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Prime 3 comprehensive plan in 2021


With generous pooled insured cover for day-to-day medical expenses, a 10% savings account, comprehensive hospital cover and extensive added insured benefits consisting of preventive and other life stage-specific benefits, this is the ideal product for families. The quality network alternative of the plan saves you 18% in monthly contributions. 

Medihelp medical aid plan Prime 3

View a summary of Prime 3’s monthly contributions and benefits:

 NetworkNon-network
Principal memberPrincipal memberR3 138
(R312 savings contribution included per month and
R3 744 per year)
R3 828
(R384 savings contribution included per month and
R4 608 per year)
DependantDependantR2 652
(R264 savings contribution included per month and
R3 168 per year)
R3 240
(R324 savings contribution included per month and
R3 888 per year)
Child dependant < 26 yearsChild dependantR912
(R90 savings contribution included per month and
R1 080 per year)
R1 116
(R114 savings contribution included per month and
R1 368 per year)
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 these benefits.

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) –
      R145 per beneficiary per month, up to R1 740 per year
    • Intra-uterine device every 60 months –
      R2 300 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 programme (from 1 April 2021)
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
  • 2 antenatal and post-natal consultations at a dietician/ breastfeeding specialist/ antenatal classes
  • Two 2D ultrasound scans
  • 9 months' antenatal iron supplements
  • 9 months' antenatal folic acid supplements
Child benefits
  • Babies under 2 years receive 2 additional visits to a GP, paediatrician or ear, nose and throat specialist
  • 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
HealthPrint

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.

 

Hospitalisation
100% of the MT

Non-network: any hospital
Network: 113 network hospitals

Day surgery network: 134 day surgeries 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
R30 400 per beneficiary per year (maximum R40 800 per family per year)
Oncology
In and out of hospital
  • PMB – 100% of the MT
  • Non-PMB – R273 700 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
Refractive surgery
Hospitalisation: 100% of the MT
R12 000 per family per year
(beneficiaries 18-50 years)
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: R64 300
    • 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 under Acute
    • Intra-ocular lenses – R4 300 per lens, 2 lenses per beneficiary per year, health essential functional prosthesis benefit applies
  • EVARS prosthesis – R135 600
  • Vascular/ cardiac prosthesis – R58 000
  • Prosthesis with reconstructive or restorative surgery and external breast prostheses (in and out of hospital) – R9 900 per family per year
  • Implantable hearing devices (including device and components) – R250 000 per year
Other core benefits
Renal dialysis, oxygen, hospice, sub-acute care and private nursing services as an alternative to hospitalisation
Palliative care
100% of the MT
R24 000 per family per year

 

10% savings account
Once your savings have run out, the insured pooled day-to-day benefits apply

  • A credit facility equalling 12 months’ savings contributions is available at the start of each financial year
  • Unclaimed savings accumulate interest and will be added to your savings for the next year
Medicine
  • Non-PMB chronic medicine
    Paid from available benefits for savings account/ day-to-day benefits
  • PMB chronic medicine
    • Non-network option – 100% of the MHRP
    • Network option – 100% of the MHRP
      (DSP and formulary apply)

Optometry
PPN network applies
Spectacles or contact lenses per beneficiary per 24-month cycle

  • R800 for a frame/ lens enhancements
  • R1 200 for contact lenses
Dentistry
DRC network applies
  • Conservative services (including routine check-ups, fillings, X-rays and oral hygiene)
  • Specialised services (including crowns, bridges and orthodontic treatment)

Insured day-to-day benefits
Paid from savings first 
GPs & specialists, clinical psychology, physiotherapy, supplementary health services, acute medicine, standard radiology and pathology 
Member = R6 000 per year 
Member+ = R11 000 per year 
Network option
GP network and specialist referrals from a network GP apply

External prostheses and medical appliances
In and out of hospital
  • Benefit per family per 3-year cycle:
    • Artificial eyes – R4 850
    • Speech and hearing aids – R4 850
    • Wheelchairs – R4 850
    • Artificial limbs – R4 850
  • CPAP apparatus – R10 000 per beneficiary per 2-year cycle
  • Medical appliances and hyperbaric oxygen treatment – R1 300 per family per year

 

Important:
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 savings/ 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 – R9 500 per admission
  • Endoscopic procedures – gastroscopy, colonoscopy, arthroscopy and sigmoidoscopy: In a day clinic/ hospital – R3 350 (services should be rendered in a day surgery network to avoid a further 35% deductible)
  • Specialised radiology (in and out of hospital) – R2 000 per examination in hospital and R1 650 out of hospital
  • 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 – R1 500 per admission

Abbreviations

BMI-Body mass index | CDL-Chronic Diseases List | COPD-Chronic obstructive pulmonary disease | CPAP-Continuous positive airway pressure | 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 | PPN-Preferred Provider Negotiators 

Prime hospital network

Day surgery network

Specialist network

Savings account explanation

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.


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