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Medihelp

Medihelp

Maximise your benefit - Visit an In Network Provider

Your benefits are contractually better at a network provider - Scheme rules apply

To confirm that you or a dependent is entitled to optical benefit, SMS your request to 45119 with the following details:

Benefit,MembershipNumber,Surname,BirthDateDependent,MainMemberID,DependantNumber, UniqueMedicalAid Key

Example: SMS 45119 Message details: Benefit 277323232 Botha 19721220 7212205065089 0 55

Important information:

Replace each comma with a space in your SMS and ensure the details are accurate and only one space is between each requirement. Kindly make sure the birthdate is in the correct format as per the example. The information will return within 1 minute on a new SMS. The full benefit breakdown per dependent is available by logging in to the PPN website or a guideline is given below. Your schemes unique medical key is 55.

MedAdd Elect (Prime 2)

2022 Optical Benefit:

Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.

Member can claim either Spectacles OR Contact Lenses

Forensic protocols and AI screening included in design

The benefits are a guideline and scheme rules apply

Negotiated Tariff : PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)

Network: One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
OR
Out of Network: Refraction to the value of R350

IN NETWORK : Frame and Lens Enhancement benefit up to the value of R 275
OR
OUT OUR NETWORK/REFUND VALUE : Frame and Lens Enhancement benefit up to the value of R 206
AND
One pair of either Single Vision or Bifocal clear standard lenses

Contact lenses: R 650 per beneficiary

MedElect (Necesse)

2022 Optical Benefit:

Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.

Member can claim either Spectacles OR Contact Lenses

Forensic protocols and AI screening included in design

The benefits are a guideline and scheme rules apply

Negotiated Tariff : PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)

Network: One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
OR
Out of Network: Refraction to the value of R350

  • IN NETWORK : Frame and Lens Enhancement benefit up to the value of R 550
OR
  • OUT OF NETWORK/REFUND VALUE : Frame and Lens Enhancement benefit up to the value of R 413
AND
  • One pair of either Single Vision or Bifocal clear standard lenses

Contact lenses: R 750 per beneficiary

MedElite (Elite)

2022 Optical Benefit:

Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.

Member can claim either Spectacles OR Contact Lenses

Forensic protocols and AI screening included in design

The benefits are a guideline and scheme rules apply

Negotiated Tariff : PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)

Network: One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
OR
Out of Network: Refraction to the value of R350
  • IN NETWORK : Frame and Lens Enhancement benefit up to the value of R 1 000
OR
  • OUT OF NETWORK/REFUND VALUE : Frame and Lens Enhancement benefit up to the value of R 750
AND
  • One pair of either Single Vision or Bifocal or Multifocal clear standard lenses

Contact lenses: R 1 680 per beneficiary

MediPlus (Plus)

2022 Optical Benefit:

Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.

Member can claim either Spectacles OR Contact Lenses

Forensic protocols and AI screening included in design

The benefits are a guideline and scheme rules apply

Negotiated Tariff : PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)

Network: One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
OR
Out of Network: Refraction to the value of R350

  • IN NETWORK : Frame and Lens Enhancement benefit up to the value of R 1 000
OR
  • OUT OF NETWORK/REFUND VALUE : Frame and Lens Enhancement benefit up to the value of R 750
AND
  • One pair of either Single Vision or Bifocal or Multifocal clear standard lenses

Contact lenses: R 1 680 per beneficiary

MedMove

2022 Optical Benefit (NEW EDO):

Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.

Forensic protocols and AI screening included in design

The benefits are a guideline and scheme rules apply

Negotiated Tariff : PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)

Member to pay cash for materials, claim to be submitted to the scheme for Tax purposes

Network: One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
OR
Out of Network: Refraction to the value of R350

Co-payment: Member is liable for a co-payment of R110 on the consultation in and out of network

In Network : Spectacles at Scheme rate

Out of Network: Spectacles at Industry rate

Member to pay cash for materials, claim to be submitted to the scheme for Tax purposes

In Network : Contact Lenses at Scheme rate

Out of Network: Contact Lenses at Industry rate

Member to pay cash for materials, claim to be submitted to the scheme for Tax purposes

MedPrime Elect (Prime 3)

2022 Optical Benefit:

Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.

Member can claim either Spectacles OR Contact Lenses

Forensic protocols and AI screening included in design

The benefits are a guideline and scheme rules apply

Negotiated Tariff : PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)

Network: One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
OR
Out of Network: Refraction to the value of R350

  • IN NETWORK : Frame and Lens Enhancement benefit up to the value of R 800
OR
  • OUT OF NETWORK/REFUND VALUE : Frame and Lens Enhancement benefit up to the value of R 600
AND
  • One pair of either Single Vision or Bifocal clear standard lenses

Contact lenses: R 1 200 per beneficiary

Find your nearest PPN optometrist