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Prime 1 Hospital plan in 2021

This hospital plan is ideal if you are healthy and want access to private healthcare at an affordable price. Cover for minor day-to-day medical expenses and extensive added insured benefits form part of Prime 1. The network alternative of the option saves you 22% in monthly contributions.

Medical aid hospital plan

View a summary of Prime 1’s monthly contributions and benefits

Principal memberPrincipal memberR1 722
R2 202
DependantDependantR1 416
R1 818
Child dependant < 26 yearsChild dependantR522
You only pay for two children younger than 18 years, after which child dependant rates will apply from the beginning of the year following the year in which they turn 18, until they are 26 years old. The monthly contribution does not take any employer subsidy into account.

These benefits are provided in addition to other insured benefits and are available annually, unless otherwise indicated. Protocols and specific item codes may apply. Network information is available on the provider search page. Register for HealthPrint, Medihelp’s free online health and wellness programme, to activate benefits as indicated.

Routine screening and immunisation
Available at network pharmacy clinics per person:
  • A combo test (blood glucose, cholesterol, BMI & blood pressure measurement)/ individual test (blood glucose or cholesterol)
  • HIV testing, counselling & support
  • A tetanus vaccine
  • A flu vaccination
  • Two HPV vaccinations for girls and boys between 10-14 years or three between 15-26 years
Women's health
  • A mammogram requested by a medical doctor per 2-year cycle (women 40-75 years)
  • A Pap smear requested by a medical doctor per 3-year cycle (women over 21 years)
  • Contraceptives:
    • Oral/ injectable/ implantable contraceptives (women up to 50 years) –
      R125 per beneficiary per month, up to R1 500 per year
    • Intra-uterine device every 60 months –
      R2 000 per beneficiary
Supporting wellness
  • Back treatment as an alternative to surgery at a Document Based Care facility for eligible patients, and the treatment is also a prerequisite for spinal surgery
  • Chronic Care programme
  • One dietician consultation if a BMI measurement indicates a BMI higher than 30
  • Early Detection programme
  • Bipolar programm
Men's health
  • A prostate test (PSA level) requested by a medical doctor (men 40 years and older)
Enhanced maternity benefits
Registration on HealthPrint’s Maternity and Baby programme will activate these additional benefits:
  • 10 antenatal and post-natal consultations with a midwife/ GP/ gynaecologist (Prime network options - a network GP referral to the gynaecologist is not needed)
  • 2 antenatal and post-natal consultations at a dietician/ breastfeeding specialist/ antenatal classes
  • Two 2D ultrasound scans
Child benefits
  • Babies under 2 years receive 2 additional visits to a GP, paediatrician or ear, nose and throat specialist (Prime network options - a network GP referral to these specialists is not needed)
  • Standard child immunisations for children up to 7 years at network pharmacy clinics
Over 50s
  • One bone mineral density test requested by a medical doctor (women >50 years)
  • A Pneumovax vaccine in a 5-year cycle per person older than 55 years (if registered for asthma or COPD)
  • An FOBT test for people over 50 years

Medihelp members get free access to this online health and wellness programme designed to add value based on their health profile through programmes such as the Maternity and Baby programme.


100% of the MT

Non-network: any hospital
Network: 113 network hospitals

Day procedure network: 240 day procedure facilities for certain procedures

Emergency transport
Netcare 911
In country of residence
RSA, Lesotho, Eswatini, Mozambique, Namibia & Botswana – unlimited
Outside country of residence
Transport by road R2 130 and by air R14 200 per case
Chronic illness/ PMB
  • 100% of the cost for 270 PMB and 26 chronic conditions (DSPs, specialist network, protocols and pre-authorisation apply)
  • Unlimited cover for trauma that necessitates hospitalisation
Specialised radiology
In and out of hospital
  • MRI and CT imaging
    100% of the MT – unlimited (see additional information - deductibles)
  • Angiography
    100% of the MT – unlimited
    Psychiatric treatment
    In and out of hospital
    R20 050 per beneficiary per year (maximum R30 400 per family per year)
    In and out of hospital
    • PMB – 100% of the MT
    • Non-PMB – R220 000 per family per year
    Confinement (childbirth)
    • In hospital – 100% of the MT
    • Home delivery – R13 500 per event
    Organ transplants
    PMB only – 100% of the cost
    Cornea implants – R29 900 per implant per year
    Other core benefits
    Renal dialysis, oxygen, hospice, sub-acute care and private nursing services as an alternative to hospitalisation
    Post-hospital care
    R1 870 per member and R2 600 per family per year for speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge
    Prostheses benefits
    • Health-essential functional prosthesis: R23 850
      • Hip, knee and shoulder replacements (non-PMB):
        • Acute injuries where replacement is the only treatment option –
          Hospitalisation: 100% of the MT
          Prosthesis: Health-essential functional prosthesis benefit applies
        • Wear and tear: no benefits
      • Intra-ocular lenses – R4 300 per lens, 2 lenses per beneficiary per year, health essential functional prosthesis benefit applies
    • EVARS prosthesis – R35 900
    • Vascular/ cardiac prosthesis – R35 900
    • Prosthesis with reconstructive or restorative surgery (in and out of hospital) – R4 400 per family per year
    Palliative care
    100% of the MT
    R20 000 per family per year


    Insured day-to-day benefits
    GP and specialist consultations, physiotherapy, acute medicine and self-medication, including visits to emergency units 
    Member = R1 250 per year 
    Member+ = R2 500 per year 
    Network option
    GP network and specialist referrals from a network GP apply


    • Non-PMB chronic medicine
      Medicine is funded from the available day-to-day benefits
    • PMB chronic medicine
      • Non-network option – 100% of the MHRP
      • Network option – 100% of the MHRP
        (DSP and formulary apply)
    DRC network applies 
    100% of the MT for the removal of impacted teeth (3rd molars only) under conscious sedation in the dentist’s chair (sedation cost)
    Dentist’s account – item codes apply



    This is only a summary of the available benefits. Please consult the registered Medihelp Rules for more information and details of services that are excluded from benefits. In case of a dispute, the Rules of Medihelp will apply (subject to approval by the Council for Medical Schemes).
    • Certain added insured benefits are not available if you have been registered for a chronic/ PMB condition, as the treatment is no longer considered as preventive care. Some benefits may be linked to a specific age/ gender/ item code. Benefits are paid at 100% of the MT.
    • Doctors’ consultations are paid from the available day-to-day benefits.
    • Benefits may be subject to pre-authorisation and/ or protocols.
    • Medihelp pays generic medicine at 100% of the MMAP, original medicine with no generic at 80% of the MT, and original medicine with a generic at 70% of the MMAP.

    Procedure-specific deductibles
    • Spinal column surgery – R15 000 per admission (non-surgical back treatment at a DBC clinic is a prerequisite)
    • All endoscopic procedures (in hospital/ day clinic) – R4 200 (services should be rendered in a day procedure network to avoid a further 35% deductible)
    • Specialised radiology (in and out of hospital) – R2 600 per examination
    • Dental procedures under general anaesthesia during hospitalisation
      Removal of impacted teeth (3rd molars – only specific item codes are paid on the dentist's account) and extensive dental treatment for children <7 years – R3 430 per admission and a further 35% deductible per admission applies if procedures are obtained in facilities other than the day procedure network
    • Hysterectomy and endometrial ablation – R6 500 per admission
    • Prostatectomy (conventional/ laparoscopic procedures only) – R6 500 per admission


    BMI-Body mass index | CDL-Chronic Diseases List | COPD-Chronic obstructive pulmonary disease | CT-Computerised tomography | DRC-Dental Risk Company |DSP-Designated service provider | EMS-Emergency medical services | EVARS-Endovascular aortic replacement surgery | FOBT-Faecal occult blood test | GP-General practitioner | HPV-Human papilloma virus | OAL-Overall annual limit |MHRP-Medihelp Reference Price | MMAP-Maximum Medical Aid Price | MRI-Magnetic resonance imaging | MT-Medihelp tariff paid by Medihelp for benefits which can include a contracted tariff or the single exit price | PMB-Prescribed minimum benefits 

    Prime hospital network

    Day procedure network

    Specialist network

    If you are interested in a medical aid, complete the form below and an accredited adviser will get in touch with you:

    To request pre-authorisation, view your benefits, and for other member services please log in to the Member Zone.