medihelp products 2012

Dimension Prime 1

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.

What makes the Dimension Prime 1 benefit option unique?

  • Private hospitalisation
  • Dependent children under 26 pay subscription for child dependants
  • You pay for maximum two children
  • Preventative care benefits - health and benefit booster

R930 / pm

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Monthly contribution

 
Member Subscription
Principle member R930
Adult dependant R756
Child dependant younger than 26 years R276 (you pay for maximum two children)

Preventative care - Health and benefit booster

 
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
Subject to protocols
(Females between 10 and 26 years)
Health tests*
Pap smear – pathology (item code 4566)
1 per beneficiary per year
Blood sugar test – pathology (item code 4057)
1 per beneficiary per year
(40 years and older)
Cholesterol test – pathology (item code 4027)
1 per beneficiary per year
(40 years and older)
Standard mammogram – radiology (item code 3605/39175/34100/34101)
1 per beneficiary per year
(Females 40 years and older)
Prostate test – pathology (item code 4519)
1 per beneficiary per year
(40 years and older)
HIV rapid test (in addition to PMB)
1 per beneficiary per year
Subject to protocols
(15 years and older)
Additional benefits
Pregnancy consultations
12 per family per year
Pregnancy sonars (2D)
2 per family per year
Paediatric consultations
2 visits in baby’s first year
Back treatment programme at a Medihelp appointed facility 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.

Major medical benefits

 
Description Benefit
HOSPITALISATION
(government and private hospitals and day clinics)
Subject to pre-registration, pre-authorisation, protocols and case management 
  • Intensive and high care wards
  • Ward accommodation
  • Theatre fees
  • Visits, treatment and ward medicine
  • Surgery and anaesthesia
100% of the contracted/scheme  tariff/medicine
price
Procedure-specific co-payments may apply (non-PMB cases)
Unlimited 20% co-payment if not pre-authorised
ORGAN TRANSPLANT
 CONFINEMENT
HYSTERECTOMY 100% of the  contracted/scheme tariff
Unlimited
R2,700 co-payment per admission
ENDOMETRIAL ABLATION  100% of the contracted/scheme tariff  
R4,250 co-payment per admission 
ONCOLOGY (SAOC NETWORK - ONCOPRIME PROTOCOL)
Subject to pre-authorisation
  • Surgery and hospitalisation
  • Chemotherapy and radiotherapy (PMB cases)
    During and not during hospitalisation
100% of the scheme tariff/cost
Unlimited
  • Chemotherapy and radiotherapy (non-PMB cases)
    During and not during hospitalisation
For member's account
GENERAL RADIOLOGY AND PATHOLOGY
During hospitalisation 		100% of the scheme tariff
Unlimited
PHYSIOTHERAPY, OCCUPATIONAL AND SPEECH THERAPY, DIETICIAN SERVICES, AUDIOMETRY, PODIATRY, MASSAGE, ORTHOPTIC, CHIROPRACTIC, HOMEOPATHIC, HERBAL AND NATUROPATHIC, OSTEOPATHIC AND BIOKINETIC SERVICES
During hospitalisation 		100% of the scheme tariff/cost
Unlimited
OXYGEN
During hospitalisation 		100% of the scheme tariff/cost
Unlimited
DIALYSIS
During and not during hospitalisation
Subject to pre-authorisation 		100% of the scheme tariff
Unlimited
TECHNOLOGIST SERVICES
During and not during hospitalisation 		100% of the scheme tariff
Unlimited
APPLICABLE MEDICINE DISPENSED AND CHARGED BY THE HOSPITAL ON DISCHARGE FROM THE HOSPITAL (TTO)
Chronic medicine excluded 		100% of the medicine price
R250 per admission
NECK AND BACK FUSIONS (non-PMB cases)
Subject to protocols and pre-authorisation 		100% of the contracted/scheme tariff
Unlimited
R15,020 co-payment per admission
CIRCUMCISION OR HYMENECTOMY      For member's account
ADENOIDECTOMY AND/OR TONSILLECTOMY    100% of the contracted/ scheme tariff
R1,750 co-payment per admission
EXCISION OF NAIL BED  100% of the contracted/ scheme tariff
R950 co-payment per admission  
DENTAL PROCEDURES UNDER GENERAL ANAESTHESIA
Subject to Denis protocols and pre-authorisation
  • Hospitalisation
  • General anaesthesia
100% of the Medihelp
Dental Tariff
R2,100 co-payment per admission 20% co-payment if not pre-authorised
  • Dentist's account
For member's account
INTERNALLY IMPLANTED PROSTHESES (non-PMB cases)
  • EVARS prosthesis
    Subject to pre-authorisation
Annual limit per family of R29,250 for all internally implanted prostheses
Sub-limits:
100% of the scheme tariff/cost
R22,230 per beneficiary per year
  • Vascular/cardiac prosthesis
100% of the scheme tariff/cost
R22,230 per beneficiary per year
  • Health-essential functional prosthesis
    Subject to pre-authorisation
  • Intra-ocular lenses
100% of the scheme tariff/cost
R14,740 per beneficiary per year

Sub-limit:
100% of the scheme tariff/cost
2 lenses per beneficiary per year
R2,760 per lens
  • Hip, knee and shoulder replacements
    Hospitalisation and prosthesis component
For member's account
  • Prosthesis with reconstructive or restorative surgery
    Subject to pre-authorisation – during and not during hospitalisation
100% of the scheme tariff/cost
R2,830 per family per year
SPECIALISED RADIOLOGY
Services rendered during and not during hospitalisation
  • MRI and CT scanning are subject to pre-authorisation
  • Angiogram
100% of the scheme tariff
R13,830 per family per year
PSYCHIATRIC TREATMENT OF A MENTAL HEALTH CONDITION
Subject to pre-authorisation
  • Professional services rendered during and not during hospitalisation by a psychiatrist
  • General ward accommodation
  • Electroconvulsive therapy
  • Medicine supplied during the period of the treatment in the facility
100% of the contracted/scheme tariff/medicine price
R12,480 per beneficiary per year (maximum R18,820 per family per year)
20% co-payment if not pre-authorised
PRIVATE NURSING - AS AN ALTERNATIVE TO HOSPITALISATION
Subject to pre-authorisation 		100% of the contracted/scheme tariff/medicine price
Unlimited
HOSPICE SERVICES AND SUB-ACUTE FACILITIES AS ALTERNATIVE TO HOSPITALISATION
Subject to pre-authorisation 		100% of the contracted/scheme tariff/medicine price
Unlimited
20% co-payment if not pre-authorised
FUNCTIONAL NASAL SURGERY  100% of the contracted/ scheme tariff
R4,250 co-payment per admission  
MYRINGOTOMY 100% of the contracted/ scheme tariff
R1,750 co-payment per admission  
REFLUX SURGERY  100% of the contracted/ scheme tariff
R8,600 co-payment per admission
REMOVAL OF SKIN LESIONS 100% of the contracted/ scheme tariff
R950 co-payment per admission 
ENDOSCOPIC PROCEDURES
  • During hospitalisation
100% of the contracted/scheme tariff
Unlimited
R2,000 co-payment per admission
  • In the doctor's rooms
100% of the scheme tariff
Unlimited
R700 co-payment per case on the doctor’s account

Major medical benefits – trauma recovery (PMB cases)

 
Description Benefit
BENEFITS FOR TRAUMA THAT NECESSITATES HOSPITALISATION IN THE CASE OF:
  • Motor vehicle accidents
  • Stab wounds
  • Gunshot wounds
  • Head trauma
  • Burns
  • Near drowning
Subject to pre-authorisation and case management 		100% of the cost
Unlimited - in accordance with PMB regulations
POST-EXPOSURE PROPHYLAXIS  (Optipharm)

Major medical benefits – prescribed minimum benefits (PMB)

 
Description Benefit
DIAGNOSIS, TREATMENT AND CARE COSTS OF 270 PMB AND 26 CHRONIC CONDITIONS ON THE CHRONIC DISEASES LIST (CDL), INCLUDING OUTPATIENT TREATMENT 
Subject to protocols, pre-authorisation and preferred providers (where applicable) 		100% of the cost
Unlimited - in accordance with PMB regulations
Co-payments may apply

In an emergency

 
Description Benefit
EMERGENCY TRANSPORT SERVICES (NETCARE 911)
Transport by road or air within the borders of the RSA, Lesotho, Swaziland, Mozambique and Namibia (residents of these countries) 		100% of the contracted tariff
Unlimited
Outside these borders:
  • Transport by road
100% of the cost
R1,360 per case
  • Transport by air
100% of the cost
R8,840 per case
BLOOD TRANSFUSION SERVICES AND THE TRANSPORT OF BLOOD AND BLOOD PRODUCTS 100% of the cost
Unlimited
24-HOUR HELPLINE AND RAPE CRISIS CENTRE (NETCARE 911) Phone 082 911 for advice in a medical emergency

Day-to-day benefits

 
Description Benefit
GENERAL MEDICAL PRACTITIONERS, MEDICAL SPECIALISTS AND EMERGENCY UNITS
  • Treatment (medical and surgical services, anaesthesia as well as material and medicines used during the rendering of a service)
Overall annual day-to-day limit:
M = R1,060 per year or
M+ = R2,010 per year
100% of the scheme tariff
Sub-limit:

M = R740 per year or
M+ = R1,380 per year
Subject to the overall annual day-to-day limit
  • Consultations and follow-up consultations
PHYSIOTHERAPY
Treatment and material
CLINICAL PSYCHOLOGISTS AND PSYCHIATRIC NURSING
Services rendered during and not during hospitalisation 		For member's account 
OCCUPATIONAL AND SPEECH THERAPY, DIETRICIAN SERVICES, AUDIOMETRY, PODIATRY, MASSAGE, ORTHOPTIC, CHIROPRACTIC, HOMEOPATHIC, HERBAL AND NATUROPATHIC, OSTEOPATHIC AND BIOKINETIC SERVICES  
MEDICINE
Medicine dispensed by the Medihelp Preferred Pharmacy Network not during hospitalisation:
  • Acute medicine (including medicine dispensed at an emergency unit and self-medication, oral contraceptives, intra-uterine devices and homeopathic, herbal, naturapathic and osteopathic medicine)
80% of the medicine price
Sub-limit:
M = R640 per year or
M+ = R950 per year
Subject to the overall annual day-to-day limit
  •  Chronic medicine
 For member's account
  • Authorised chronic PMB medicine (CDL conditions only)
100% of the cost
Unlimited
Co-payments may apply
OPTOMETRY
Optometric examinations, spectacles or contact lenses 		For member's account
DENTAL SERVICES 
All benefits are subject to clinical protocols determined by Denis 
  • Routine check-ups
For member's account
  • Oral hygiene
  •  Fillings
  •  Tooth extractions and root canal treatment in the dentist's chair
  •  Laughing gas (in the dentist's chair)
  • Dental procedures under conscious sedation in the dentist's chair (sedation costs)
    Subject to pre-authorisation
100% of the Medihelp Dental tariff for the removal of impacted wisdom teeth only
Dentist's account: For member's account
  • Plastic dentures
For member's account
  • Specialised dental services
    • Partial metal frame dentures
  • Maxillofacial surgery and oral pathology
  • Crowns and bridges
  • Implants
  • Orthodontic treatment
  • Periodontal treatment
  • X-rays
    • Intra-oral X-rays
  • Extra-oral X-rays
PATHOLOGY For member's account
GENERAL RADIOLOGY
MEDICAL, SURGICAL AND ORTHOPAEDIC APPLIANCES 
Services rendered during and not during hospitalisation:
  • Artificial eyes, speech and hearing aids
100% of the cost/scheme tariff
R3,210 per family per 3-year cycle
  • Artificial limbs and wheelchairs
  • Other appliances, including hyperbaric oxygen treatment
 For member's account
  • Stoma components and urine bags
100% of the cost/scheme tariff
Unlimited
OXYGEN
Not during hospitalisation
Subject to pre-authorisation 		100% of the scheme tariff/cost
20% co-payment if not pre-authorised
Rules and exclusions

This is a summary of the available benefits. In the event of a dispute the registered Rules of Medihelp will apply, subject to approval by the Registrar of Medical Schemes. If a beneficiary joins during the course of a financial year, the benefits (limits) are calculated pro rata according to the remaining number of months per year. Click here