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Prime 2 - 15% savings plan in 2021

The combination of a savings account, an insured benefit activated after depletion of the savings account and a basket of preventive and insured benefits for every life stage takes care of your healthcare needs. Prime 2 provides extensive hospital cover either at any facility or through a quality network (pay 22% less for the network option).
Prime 2 Product Block

View a summary of Prime 2’s monthly contributions and benefits

 NetworkNon-network
Principal memberPrincipal memberR2 286
(R342 savings contribution included per month and
R4 104 per year) 		R2 934
(R438 savings contribution included per month and
R5 256 per year)
DependantDependantR1 884
(R282 savings contribution included per month and
R3 384 per year) 		R2 412
(R360 savings contribution included per month and
R4 320 per year)
Child dependant < 26 yearsChild dependantR684
(R102 savings contribution included per month and
R1 224 per year) 		R882
(R132 savings contribution included per month and
R1 584 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) –
      R135 per beneficiary per month, up to R1 620 per year
    • Intra-uterine device every 60 months –
      R2 200 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
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
    R25 300 per beneficiary per year (maximum R34 800 per family per year)
    		Oncology
    In and out of hospital
    • PMB – 100% of the MT
    • Non-PMB – R240 840 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: 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
      • 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 (in and out of hospital) – R9 900 per family per year
    		Palliative care
    100% of the MT
    R22 000 per family per year

     

    15% 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
    • Choose to include or exclude in-hospital deductibles/ shortfalls
    		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)
    Insured day-to-day benefits
    Paid from savings first
    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

     

    		Dentistry
    DRC network applies
    • Conservative and specialised dental services – savings account
    • 100% of the MT for dental procedures 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
    Optometry
    Savings account
    		External prostheses and medical appliances
    In and out of hospital
    • Savings account
    • Hyperbaric oxygen treatment – R650 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.
    Procedure-specific deductibles
    • Spinal column surgery – R10 850 per admission
    • All endoscopic procedures (in hospital/ day clinic) – R4 050 (services should be rendered in a day surgery network to avoid a further 35% deductible)
    • Specialised radiology (in and out of hospital) – R2 500 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
    • Hysterectomy and endometrial ablation – R6 000 per admission
    • Prostatectomy (conventional/ laparoscopic procedures only) – R6 000 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 | 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

    View 2021 list

    Day surgery network

    View 2021 list

    Specialist network

    More info

    Savings account explanation

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