment This is an amount that you need to pay towards a healthcare service/or treatment.
• A co-payment can be levied on specific procedures/services/treatment, and is specified in your
specific option’s benefit guide available on www.medshield.co.za.
• A co-payment is also the difference between the cost of the service provider and the amount
the Scheme pays, as detailed in your option’s benefit guide.
To minimise co-payments it is important that you obtain healthcare services from the dedicated DSPs on the
various networks for your chosen benefit option, available on www.medshield.co.za.

Day-to-Day Limit The Day-to-Day limit is an allocation to members from Risk. The Day-to-Day limit is available on the
MediBonus, MediPlus Prime & Compact, MediValue Prime and Compact and the MediPhila benefit options.

DSP Each benefit option has specific networks of Designated Service Providers, which are healthcare providers
Designated Service (such as doctors, specialists, pharmacies, hospitals, optometrists and dentists) who provide treatment to
Providers Medshield members at a contracted rate.
You are encouraged to use only these DSP’s for healthcare services to ensure that you don’t have to pay
co-payments. Visit www.medshield.co.za and click on Member Networks under the Member tab or click on
Networks on the Medshield app to view the full list of DSPs per benefit option.

DTP A Diagnosis and Treatment Pair links a specific diagnosis to a treatment based on best practice healthcare and
Diagnosis and affordability of the treatment, and broadly indicates how these 271 DTP PMB conditions should be treated.
Treatment Pair Should there be a disagreement about the treatment of a specific case, the standards (also called practice and
protocols) in force in the public sector will be applied.

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 MediCurve

TERM DESCRIPTION AS IT RELATES TO PMBs

Hospital Plan Medshield’s Hospital Plan (MediCore & MediSwift) do not have a Savings or Day-to-Day Limit.

In-Hospital Treatment received whilst admitted in a hospital.

ICD-10 ICD-10 code is an international diagnostic coding standard owned and maintained by the World Health
Organisation (WHO).

Out-of-Hospital Treatment received without being admitted to a hospital.

PMB The Medical Schemes Act 131 of 1998 stipulates that all medical schemes have to cover the costs related to the
diagnosis, treatment and care of a defined list of conditions. These conditions are available on the Council for
Medical Schemes’ website at www.medicalschemes.co.za/resources/pmb/

PMB Level of Care The treatment needed for your PMB condition, based on the guidelines and established practices at most
public hospitals or government facilities.

Risk (OAL) The Scheme covers the costs, and it is not taken from your benefits as shown on your option’s benefit guide.

Related Claims Any claim from a healthcare service provider other than the hospital account, for one specific healthcare
event and treatment/services that stems from that event.

Savings Personal Medical Saving Account consist of actual contributions received from members. These are available
on the PremiumPlus and MediSaver benefit options.

Scheme Rules According to the Medical Schemes Act, the Scheme Rules of a medical scheme shall be binding on both the
Scheme and its members. The Rules contain the exact details of benefits payable by the medical scheme
and include the specific benefits pertaining to each benefit option, the rate of reimbursement, sub-limits
or co-payments that may apply, exclusions, the use of DSPs etc. All medical scheme memberships are
governed by the Rules of the medical scheme that regulate the relationship with all members equally. The
Scheme Rules can be requested via the Medshield website on www.medshield.co.za.

Important checklist about accessing benefits for a PMB condition

• The condition must qualify as a PMB and must be on the Chronic Disease List or 271 DTP, or a life-threatening medical
emergency
• When diagnosed your treatment must match those in the defined benefits available on the PMB list. Check whether your
chosen benefit option qualifies as PMB Level of Care payment or PMB, as some options allow richer treatment than
what is specified as PMB Level of Care
• It is important to use the Designated Service Providers as specified on your chosen benefit option. If your option has
preferred networks for chronic medicine, hospitals, pharmacies or healthcare providers, you have to obtain services
from those providers otherwise you might be liable for a portion or the whole cost, or it might pay from your Day-to-Day
allocation or Savings portion
• Scheme Rules apply – even if your condition is identified as a PMB you have to follow the rules as set out by your benefit
option
• Review the requirements in this Guide to ensure you complete a PMB application form when required.

Your Medshield Cover for a PMB

PMB cover can be divided into 2 groups:
1. In-Hospital admissions for the treatment of a PMB
2. Out-of-Hospital management of a PMB condition

23
2023 Benefit Guide

1. In-Hospital admissions for the treatment of a PMB

If you are diagnosed with a PMB condition that requires hospitalisation, you have to follow the Medshield hospital
authorisation process. All costs for stay and treatment has negotiated rates so it is important for you to use a hospital that
is part of the Hospital Network on your chosen benefit option. Specialist services obtained whilst admitted is paid at the
Scheme rate. If the Scheme rate does not cover the full amount of the claim, you need to apply to the Scheme and request
that the Specialists rate be paid at cost instead of the Scheme rate via pmbapplications@medshield.co.za. The Scheme
will review the request and might request additional information.

2. Out-of-Hospital treatment and management of a PMB

26 CDL CONDITIONS
If you have been diagnosed with a condition that forms part of the CDL list:
• Apply to Mediscor to obtain authorisation. Contact details are available on the Scheme website at
www.medshield.co.za.
• Once the Scheme receives the claim from your healthcare provider with the ICD-code as per the authorisation, the
member automatically receives a communication with their Care Plan (treatment plan).
• The benefits (e.g. radiology or pathology etc.) and doctors’ visits are then detailed on the Care Plan and is approved for
payment.
• If your condition changes or you require additional treatment after the treatment on your Care Plan has been used, you
need to complete a PMB Application form together with your treating provider to obtain authorisation and approval. The
PMB Application form is available under the member tab of on the Scheme website at www.medshield.co.za.
• If approved, you will receive a new Care Plan with the additional treatment specified.

It is important to note that payment for these conditions are benefit option specific:
• MediBonus, MediPlus Prime and Compact, MediValue Prime and Compact, MediPhila
The Day-to-Day limit on your benefit option or plan is an allocation given to members from Risk.
Therefore a PMB will pay from your Day-to-Day limit until it is depleted then pay from Risk until the
allocated services on your Care Plan has been used. If you require additional services that is not listed on the Care Plan,
you together with your treating provider, need to complete a new PMB Application form. (Clinical Protocols apply).

• PremiumPlus, MediSaver
Personal Medical Savings Accounts consist of actual contributions received from members, and therefore the costs
of the treatment detailed on the Care Plans are paid directly from Risk (OAL). If a member has paid out of pocket for
services that was approved and appear on the Care Plan, then the member can request the Scheme to reprocess those
claims. It is important to note that this applies only to the services listed on the approved Care Plan.

• MediCore, MediCurve and MediSwift

The costs of the treatment detailed on the Care Plans are paid directly from Risk (OAL).
For additional treatment members need to complete a PMB application form.

271 DTP CONDITIONS

• Members on all options that has been diagnosed with a DTP condition need to, together with their treating doctor,
complete a PMB application form with details of treatment required.
• If you do not complete a PMB Application form the treatment will be paid from your available Day-to-Day or Savings,
and if depleted you will be liable for the costs.
• Submit the PMB Application form to pmbapplications@medshield.co.za.
• Once clinically reviewed and approved you will receive a Care Plan (treatment plan) which details the approved treatment
that are covered for your condition.

COVID-19 as a PMB
Covid-19 is included under the respiratory DTP PMB conditions. When you suspect that you have COVID-19, you will most
likely go to a doctor to be diagnosed and after the consultation may be required to do a COVID-19 PCR or SARS-CoV-2
Antigen test. You will need to be referred by a registered healthcare practitioner (Doctor or Nurse) in order to access this
benefit and payment will be accorded as per the Scheme Rules. Please note that your cover includes either a PCR or an
Antigen test, but not both in one diagnosis. This is a pathology test and the results will be either positive or negative.

24
 MediCurve

COVID-19 Access to Care

COVID-19 is included under the respiratory DTP PMB conditions. When you suspect that you have COVID-19, you will most likely go to a doctor
to be diagnosed, and after the consultation may be required to do a COVID-19 PCR or SARS-CoV-2 Antigen Test. You will need to be referred by
a registered healthcare practitioner (Doctor or Nurse) in order to access this benefit and payment will be according to the Scheme Rules. Please
note that your cover includes either a PCR or an Antigen test, but not
both in one diagnosis. This is a pathology test and the results will be either positive or negative.

· 1st COVID PCR or Antigen test included in Overall Annual Limit (OAL), whether the result is positive or negative. (Please
read below as well)
· 2nd and subsequent negative PCR or Antigen tests are paid from your Savings or Day-to-Day limit. If these are depleted
you will be liable to pay out-of-pocket for these tests. Please note for reimbursement you would need to have been referred
for testing by a registered healthcare practitioner (Doctor or Nurse) due to having signs and symptoms attributable to a
COVID-19 infection. The aforementioned excludes tests for travel purposes.
· 2nd and subsequent positive PCR or Antigen tests are funded from your available Day-to-Day benefit or Savings first,
and if depleted from OAL because a positive result is PMB eligible.
COVID-19 · You should email the positive results to member@medshield.co.za and then the pathology test will retrospective be paid
PCR Test OR Antigen as a PMB from Risk. You need to complete a PMB Application form to apply for related benefits to be paid from Risk
Tests (Please refer (Clinical Protocols apply). Please note for reimbursement you
to the Medshield would need to have been referred for testing by a registered healthcare practitioner (Doctor or Nurse) due to having signs
PMB Guide for and symptoms attributable to COVID-19 infection. The aforementioned excludes tests for travel purposes and non-
more detail) symptomatic COVID-19 infections.
- The Day-to-Day limit is an allocation to members from Risk. Therefore the COVID-19 treatment as a PMB will pay from
your Day-to-Day limit until it is depleted and will then continue to pay from Risk (OAL). You need to complete a PMB
Application form to apply for related benefits to be paid from Risk otherwise you might be responsible to settle the costs
once your Day-to-Day benefit is depleted (Clinical Protocols apply)
- Personal Medical Savings Accounts consist of actual contributions received from members, and therefore the costs
of 2nd, and subsequent, positive tests will be retrospectively reviewed for possible reimbursement to the Savings
account. You need to complete a PMB Application form to apply for related benefits to be paid from Risk (Clinical
Protocols apply).

Telephonic and · Safe consultation with your Family Practitioner

Video Doctor · Access to current Doctors via remote consultation (telephonic and video)
Consultations · Pays from available Family Practitioner Consultations and Visits: Out-of-Hospital benefit

· SmartCare covers members for Nurse-led and Videomed doctor consultations

· Available benefit on all Medshield 2023 benefit options
Video and Nurse
Consultations · A one-stop healthcare facility that is convenient, quick and efficient
· The amount of visits and Videomed consultations are dependent on the member’s chosen benefit option
· Available at any SmartCare-enabled clinic or pharmacy in South Africa
· The list of SmartCare enabled clinics are available on the Medshield website at
www.medshield.co.za/medshield-networks/

Online · Free mobile doctors consultations

assessments · Assessments for COVID-19
and consultations · Available to all Medshield members
· WhatsApp ‘Hi’ to 087 250 0643
· Monday to Friday 9am – 5pm and Saturday 9am – 1pm
· Calls charged at local call rates

· Have Chronic Medicine delivered to your home

· MediValue Compact; MediPlus Compact; MediCore, MediPhila, MediValue Prime:
Easy access to your
Obtain medicine from Clicks Retail pharmacy or register with Clicks Direct (Chronic Courier)
Chronic Medicine
on 0861 444 405 or Pharmacy Direct (HIV Medicine) on 086 002 7800, to deliver
– delivered to your
· Premium Plus, MediBonus, MediSaver, MediPlus Prime: Obtain your chronic medication from your DSP
home
i.e. Dischem, Clicks Retail pharmacy, or register with Clicks Direct (Chronic Courier)
on 0861 444 405 to deliver

· Paid from Wellness Benefit

· Available to adults older than 18 years
Flu Vaccine
· Available at Medshield Pharmacy Network providers, Clicks Pharmacies and selected SmartCare Clinics
· Visit the website at www.medshield.co.za/medshield-networks/ for a list of providers

· High-risk members
· Seniors over 60 years of age
Pneumococcal
· Pre-existing conditions e.g. heart conditions, lung conditions, chronic renal disease,
Vaccine
Diabetes and immuno-compromised members
· Available on Wellness Benefit (excluding MediPhila members)

25
 Medshield SmartCare
COVID-19 WhatsApp Advice Line
To consistently provide access to care, Medshield’s WhatsApp
channel allows members to communicate with a Doctor from the comfort of their home.
By using this channel a Doctor will be able to assess a patient for COVID-19.

Not sure if you need to be tested for COVID-19?

Use the Medshield SmartCare COVID-19
WHATSAPP ADVICE LINE FOR PEACE OF MIND!

1 2
Say ‘Hi’ to
A registered Doctor
087 250 0643
Service available on
will respond with
Mon – Fri: 09h00 to 17h00 “HI, I’M DR X, I’LL BE
and Sat: 09h00 to 13h00 HELPING YOU TODAY.”
T’s & C’s Apply.

4 3
Doctor REQUESTS
Patient AGREES
YOUR INFORMATION
to the terms and
e.g. name, age,
conditions
symptoms and
of using the service.
medical history.

5 6
Doctor REVIEWS THE Doctor ASSESSES
INITIAL QUESTIONS and ALL INFORMATION.
discusses with patient. IF YOU ARE:

NOT A SUSPECTED
SUSPECTED COVID-19 CASE:
COVID-19 CASE:
Doctor assesses patient risk
Doctor provides relevant
and ask for more information.
treatment or referral.

8 Doctor REFERS PATIENT for testing.

T’s & C’s - You will receive advice from a Healthforce doctor over WhatsApp. All such doctors are registered with the Health Professions Council of South Africa and have been vetted by Healthforce.
You cannot hold Healthforce, Medshield or anyone involved in this conversation responsible for injury or harm. This line is intended for advice and not to replace medical treatment. This chat will be saved
on a 3rd party app, for the purposes of data collection and future review. We’ll never share that information with a 3rd party unless it is required for your treatment, to fund your treatment, or by law.
You will be sharing your information on WhatsApp. Although encrypted, there is a small risk that an outsider can access information that is transmitted over the internet.

26
 MediCurve

Addendum A
INFERTILITY INTERVENTIONS AND INVESTIGATIONS

Limited to interventions and investigations as prescribed by the Regulations to the Medical Schemes Act 131 of 1998 in Addendum A paragraph 9, code 902M.
This benefit will include the following procedures and interventions:

Hysterosalpinogram Rubella

Laparoscopy HIV

Hysteroscopy VDRL

Surgery (uterus and tubal) Chlamydia

Manipulation of the ovulation defects and deficiencies Day 21 Progesteron

Semen analysis (volume, count, mobility, morphology, MAR-test) Basic counselling and advice on sexual behaviour

Day 3 FSH/LH Temperature charts

Oestradoil Treatment of local infections

Thyroid function (TSH) Prolactin

Addendum B
ROUTINE DIAGNOSTIC ENDOSCOPIC PROCEDURES (CO-PAYMENTS WILL APPLY IN-HOSPITAL*)

Hysteroscopy Oesophageal motility studies

Upper and lower gastro-intestinal fibre-optic endoscopy Fibre optic Colonoscopy

24 hour oesophageal PH studies Sigmoidoscopy

Cystoscopy Urethroscopy

Colposcopy (excluding after-care) Oesophageal Fluoroscopy

Note: *No co-payment applicable In-Hospital for children 8 years and younger.
The above is not an exhaustive list.

27
2023 Benefit Guide

Exclusions
Alternative Healthcare Practitioners Root Canal Therapy and Extractions
Herbalists; Root canal therapy on primary (milk) teeth;
Therapeutic Massage Therapy (Masseurs); Direct and indirect pulp capping procedures.
Aromatherapy;
Ayurvedics; Plastic Dentures/Snoring Appliances/Mouth guards
Iridology; Diagnostic dentures and the associated laboratory costs;
Reflexology. Snoring appliances and the associated laboratory costs;
The laboratory cost associated with mouth guards (The clinical fee will
Appliances, External Accessories and Orthotics be covered at the Medshield Dental Tariff where managed care protocols
Appliances, devices and procedures not scientifically proven or apply);
appropriate; High impact acrylic;
Back rests and chair seats; Cost of gold, precious metal, semi-precious metal and platinum foil;
Bandages and dressings (except medicated dressings and dressings Laboratory delivery fees.
used for a procedure or treatment);
Beds, mattresses, pillows and overlays; Partial Metal Frame Dentures
Cardiac assist devices – e.g. Berlin Heart (unless PMB level of care, DSP Metal base to full dentures, including the laboratory cost;
applies); High impact acrylic;
Diagnostic kits, agents and appliances unless otherwise stated (except for Cost of gold, precious metal, semi-precious metal and platinum foil;
diabetic accessories) (unless PMB level of care); Laboratory delivery fees.
Electric tooth brushes;
Humidifiers; Crown and Bridge
Ionizers and air purifiers; Crown on 3rd molars;
Orthopeadic shoes and boots, unless specifically authorised and unless Crown and bridge procedures for cosmetic reasons and the associated
PMB level of care; laboratory costs;
Pain relieving machines, e.g. TENS and APS; Crown and bridge procedures where there is no extensive tooth structure
Stethoscopes; loss and associated laboratory costs;
Oxygen hire or purchase, unless authorised and unless PMB level of care; Occlusal rehabilitations and the associated laboratory costs;
Exercise machines; Provisional crowns and the associated laboratory costs;
Insulin pumps unless specifically authorised; Emergency crowns that are not placed for immediate protection in tooth
CPAP machines, unless specifically authorised; injury, and the associated laboratory costs;
Wearable monitoring devices. Cost of gold, precious metal, semi-precious metal and platinum foil;
Laboratory delivery fees;
Blood, Blood Equivalents and Blood Products Laboratory fabricated temporary crowns.
Hemopure (bovine blood), unless acute shortage of human blood and
blood products for acutely aneamic patients; Implants
Dolder bars and associated abutments on implants’ including the
Dentistry laboratory cost;
Exclusions as determined by the Schemes Dental Management Laboratory delivery fees.
Programme:
Orthodontics
Preventative Care Orthodontic treatment for cosmetic reasons and associated laboratory
Oral hygiene instruction; costs;
Oral hygiene evaluation; Orthodontic treatment for a member or dependant younger than 9 and
Professionally applied fluoride is limited to beneficiaries from age 5 and older than 18 years of age;
younger than 13 years of age; Orthodontic re-treatment and the associated laboratory costs;
Tooth Whitening; Cost of invisible retainer material;
Nutritional and tobacco counselling; Laboratory delivery fees.
Cost of prescribed toothpastes, mouthwashes (e.g. Corsodyl) and
ointments; Periodontics
Fissure sealants on patients 16 years and older. Surgical periodontics, which includes gingivectomies, periodontal flap
surgery, tissue grafting and hemisection of a tooth for cosmetic reasons;
Fillings/Restorations Perio chip placement.
Fillings to restore teeth damaged due to toothbrush abrasion, attrition,
erosion and fluorosis; Maxillo-Facial Surgery and Oral Pathology
Resin bonding for restorations charged as a separate procedure to the The auto-transplantation of teeth;
restoration; Sinus lift procedures;
Polishing of restorations; The closure of an oral-antral opening (item code 8909) when claimed
Gold foil restorations; during the same visit with impacted teeth (item codes 8941, 8643 and
Ozone therapy. 8945);
Orthognathic (jaw correction) surgery and any related hospital cost, and
the associated laboratory costs.

28
 MediCurve

Hospitalisation (general anaesthetic); Infertility

Where the reason for admission to hospital is dental fear or anxiety; Medical and surgical treatment, which is not included in the Prescribed
Multiple hospital admissions; Minimum Benefits in the Regulations to the Medical Schemes Act 131 of
Where the only reason for admission to hospital is to acquire a sterile 1998, Annexure A, Paragraph 9, Code 902M;
facility; Vasovasostomy (reversal of vasectomy);
The cost of dental materials for procedures performed under general Salpingostomy (reversal of tubal ligation).
anaesthesia.
Maternity
The Hospital and Anaesthetist Claims for the following procedures 3D and 4D scans (unless PMB level of care, then DSP applies);
will not be covered when performed under general anaesthesia Caesarean Section unless clinically appropriate;
Apicectomies;
Dentectomies; Medicine and Injection Material
Frenectomies; Anabolic steroids and immunostimulants (unless PMB level of care, DSP
Conservative dental treatment (fillings, extractions and root canal therapy) applies);
In-Hospital for children above the age of 6 years and adults; Cosmetic preparations, emollients, moisturizers, medicated or otherwise,
Professional oral hygiene procedures; soaps, scrubs and other cleansers, sunscreen and sun tanning
Implantology and associated surgical procedures; preparations, medicated shampoos and conditioners, except for the
Surgical tooth exposure for orthodontic reasons. treatment of lice, scabies and other microbial infections and coaltar
products for the treatment of psoriasis;
Additional Scheme Exclusions Erectile dysfunction and loss of libido medical treatment (unless caused
Special reports; by PMB associated conditions subject to Regulation 8);
Dental testimony, including dentolegal fees; Food and nutritional supplements including baby food and special milk
Behaviour management; preparations unless PMB level of care and prescribed for malabsorptive
Intramuscular and subcutaneous injections; disorders and if registered on the relevant Managed Healthcare
Procedures that are defined as unusual circumstances and procedures Programme; or for mother to child transmission (MTCT) prophylaxis and if
that are defined as unlisted procedures; registered on the relevant Managed Healthcare Programme;
Appointments not kept; Injection and infusion material, unless PMB and except for outpatient
Treatment plan completed (code 8120); parenteral treatment (OPAT) and diabetes;
Electrognathographic recordings, pantographic recordings and other such The following medicines, unless they form part of the public sector
electronic analyses; protocols and specifically provided for in Annexure B and are authorised
Caries susceptibility and microbiological tests; by the relevant Managed Healthcare Programme:
Pulp tests; Maintenance Rituximab or other monoclonal antibodies in the first line
Cost of mineral trioxide; setting for haematological malignancies unless used for Diffuse large
Enamel microabrasion. B-cell lymphoma in which event DSP applies (unless PMB level of care,
Dental procedures or devices which are not regarded by the relevant DSP applies);
Managed Healthcare Programme as clinically essential or clinically Liposomal amphotericin B for fungal infections (unless PMB level of care,
desirable; DSP applies);
General anaesthetics, moderate/deep sedation and hospitalisation for Protein C inhibitors, for septic shock and septicaemia (unless PMB level of
dental work, except in the case of patients under the age of 6 years or care, DSP applies);
with bony impaction of the third molars/impacted/wisdom teeth, no Any specialised drugs that have not convincingly demonstrated a survival
benefit; advantage of more than 3 months in metastatic malignancies in all
General anaesthetics, moderate/deep sedation and hospitalisation for organs for example sorafenib for hepatocellular carcinoma, bevacizumab
dental work, except in the case of patients under the age of 6 years or for colorectal and metastatic breast cancer (unless PMB level of care,
with bony impaction of the third molars, no benefit; DSP applies). Avastin for the treatment of Macular Degeneration is not
All general anaesthetics and moderate/deep sedation in the practitioner’s excluded, however DSP applies;
rooms, unless pre-authorised. Lucentis, Eylea and Ozurdex for the treatment of Vitreoretinal conditions is
not excluded, unless stipulated in Annexure B (DSP applies);
Hospitalisation Trastuzumab for the treatment of HER2-positive early breast cancer that
If application for a pre-authorisation reference number (PAR) for a clinical exceeds the dose and duration of the 9 week regimen as used in ICON
procedure, treatment or specialised radiology is not made or is refused, protocol (unless PMB level of care, DSP applies);
no benefits are payable; Trastuzumab for the treatment of metastatic breast cancer (unless PMB
Accommodation and services provided in a geriatric hospital, old age level of care or included in the ICON protocol applicable to the member’s
home, frail care facility or similar institution (unless specifically provided for option, DSP applies).
in Annexure B) (unless PMB level of care, then specific DSP applies); Medicines not included in a prescription from a medical practitioner or
Nursing services or frail care provided other than in a hospital shall only be other Healthcare Professional who is legally entitled to prescribe such
available if pre-authorised by a Managed Health Care Provider; medicines (except for schedule 0,1 and 2 medicines supplied by a
Frail care services shall only be considered for pre-authorisation if certified registered pharmacist);
by a medical practitioner that such care is medically essential and such Medicines for intestinal flora;
services are provided through a registered frail care centre or nurse; Medicines defined as exclusions by the relevant Managed Healthcare
Hospice services shall only be paid for if provided by an accredited Programme;
member of the Hospice Association of Southern Africa and if Medicines and chemotherapeutic agents not approved by the SAHPRA
pre-authorised by a Managed Health Care Provider; (South African Health Products Regulatory Authority) unless Section
21 approval is obtained and pre-authorised by the relevant Managed
Healthcare Programme;

29
2023 Benefit Guide

Medicines not authorised by the relevant Managed Healthcare Scheme;

Programme; International donor search costs for transplants.
Patent medicines, household remedies and proprietary preparations and
preparations not otherwise classified; Additional Medical Services
Slimming preparations for obesity; Art therapy.
Smoking cessation and anti-smoking preparations unless pre-authorised
by the relevant Managed Healthcare Programme; Pathology
Tonics, evening primrose oil, fish liver oils, multi-vitamin preparations Exclusions as per the Schemes Pathology Management Programme;
and/or trace elements and/or mineral combinations except for registered Allergy and Vitamin D testing In-Hospital;
products that include haemotinics and products for use for: Gene Sequencing.
Infants and pregnant mothers;
Malabsorption disorders; Physical Therapy (Physiotherapy, Chiropractics
HIV positive patients registered on the relevant Managed Healthcare and Biokinetics)
Programme. X-rays performed by Chiropractors;
Biological Drugs, except for PMB level of care and when provided Biokinetics and Chiropractics In-Hospital.
specifically in Annexure B. (DSP applies);
All benefits for clinical trials unless pre-authorised by the relevant Prostheses and Devices Internal and External
Managed Healthcare Programme; Cochlear implants (Processors speech, Microphone headset, audio input
Diagnostic agents, unless authorised and PMB level of care; selector), auditory brain implants (lost auditory nerves due to disease)
Growth hormones, unless pre-authorised (unless PMB level of care, DSP unless specifically provided for in Annexure B;
applies); Osseo-integrated implants for dental purposes to replace missing teeth,
Immunoglobulins and immune stimulents, oral and parenteral, unless pre- unless specifically provided for in Annexure B or PMB specific DSP
authorised (unless PMB level of care, DSP applies); applies;
Erythropoietin, unless PMB level of care; Drug eluting stents, unless Prescribed Minimum Benefits level of care
Medicines used specifically to treat alcohol and drug addiction. Pre- (DSP applies);
authorisation required (unless PMB level of care, DSP applies); Covered aortic stents, unless Prescribed Minimum Benefits level of care
Imatinib mesylate (Gleevec) (unless PMB level of care, DSP applies); (DSP applies);
Nappies and waterproof underwear; Peripheral vascular stents, unless Prescribed Minimum Benefits level of
Oral contraception for skin conditions, parentaral and foams. care (DSP applies);
TAVI procedure – transcatheter aortic –valve implantation. The procedure
Mental Health will only be funded up to the global fee calculated amount as stated in the
Sleep therapy, unless provided for in the relevant benefit option. Annexure B, for the equivalent of PMB level of care. (open Aortic valve
replacement surgery);
Non-Surgical Procedures and Tests Implantable Cardioverter Defibrillators (unless PMB level of care, DSP
Epilation – treatment for hair removal (excluding Opthalmology); applies);
Hyperbaric oxygen therapy except for anaerobic life threatening Mirena device In-Hospital, (if protocols/criteria has been met, the
infections, Diagnosis Treatment Pairs (DTP) 277S and specific conditions Scheme will pay at Scheme Tariff only for the device and its insertion in
pre-authorised by the relevant Managed Healthcare Programme and at a the practitioners’ rooms. The Scheme will not be liable for theatre costs
specific DSP; related to the insertion of the device);
Conservative Back and Neck Treatment; Custom-made hip arthroplasty for inflammatory and degenerative
Nail Disorders; joint disease unless authorised by the relevant Managed Healthcare
Investigations and diagnostic work-up unless stipulated in 3.4.6 or Programme;
specified in Annexure B; Internal Nerve Stimulators.
Healthcare services (including scans and scopes) that should be done
Out-of-Hospital and for which an admission to hospital is not necessary. Radiology and Radiography
MRI scans ordered by a General Practitioner, unless there is no
Optometry reasonable access to a Specialist;
Plano tinted and other cosmetic effect contact lenses (other than PET (Positron Emission Tomography) or PET-CT for screening (unless
prosthetic lenses) ,and contact lens accessories and solutions; PMB level of care, DSP applies);
Optical devices which are not regarded by the relevant Managed Bone densitometry performed by a General Practitioner or a Specialist not
Healthcare Programme, as clinically essential or clinically desirable; included in the Scheme credentialed list of specialities;
OTC sunglasses and related treatment lenses, example wrap-around CT colonography (virtual colonoscopy) for screening (unless PMB level of
lenses, polarised lenses and outdoor tints; care, DSP applies);
Contact lens fittings; MDCT Coronary Angiography and MDCT Coronary Angiography for
Radial Keratotomy/Excimer Laser/Intra-ocular Lens, unless otherwise screening (unless PMB level of care, DSP applies);
indicated in the Annexure B, no benefits shall be paid unless the refraction CT Coronary Angiography (unless PMB level of care, DSP applies);
of the eye is within the guidelines set by the Board from time to time. The If application for a pre-authorisation reference number (PAR) for
member shall submit all relevant medical reports as may be required by specialised radiology procedures is not made or is refused, no benefits
the Scheme in order to validate a claim; are payable;
Exclusions as per the Schemes Optical Management Programme. All screening that has not been pre-authorised or is not in accordance
with the schemes policies and protocols.
Organs, Tissue and Haemopoietic Stem Cell (Bone Marrow)
Transplantation and Immunosuppressive Medication Surgical Procedures
Organs and haemopoietic stem cell (bonemarrow) donations to any Abdominoplasties and the repair of divarication of the abdominal muscles
person other than to a member or dependant of a member on this (unless PMB level of care, DSP applies);

30
 MediCurve

Gynaecomastia; Items not mentioned in Annexure B

Blepharoplasties and Ptosis unless causing demonstrated functional Appointments which a beneficiary fails to keep;
visual impairment and pre-authorised (unless PMB level of care, DSP Autopsies;
applies); Cryo-storage of foetal stemcells and sperm;
Breast augmentation; Holidays for recuperative purposes, accommodation in spa’s, health
Breast reconstruction unless mastectomy following cancer and pre- resorts and places of rest, even if prescribed by a treating provider;
authorised within Scheme protocols/guidelines (unless PMB level of care, Travelling expenses & accommodation (unless specifically authorised for
DSP applies); an approved event);
Breast reductions, Benign Breast Disease; Veterinary products;
Erectile dysfunction surgical procedures; Purchase of medicines prescribed by a person not legally entitled thereto;
Gender reassignment medical or surgical treatment; Exams, reports or tests requested for insurance, employment, visas
Genioplasties as an isolated procedure (unless PMB level of care, DSP (Immigration or travel purposes), pilot and drivers licences, and school
applies); readiness tests.
Keloid surgery, except following severe burn scars on the face and neck, SmartCare Clinics - Private Nurse Practitioner has the following
for functional impairment such as contractures and excision of a tattoo exclusions:
(unless PMB level of care, DSP applies);skin disorders (life threatening/ No children under the age of 2 may be seen for anything other than a
non-life threatening) including benign growths; prescription for a routine immunisation;
Obesity – surgical treatment and related procedures e.g. bariatric surgery, No consultations related to mental health;
gastric bypass surgery and other procedures (unless PMB level of care, No treatment of emergency conditions involving heavy bleeding and/or
DSP applies); trauma;
Otoplasty, pre-certification will only be considered for otoplasty performed No treatment of conditions involving sexual assault;
on beneficiaries who are under the age of 13 years upon submission of a SmartCare services cannot provide Schedule 5 and up medication.
medical motivation and approval by the Scheme. No benefit is available Pharmaceutical Electronic Standards Authority
for otoplasty for any beneficiary who is 13 years or older; Pharmacy Product Management Document listing the PESA Exclusions
Pectus excavatum / carinatum (unless PMB level of care, DSP applies); Categories, refer to MSD-C1-2021-003.
Refractive surgery, unless specifically provided for in Annexure B;
Revision of scars, except following burns and for functional impairment
(unless PMB level of care, DSP applies);
Rhinoplasties for cosmetic purposes (unless PMB level of care, DSP
applies);
Uvulo palatal pharyngoplasty (UPPP and LAUP) (unless PMB level of care,
DSP applies);
All costs for cosmetic surgery performed over and above the codes
authorised for admission (unless PMB level of care, DSP applies);
Joint replacement including but not limited to hips, knees, shoulders and
elbows, unless Prescribed Minimum Benefits level of care, DSP applies;
Back and Neck surgery, unless PMB level of care, DSP applies);
Rhizotomies, Kyphoplasties, Vertebroplasties and Facet Pain Blocks,
subject to Managed Care Protocols. Prosthesis for spinal procedures paid
up to the value of PMB level of care, where applicable, unless PMB level
of care, DSP applies);
Varicose veins, surgical and medical management (unless PMB level of
care, DSP applies);
Arthroscopy for osteoarthritis (unless PMB level of care, DSP applies);
Portwine stain management, subject to application and approval, laser
treatment will be covered for portwine stains on the face of a beneficiary
who is 2 years or younger;
Circumcision In-Hospital except for a new born or child under 12 years,
subject to Managed Care Protocols;
Prophylactic Mastectomy (unless PMB level of care, DSP applies);
Surgery for oesophageal reflux and hiatus hernia, unless PMB level of
care, DSP applies);
Correction of Hallux Vulgus and Bunionectomy;
Endoscopic and Laparoscopic Surgery;
Endoscopic Surgery and Laparoscopic Surgery unless specifically
provided for in the Annexure B, section D13 - Routine Diagnostic
Endoscopic Procedures;
All cosmetic treatment including but not limited to septoplasties,
osteotomies and nasal tip surgery functional nasal problems and
functional sinus problems;
Da Vinci Robotic assisted Radical surgery, including radical
prostatectomy, additional costs relating to use of the robot during
such surgery, and including additional fees pertaining to theatre time,
disposables and equipment fees remain excluded;
Balloon sinuplasty.

31
 MediCurve

Directory of Medshield MediCurve Partners

SERVICE PARTNER CONTACT DETAILS
Ambulance and Emergency Netcare 911 Contact number: 086 100 6337 (+27 10 209 8011)
Services for members outside of the borders of South Africa
Chronic Medicine Mediscor Contact number: 086 000 2120 (Choose relevant option) or contact
Authorisations and Medicine +27 10 597 4701 for members outside the borders of South Africa
Managem ent Facsimile: 0866 151 509 Authorisations: medshieldauths@mediscor.co.za
Dental Authorisations Denis Contact number: 086 000 2121 (+27 11 671 2011)
for members outside of the borders of South Africa
- Crowns/Bridges and Dental Implant Authorisations
email: crowns@denis.co.za
- Periodontic Applications email: perio@denis.co.za
- Orthodontic Applications email: ortho@denis.co.za
- Plastic Dentures email: customercare@denis.co.za
In-Hospital Dental Authorisations email: hospitalenq@denis.co.za
Disease Management Medscheme Contact number: 086 000 0376
Programme Facsimile: +27 10 597 4706 email: diseasemanagement@medshield.co.za
Diabetes Care Programme Medshield Contact number: 086 000 2120 (+27 10 597 4701)
for members outside the borders of South Africa
Facsimile: +27 10 597 4706
email: Diabetesdiseasemanagement@medshield.co.za
Disease Management Care Mediscor Contact number: 086 000 2120 (+27 10 597 4701)
Plans for members outside of the borders of South Africa
Facsimile: +27 10 597 4706 email: pmbapplications@medshield.co.za
HIV and AIDS Management HaloCare Contact number: 086 014 3258 (Mon - Fri: 07h30 to 16h00)
Facsimile: +27 086 570 2523 email: medshield@halocare.co.za
HIV Medication Designated Pharmacy Direct Contact number: 086 002 7800 (Mon to Fri: 07h30 to 17h00)
Service Provider (DSP) Facsimile: 086 611 4000/1/2/3 email: care@pharmacydirect.co.za
Hospital Authorisations Medscheme Contact number: 086 000 2121 (+27 11 671 2011)
for members outside of the borders of South Africa
email: preauth@medshield.co.za
Hospital Claims Medscheme Contact number: 086 000 2121 (+27 11 671 2011)
for members outside of the borders of South Africa
email: hospitalclaims@medshield.co.za
Oncology Disease ICON and Medscheme Contact number: 086 000 2121 (+27 11 671 2011)
Management Programme for members outside of the borders of South Africa
(for Cancer treatment) email: oncology@medshield.co.za
Medshield has partnered with the Independent Clinical Oncology Network
(ICON) for the delivery of Oncology services. Go to the ICON
website: www.cancernet.co.za for a list of ICON oncologists
Optical Services Iso Leso Optics Contact number: 086 000 2120 (+27 10 597 4701)
for members outside of the borders of South Africa
Facsimile: +27 11 782 5601 email: member@isoleso.co.za

Complaints Escalation Process Fraud

In the spirit of promoting the highest level of professional and Fraud presents a significant risk to the Scheme and
ethical conduct, Medshield Medical Scheme is committed to members. The dishonesty of a few individuals may
a complaint management approach that treats our members negatively impact the Scheme and distort the principles and
fairly and effectively in line with our escalation process. trust that exist between the Scheme and its stakeholders.
Fraud, for practical purposes, is defined as a dishonest,
In the event of a routine complaint, you may call Medshield
unethical, irregular, or illegal act or practice which is
at 086 000 2120 and request to speak to the respective
characterised by a deliberate intent at concealment of
Manager.
a matter of fact, whether by words, conduct, or false
Complaints can be directed via email to representation, which may result in a financial or non-
complaints@medshield.co.za, which directs the complaint to financial loss to the Scheme. Fraud prevention and control
the respective Manager. The complaint will be dealt with in line is the responsibility of all Medshield members and service
with our complaints escalation procedure in order to ensure fair providers so if you suspect someone of committing fraud,
and timeous resolution. report it to us immediately.

Medshield Banking Details Hotline: 0800 112 811

Bank: Nedbank | Branch: Rivonia email: fraud@medshield.co.za
Branch code: 196905 | Account number: 1969125969

33
2023 Benefit Guide

NOTES

34
 MediCurve

NOTES

35
2023 Benefit Guide

Medshield Head Office

5th - 7th Floor, 192 Bram Fischer Drive (Entrance on Sneddon Street), Ferndale, Randburg, 2196
email: member@medshield.co.za
Postal Address: PO Box 4346, Randburg, 2125

Medshield Regional Offices

Bloemfontein Medshield Contact Centre
Suite 13, Office Park, 149 President Reitz Ave, Westdene Contact number: 086 000 2120 (+27 10 597 4701)
email: medshield.bloem@medshield.co.za for members outside the borders of South Africa.
Facsimile: +27 10 597 4706,
Durban
email: member@medshield.co.za
Unit 4A, 95 Umhlanga Rocks Drive, Durban North
email: medshield.durban@medshield.co.za East London
Unit 3, 8 Princes Road, Vincent
Cape Town
email: medshield.el@medshield.co.za
Podium Level, Block A, The Boulevard,
Searle Street, Woodstock Port Elizabeth
email: medshield.ct@medshield.co.za Unit 3 (b), The Acres Retail Centre,
20 Nile Road, Perridgevale
email: medshield.pe@medshield.co.za

Disclaimer
This brochure acts as a summary and does not supersede the Registered Rules of the Scheme.
All benefits in accordance with the Registered Rules of the Scheme. Terms and conditions of
membership apply as per Scheme Rules. Pending CMS approval. September 2022.
An Authorised Financial Services Provider (FSP 51381)

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