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MedPrime


MedPrime offers comprehensive medical cover for large families with children of school-going age, with a wealth of out-of-hospital cover available from the savings account and other benefits. Pay 22 % less when opting for MedPrime Elect, the network alternative of this plan.

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Quick price overview: include dependants

Adult

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Child

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*You only pay for two children younger than 18 years, until they are 26 years old
MedPrime

Added insured benefits

Women’s & men’s health tests

Contraceptives

Maternity & baby benefits

Screenings & immunisations

MedPrime

Core benefits

Specialised radiology

Emergency transport services | Post-hospital | Trauma cover

Hospital benefits (no overall annual limit)

MedPrime Elect Network hospitals

270 PMB conditions - diagnosis, treatment & care | 26 chronic illnesses (CDL)

MedPrime

Day-to-day benefits

10% savings account
Insured pooled benefits after depletion of savings account funds
GPs, specialists, medicine & other day-to-day services
M = R6 300 | M+ = R11 500
10% savings account
Dentistry | Optometry
Care extender benefit

 MedPrime ElectMedPrime
Principal memberPrincipal memberR3 198
(R318 savings contribution included per month and R3 816 per year)
R3 906
(R396 savings contribution included per month and R4 752 per year)
DependantDependantR2 706
(R270 savings contribution included per month and R3 240 per year)
R3 306
(R330 savings contribution included per month and R3 960 per year)
Child dependant <26 yearsChild dependantR930
(R90 savings contribution included per month and R1 080 per year)
R1 140
(R120 savings contribution included per month and R1 440 per year)
Pay for only 2 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
  • 10 antenatal and post-natal consultations at a midwife/ GP/ gynaecologist
  • 2 antenatal and post-natal consultations at a dietician/ lactation specialist/antenatal classes
  • Two 2D ultrasound scans
  • 9 months’ antenatal iron supplements
  • 9 months’ antenatal folic acid supplements
Babies < 2 years
2 consultations at a paediatrician/ GP/ ear, nose and throat specialist
Child immunisation
Standard immunisation up to 7 years
Health screening tests
  • One combo health screening (blood glucose, cholesterol, BMI & blood pressure measurement)*
    or
    an individual test (blood glucose or cholesterol)
  • HIV testing, counselling & support
Preventive care benefits
  • A tetanus vaccine
  • A flu vaccine
  • A mammogram* every 2 years
  • A Pap smear* every 3 years
  • A prostate test*
  • A Pneumovax vaccine
  • A Faecal occult blood test (FOBT)*
  • A bone mineral density test* every 2 years
  • 2 HPV vaccinations for girls and boys between 10-14 years or three between 15-26 years
Contraceptives
  • Oral/injectable/implantable contraceptives – R155 per month, up to R1 820 per year
  • Intra-uterine device – R2 400 every 60 months
Supporting wellness
  • Back treatment at a Document Based Care facility (a prerequisite for spinal column surgery)
  • Chronic Care programme
  • One dietician consultation if BMI is >30

*Care extender benefits are extra benefits activated when a beneficiary make use of certain added insured benefits. 

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

Hospitalisation
No overall annual limit
MedPrime: Any private hospital
MedPrime Elect: Network hospitals and day procedure network applies for certain day procedures
Refractive surgery
R12 500 per family per event (18-50 years)
Trauma that necessitates hospitalisation
Unlimited
Childbirth
  • In hospital – unlimited
  • Home delivery – R14 100 per event
Specialised radiology
Angiography, MRI and CT imaging – unlimited
Post-hospital care for speech therapy, occupational therapy and physiotherapy
R2 000 per member and R2 800 per family
Emergency transport (Netcare 911)
  • In country of residence
    Unlimited (RSA, Lesotho, Eswatini, Mozambique, Zimbabwe, Namibia & Botswana)
  • Outside country of residence
    R2 210 for road transport and R14 700 for air transport
Treatment of life-threatening conditions
Unlimited
Includes 270 PMB and 26 Chronic Diseases List (CDL) conditions
PMB medicine
Unlimited
Cancer treatment
  • PMB – unlimited
  • Non-PMB – R285 000 per family
Mental health (psychiatric treatment)
R31 600 per person to a maximum of R42 500 per family
Health-essential functional prostheses
R67 000 per person
  • Intra-ocular lenses – R4 480 per lens, 2 lenses per person
  • Hip, knee and shoulder replacements – non-PMB cases are limited to replacements caused by an acute injury
Other prostheses
  • EVARS prosthesis – R141 200 per person
  • Vascular/cardiac prosthesis – R60 400 per person
  • Prosthesis with reconstructive or restorative surgery and external breast prostheses – R10 300 per family
  • Implantable hearing devices (including device and components) – R260 000 per person
Organ transplants
PMB – unlimited
Cornea implants – R31 100 per implant
Palliative care
R25 000 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 = R3 816 per year
Member +1 = R7 056 per year
Member +2 = R8 136 per year

MedPrime:
Member = R4 752 per year
Member +1 = R8 712 per year
Member +2 = R10 152 per year

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

GPs & specialists, clinical psychology, physiotherapy, supplementary health services, acute medicine, non-PMB chronic medicine, standard radiology and pathology
Available after depletion of savings account

Member = R6 300
Family = R11 500

Optometry (PPN network)
Per person per 24-month cycle
  • Eye test
  • R800 for a frame/lens enhancements
  • R1 200 for contact lenses
  • Replacement of lost/broken spectacles
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 3-year cycle
  • Artificial eyes – R5 000
  • Speech and hearing aids – R5 000
  • Wheelchairs – R5 000
  • Artificial limbs – R5 000

CPAP apparatus – R10 400 per person per 2-year cycle

Medical appliances and hyperbaric oxygen treatment – R1 400 per family

Radiography
R1 150 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

R450 for self-medication
Activates for the family once the first claim for a combo health screening (blood glucose, cholesterol, BMI & 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.