MedPrime

MedPrime

Apart from private hospitalisation, you get excellent cover for out-of-hospital services through a savings account and insured pooled benefits, as well as comprehensive separate dental and optometry benefits. Pay less for MedPrime Elect, the network alternative of this plan.

from
R3 918 per month
in 2024
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Children aged 18-25

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Looking for a new medical aid?

Choosing a new medical aid is made easier by speaking to an accredited adviser about the plan that will suit your healthcare needs and pocket best. Whether you’re studying, moving up the corporate ladder or planning a family, we will help you make an informed decision.

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


MedPrime

Added insured benefits

Women’s and men’s health tests

Contraceptive benefits

Maternity and baby benefits

Cover for health tests, vaccinations, and screenings

MedPrime

Core benefits

Specialised radiology benefit

Emergency transport services | Post-hospital benefit | Trauma cover

Hospital benefits (no overall annual limit)

MedPrime Elect (network hospitals)

271 PMB conditions - diagnosis, treatment, and care and 26 chronic illnesses (CDL)

MedPrime

Day-to-day benefits

10% savings account
Insured pooled benefits after depletion of savings account funds
GPs, specialists, medicine, and other day-to-day services
Member = R6 900 | Family = R12 700
10% savings account
Dentistry | Optometry
Care extender benefit

 MedPrime ElectMedPrime
Main memberMain member

R3 918

(R390 savings contribution included per month and R4 680 per year)

R4 782

(R480 savings contribution included per month and R5 760 per year)

DependantDependant

R3 306

(R330 savings contribution included per month and R3 960 per year)

R4 044

(R402 savings contribution included per month and R4 824 per year)

Child dependant <26 yearsChild dependant

R1 140

(R114 savings contribution included per month and R1 368 per year)

R1 398

(R138 savings contribution included per month and R1 656 per year)

Pay for only two children under the age of 18 and pay child dependant rates until they turn 26

 

These benefits are provided in addition to your insured day-to-day benefits and are activated when you register on HealthPrint, Medihelp’s free wellness programme for members, on the Member Zone. Your health screening results from Dis-Chem or Clicks will automatically upload to your health record on HealthPrint.

Maternity benefits
  • Ten antenatal and postnatal consultations at a midwife/ GP/ gynaecologist
  • Two antenatal and postnatal consultations at a dietician/ lactation specialist/ antenatal classes
  • Two 2D ultrasound scans
  • Nine months’ antenatal iron supplements
  • Nine months’ antenatal folic acid supplements
Babies < 2 years
Two consultations at a paediatrician/ GP/ ear, nose, and throat specialist
Child immunisation
Standard immunisation up to seven years
Health screening tests
  • One combo health screening (blood glucose, cholesterol, BMI, and blood pressure measurement)*
    or
    an individual test (blood glucose or cholesterol)
  • HIV testing, counselling, and support
Preventive care benefits
  • A tetanus vaccine
  • A flu vaccine
  • A mammogram* every two years
  • A Pap smear* every three years
  • A prostate test*
  • A pneumococcal vaccine
  • An FOBT test*
  • A bone mineral density test* every two years
  • Two HPV vaccinations for girls and boys between 10-14 years or three between 15-26 years
Contraceptives
  • Oral/ injectable/ implantable contraceptives – R170 per month, up to R2 250 per year
  • Intra-uterine device – R2 600 every 60 months
Supporting wellness
  • Back treatment at a Documentation Based Care facility (a prerequisite for spinal column surgery)
  • One dietician consultation if BMI is >30

*Making use of these benefits activate the care extender benefit.

In-hospital treatment and life-essential services (insured benefits)

Hospitalisation
No overall annual limit
MedPrime: Any private hospital. Day procedure facilities apply for certain day procedures
MedPrime Elect: Network hospitals. Network day procedure facilities apply for certain day procedures
Refractive surgery
R13 700 per family per event (beneficiaries 18 to 50 years)
Trauma that necessitates hospitalisation
Unlimited
Childbirth
  • In hospital – unlimited
  • Home delivery – R15 600 per event
Specialised radiology
Angiography, MRI, and CT imaging – unlimited
Post-hospital care for speech therapy, occupational therapy, and physiotherapy
R2 200 per member and R3 150 per family
Emergency transport (Netcare 911)
  • In country of residence
    Unlimited (RSA, Lesotho, Eswatini, Mozambique, Zimbabwe, Namibia, and Botswana)
  • Outside country of residence
    R2 400 for road transport and R16 100 for air transport
Treatment of life-threatening conditions
Unlimited
Includes 271 PMB and 26 Chronic Disease List (CDL) conditions
PMB medicine
Unlimited
MedPrime Elect: Formulary and DSPs may apply
Cancer treatment
  • PMB – unlimited
  • Non-PMB – R313 900 per family
Mental health (psychiatric treatment)
R34 700 per person to a maximum of R46 800 per family
Health-essential functional prostheses
R73 800 per person
  • Intra-ocular lenses – R4 900 per lens, two lenses per person
  • Hip, knee, and shoulder replacements – non-PMB cases are limited to replacements caused by an acute injury
Other prostheses
  • EVARS prosthesis – R155 600 per person
  • Vascular/ cardiac prosthesis – R66 500 per person
  • Prosthesis with reconstructive or restorative surgery and external breast prostheses – R11 300 per family
  • Implantable hearing devices (including device and components) – R286 600 per person
Organ transplants
PMB – unlimited
Cornea implants – R34 200 per implant
Palliative care
R27 500 per family
Other core benefits
Including renal dialysis, prostatectomy, oxygen, hospice, subacute care, and private nursing services as an alternative to hospitalisation

 

Savings account

10% savings available at the beginning of the year (see monthly contributions)

Example of savings:

MedPrime Elect:
Member = R4 680 per year
Member + dependant = R8 640 per year
Member + dependant + child = R10 008 per year

MedPrime:
Member = R5 760 per year
Member + dependant = R10 584 per year
Member + dependant + child = R12 240 per year

Unused savings are carried over to the next year and accumulate interest. Once your savings are depleted, insured day-to-day benefits become available

GPs and specialists, clinical psychology, physiotherapy, supplementary health services, acute medicine, non-PMB chronic medicine, standard radiology, and pathology (Ampath, Lancet, and PathCare Vermaak)
Available after depletion of savings account

Member = R6 900
Family = R12 700

Optometry (PPN network)
Per person per 24-month cycle
  • Eye test
  • R865 for a frame/ lens enhancements
  • R1 270 for contact lenses
Conservative dentistry (DRC network)
Routine check-ups, fillings, X-rays, and oral hygiene
Specialised dentistry (DRC network)
Crowns, bridges, and orthodontic treatment
External prostheses and medical appliances
Per family per three-year cycle
  • Artificial eyes – R5 450
  • Speech and hearing aids – R5 450
  • Wheelchairs – R5 450
  • Artificial limbs – R5 450

CPAP apparatus – R11 400 per person per two-year cycle

Medical appliances and hyperbaric oxygen treatment – R1 550 per family

Radiography
R1 250 per family

 

One additional GP consultation
Activates for the family once the first claim for either a Pap smear, mammogram, prostate test, faecal occult blood test (FOBT) or bone mineral density test is paid from your added insured benefits

R490 for self-medication
Activates for the family once the first claim for a combo health screening (blood glucose, cholesterol, BMI, and blood pressure measurement) is paid from your added insured benefits

 

This is only a summary of the available benefits, and co-payments may apply to certain benefits. Please consult the registered Rules of Medihelp and your plan’s brochure for more details. 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 the patient has registered the medical condition for PMB or chronic medicine benefits, as the treatment is no longer considered as preventive care.
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