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MediPhila - Medshield

12020 BENEFIT GUIDEB enefit adjustments are pending CMS 20202020 BENEFIT GUIDE2 MediPhilaMediPhila ContentsAn overview of the benefits offeredAbout MediPhilaInformation members should take note ofHow your claims will be coveredOnline Services In-Hospital benefit access guideCo-paymentsIn-Hospital BenefitsMaternity BenefitsOncology BenefitsChronic Medicine BenefitsDentistry BenefitsOut-of-Hospital BenefitsDay-to-Day BenefitsWellness BenefitsSmartCare Ambulance ServicesMonthly ContributionsPrescribed Minimum Benefits (PMB)Contact detailsBanking DetailsFraudComplaints Escalation ProcessAddendums Exclusions34455691013 14 1415 16 17 192021212326262626273332020 BENEFIT GUIDEThis is an overview of the benefits offered on the MediPhila option:Major Medical Benefits (In-Hospital) Unlimited PMB subject to services being obtained in line with the Scheme s approved protocols Specified limit for non-PMB services, obtained in line with th

Provider and formularies will apply. Any medication outside of the formulary will attract a 40% co-payment. ... procedure prior to hospital admission according to clinical protocols and guidelines. The following information is required when requesting pre-authorisation for hospitalisation • Membership number

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