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Medihelp

Why choose Medihelp?

Medihelp strives to meet the needs of their customers. 

  • Medihelp has a state of the art call centre that logs all calls and handles more than 3500 calls per day assisting their members with the best possible service.
  • All communication whether written or electronically is subject to quality control ensuring that Medihelp offers the best and sufficient service.
  • Medihelp has offices in Pretoria, Cape Town, Bloemfontein, Durban and Port Elizabeth.
  • Communication with Medihelp members include personalised letters, e-mails, SMSs, a free health magazine called élan, newsletters, summarised statements, and even regional information sessions which members can attend.
  • Medihelp has custom IT systems in place that allows all electronic documents to be managed in an orderly work flow.
  • An internal audit team provides independent and objective assurance and consulting services to the scheme. The internal audit team audits the scheme’s risk management, control and governance processes.
  • A forensic audit team is involved in the implementation of the scheme’s anti-fraud strategy and investigates all cases of suspected fraud and abuse.
  • For members that are visually impaired Medihelp sends tailor-made e-statements.
  • Medihelp’s website offers a wealth of information and services with a secure login that allows members to login and conduct their Medihelp business on-line.
  • Claims can be easily submitted via Medihelp’s website in scanned format.
  • Summarised statements can be received either by mail or e-mail.
  • Medihelp offers a choice between English and Afrikaans as their preferred language. Members can receive all communication in their language of choice.
  • To corporate clients, Medihelp offers a dedicated Client Relations Consultant to assist the Human Resources departments, individual employees as well as the appointed healthcare consultants like Care Line Group.

Medihelp medical scheme measures there success in terms of:

  • Experience: Experience within the medical aid industry is invaluable in predicting claims trends, honing administrative skills, and dealing with the many challenges of providing sustainable and affordable healthcare cover. Medihelp has been in the medical aid business for 106 years, and has been an open scheme since 1992
  • Size: Medihelp is the third-largest open medical scheme in South Africa, they have 246,106 members. 
  • Financial stability: Medihelp’s consistent financial performance shows than there is adequate provision for payment of claims. Medihelp concluded the 2010 financial year with a solvency ratio of 27.48% which is well above the required rate of 25% as prescribed by the Council for Medical Schemes. Medihelp’s culminated in a net surplus of R26,8 million in 2010.
  • Claims payment: The independent ratings company Global Credit Rating once again awarded Medihelp’s claims-paying ability with an AA- rating, one of the highest ratings in the industry.
  • Administrative costs: Medihelp’s administrative cost as a percentage of gross contribution income has consistently been below the industry average, which means that members get more healthcare cover for every rand they contribute. Healthcare expenses constitute a highly competitive 90,6% of subscriptions received.
  • Customer satisfaction: a Customer Service Index survey conducted by Consulta proofed that Medihelp has consistently been rated among the best in terms of client service. 
  • Product offering and performance: Competitive pricing and benefits give our members access to good quality private healthcare. Medihelp’s product range consists of benefit options designed to make provision for different life stages and needs.
  • Employee satisfaction: Medihelp believes that contented employees render excellent service. In Deloitte and the Financial Mail’s Best Company to Work For survey, Medihelp took 7th place in the medium-sized company’s category in 2009.

Medihelp invites anybody that would like to attend to a regional information session and their annual general meeting date and times are available on Medihelp’s website.

Medihelp has a board of trustees that is elected by members; the trustees have impressive careers in a variety of fields and represent the public service as well as private sector.
Chairperson: Mr Chris Klopper
Vice chairperson: Mr Pieter Vosloo
Mr Ernst du Preez
Dr Hester Vosloo
Prof Tien van Staden
Me Elsabé Malan

Mission and values of Medihelp Medical Scheme

Medihelp’s mission

Their mission is to enhance quality of life through the cost-effective and efficient financial cover of healthcare services, in particular those that are life-saving and life-sustaining.

Medihelp’s values

Their values guide the way they do business within the scheme…

They are strategy-focused

Clarity of thought and insight allow them to focus on what really matters to their business

They are competitive

Their unique business approach and entrepreneurial spirit allow each of them to take ownership of and create new opportunities

They build relationships

Listening to and understanding their customers allow them to provide compassionate service, enabling them to meet and exceed expectations

They constantly look for ways to improve

Their belief in the value of continuous improvement drives them to be always learning, enterprising and striving for success

They live their brand

They are committed to deliver their brand in everything they do – experiencing a fresh sense of self

Medihelp offers plans that is affordable and has applicable benefits. 

Necesse (network option)

  • This primary care option focuses on making private healthcare services accessible to more South Africans
  • Subscription for this option is based on income
  • Proof of income must be provided in order to qualify for one of the lower income categories
  • Most healthcare services are provided by specific network doctors or providers
  • Formularies, protocols and a pre-authorisation or registration process apply to most services
  • Benefits are subject to an overall annual limit of R800,000 per family per year, with sub-limits applicable to some services

Dimension Prime 1

Dimension Prime 2

Dimension Prime 3

 

 

 

  • Your health determines your quality of life. Maintaining your health and making provision for the best care when you or your loved ones need it, is important. That’s why it is essential to invest in your future by partnering with a medical scheme that offers you access to the best quality private healthcare.

Dimension Elite

 

  • Dimension Elite is the top option in the Dimension range and offers ample benefits for families and individuals who prefer to provide for their extensive day-to-day healthcare needs by means of insured benefits. The option also offers comprehensive cover for medical emergencies and hospitalisation. Add to that the preventative care benefits of the health and benefit booster and you can rest assured that your family’s health is in good hands.

Major medical benefits
(not applicable on Necesse option) 

  • Private hospital cover – with no overall annual limit
  • Freedom of choice of private hospital Trauma recovery benefits
  • Benefits for trauma that necessitates hospitalisation 
  • Post-exposure prophylaxis in the event of sexual assault or accidental exposure to HIV

Prescribed Minimum Benefits (PMB)
Cover for the diagnosis, treatment and care costs of 270 PMB and 26 chronic conditions on the Chronic Diseases List (CDL)

Emergency medical services (EMS)
(not applicable on Necesse option) 
Unlimited emergency medical services within the borders of the RSA 

Day-to-day benefits
The day-to-day benefits per option vary to suit different needs

Preventative care
Health and benefit booster
(not applicable on Necesse option)
The health and benefit booster offers a basket of preventative and additional care benefi ts, augmenting members’ insured day-to-day benefits

*Immunisations 

  • Standard immunisation for children younger than 7 years (vaccine only)
  • Flu vaccination; 1 per beneficiary per year
  • Tetanus vaccine; 1 per beneficiary per year (Subject to protocols)
  • HPV vaccine; 1 per beneficiary per year(Subject to protocols)(Females between 10 and 26 years)

*Health tests

  • Pap smear – pathology; 1 per beneficiary per year (40 years and older)
  • Blood sugar test – pathology; 1 per beneficiary per year (40 years and older)
  • Cholesterol test – pathology; 1 per beneficiary per year (40 years and older)
  • Standard mammogram – radiology; 1 per beneficiary per year (Females 40 years and older)
  • Prostate test – pathology; 1 per beneficiary per year (40 years and older)
  • HIV rapid test; 1 per beneficiary per year, Subject to protocols (15 years and older)

Additional benefits

  • Pregnancy consultations; 12 per family per year
  • Pregnancy sonar’s (2D); 2 per family per year
  • Paediatric consultations; 2 visits in baby’s first year
  • Back treatment programme; At a Medihelp appointed facility within reasonable proximity as a prerequisite for spinal column surgery Subject to protocols and pre-approval 1 programme per beneficiary per year

*Benefits are provided at 100% of the contracted/scheme tariff and do not include the consultation fee, which will be paid from the available day-to-day benefits where applicable.

Medihelp gives back.

Medihelp’s corporate social investment strategy focuses on the funding of programmes and projects that offer disadvantaged communities access to sustainable healthcare services. Medihelp hopes to also make a positive contribution to the education of children by preparing them for school and to support projects which may be emulated in other communities.

Projects they are involved in:

The Darling Trust
www.thedarlingtrust.org

Medihelp first became involved with the Darling Trust in 2009 – an initiative that focuses on the needs of residents in the Darling area in the Western Cape who are affected by HIV/Aids, among others. The first project undertaken as part of this initiative was to build a healthcare, education and sports centre. During the first phase of the project, a community swimming pool was built – the first in Darling – and was completed in February 2010. Further plans include the upgrading of the existing clinic that renders primary healthcare services to the community and is located on the same site as the centre.

The beds of hope campaign
www.bedsofhope.ufs.ac.za

Medihelp donated funds to the University of the Free State to purchase a three-dimensional heart sonar programme, the first of its kind in South Africa, in 2009. This donation forms part of the university’s Beds of Hope campaign, which aims to help underprivileged children who undergo open-heart surgery. The heart sonar programme is specifically designed for the post-operative treatment of cardiac patients and is used instead of expensive MRI scans, which are difficult to use on children.

Medihelp decided to support the Beds of Hope campaign because more than a million children depend on the tertiary care provided by the Universitas and Pelonomi hospitals. These children come from all over the Free State and Northern Cape, and also from the North West, the Eastern Cape and Lesotho.

Source of article information www.medihelp.co.za

Care Line Group is a Medihelp Broker and can assist you in signing up with Medihelp.
Click Here to full in  our on-line medical aid quote form and one of our friendly consultants will contact you as soon as possible. 

 

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the financial services board and the council for medical schemes
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