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.
View a summary of Prime 1’s monthly contributions and benefits
| Network | Non-network | ||
| Principal member |  | R1 722 | R2 202 |
| Dependant | | R1 416 | R1 818 |
| Child dependant < 26 years |  | R522 | R672 |
| 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:
| Women's health
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Supporting wellness
| Men's health
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| Enhanced maternity benefits Registration on HealthPrint’s Maternity and Baby programme will activate these additional benefits:
| Child benefits
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Over 50s
| 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 Non-network: any hospital 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
| Specialised radiology
In and out of hospital
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| Psychiatric treatment In and out of hospital R20 050 per beneficiary per year (maximum R30 400 per family per year) | Oncology In and out of hospital
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Confinement (childbirth)
| 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
| 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
| Medicine
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| Dentistry 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
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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
Abbreviations
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