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Targeted at members requiring hospital cover primarily. The extensive in and out of hospital benefits are for PMB conditions/treatment only with some value-added benefits and 26 Chronic conditions. Members on the Hospicare Network option can enjoy significant savings on their monthly contributions and still enjoy comprehensive benefits.


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MHC’s philosophy is to provide quality, comprehensive healthcare while maintaining affordable contributions. In order to strike the necessary balance to achieve our philosophy, it is necessary to introduce DSPs. In this way, MHC can contain spiralling healthcare costs but nevertheless ensure that members receive the most appropriate treatment.

Members may choose not to use the DSP but will be liable for any co-payment over and above what is charged by the DSP.


Not sure what we mean? Refer to glossary on page 77 of the Member Guide.

Day-to-day As part of an approved treatment plan
General practitioners (GPs) and specialists 271 DTPs; PMB treatment only
Specialists subject to preferred provider rates
Network provider
Co-payment for non-formulary medicine
Co-payment for non-network provider

271 DTPs; PMB treatment only
26 conditions (see page 51 of Member Guide)
Scheme’s pharmacy network

Non-CDL chronic medicine limit 271 DTPs; PMB treatment only
Optometry 271 DTPs; PMB treatment only
Dentistry Basic and specialised 271 DTPs; PMB treatment only
Auxiliary services 271 DTPs; PMB treatment only


Free Hello Doctor consults

Telephonic consults via HELLO DOCTOR. Talk or text a doctor on your phone, anytime, anywhere, in any official language – for free Refer to page 10 for detailed information


• 12 antenatal visits
• Two 2D scans per pregnancy
• 3D and 4D scans are paid up to the rate of 2D scans.
• Two paediatric visits
• Pregnancy related vitamins

Medical and surgical appliances 271 DTPs; PMB treatment only
Hearing aids 271 DTPs; PMB treatment only
Mental health 271 DTPs; PMB treatment only
Child immunisations Up to the age of 6 years, as per Department of Health protocols
Patient care programmes (Diabetes, HIV, oncology) Subject to registration and managed care protocols


IMPORTANT: Treatment performed in-hospital or falls within the Major Medical Benefits needs to be pre-authorised prior to commencement of treatment. Conditions such as cancer will require you to register onto the Patient Care Programme to access benefits. MHC will pay benefits in accordance with the Scheme Rules and clinical protocols per condition. The sub-limits specified below apply per year. If you join the Scheme after January your limits will be pro-rated.
All services are subject to preauthorisation and managed care protocols Any hospital – PMBs only
Public and private hospital Unlimited – PMBs only
GPs and specialists 271 DTPs; PMB treatment only
To-take-out medicine Up to 7 days
Organ transplant* Unlimited – PMBs only
Prostheses Unlimited – PMBs only
Reconstructive surgery Unlimited – PMBs only
MRI, CT, PET and radio isotope scans Unlimited – PMBs only
Alternate care instead of hospitalisation Unlimited – PMBs only Subject to clinical protocols and pre-authorization
Mental health 100% of Scheme rate subject to managed care protocols
Alcohol and drug rehabilitation 100% of negotiated rate, at a South African National Council on Alcoholism and Drug Dependence (SANCA)-approved facility. Subject to managed care protocols
Dialysis Unlimited – PMBs only
Oncology Treatment covered at DSP rates if a network provider is used Unlimited – PMBs only
Pathology and radiology Unlimited – PMBs only
Ambulance transportTreatment covered at DSP rates if a network provider is used Road and air transportation
PMB Only
Subject to use of preferred provider,
clinical protocols and pre-authorization
Only the 7 non-PMB procedures listed are covered in hospital at a network provider and is paid at the Scheme rate Tonsillectomy
Basic dentistry – up to the age of 8
Carpal tunnel
Varicose veins

*Organ transplant benefit includes:

  • Heart, liver and kidney transplants, including harvesting and transportation costs
  • Corneal transplant, including harvesting and transportation costs

All requests will be subject to clinical protocols and use of a national donor only.


Unless stated Non-PMB procedures in hospital

All non-PMB general exclusions as set out in the Annexure D of the Rules

All non-PMB dental exclusions as set out in Annexure F of the Rules