Dimension Prime 2 - 2018

from R1 800 per month

Dimension Prime 2 is ideal for young, healthy couples and provides the value of private hospital cover combined with a 15% savings account and added preventive care and insured benefits, should you plan on starting a family. By choosing the wide network of 108 private hospitals you save 22% in monthly premiums.

Medihelp Medical Scheme Savings plan
 

Monthly contributions
Member Network option
Principal member R1 800 (R270 savings contribution included per month and R3 240 per year)
Dependant R1 476 (R222 savings contribution included per month and R2 664 per year)
Child dependant <26 years*R534 (R78 savings contribution included per month and R936 per year)
Member Non-network option
Principal member R2 310 (R348 savings contribution included per month and R4 176 per year)
Dependant R1 890 (R282 savings contribution included per month and R3 384 per year)
Child dependant <26 years*R690 (R102 savings contribution included per month and R1 224 per year)
*You only pay for two children younger than 18 years on the Dimension Prime range, 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. If you join Dimension Prime 2 after January, your savings amount will be calculated by counting the remaining months in the year.                      
 

Additional insured benefits

Additional insured benefits which give you access to pregnancy and baby-related benefits, screenings, preventive and wellness services as well as a back treatment programme.

PREGNANCY AND BABY BENEFITS

  • 8 pregnancy consultations per family per year
  • Two 2D sonars per family per year
  • 2 consultations for babies <1 year old - first 2 consultations at a general practitioner or specialist

PREVENTIVE CARE
Health tests  (One test per beneficiary per year)
  • 1 combo test (blood glucose, cholesterol, BMI and blood pressure measurement) or individual blood glucose or cholesterol tests (at Clicks and Dis-Chem pharmacy clinics - consultation fee included)
  • 1 dietician consultation for HealthPrint members if BMI test result at wellness provider indicates a BMI >30

Consultation fees for the tests listed below are paid from the available day-to-day benefits:

  • 1 pap smear (pathology: 4566/ 4559)
  • 1 mammogram for women >40 years (radiology: 3605/ 39175/ 34100/ 34101)
  • 1 prostate test (PSA level) >40 years (pathology: 4519)
  • 1 FOBT for beneficiaries >50 years (pathology: 4351)
  • 1 bone mineral density test for women >50 years (radiology: 3604/ 50120)
  • HIV - voluntary counselling and testing (at Clicks or Dis-Chem pharmacy clinics)

Immunisation 
  • 1 flu vaccine per beneficiary per year (administering fee at Dis-Chem or Clicks pharmacy clinics included)
  • 1 tetanus vaccine per beneficiary per year (administering fee at Dis-Chem or Clicks pharmacy clinics included)
  • HPV vaccine once per lifetime – administering fee at Dis-Chem or Clicks pharmacy clinics included
    • 10 to 14 years – 2 injections according to protocol
    • 15 to 26 years – 3 injections according to protocol
  • 1 Pneumococcal vaccination in a 5-year cycle for beneficiaries >55 years - Must be registered on Medihelp's treatment programme for asthma or COPD (NAPPI code 755826027)
  • Standard immunisation for children <7 years old, as published by the Department of Health (administering fee at Dis-Chem or Clicks pharmacy clinics included)

    Back treatment programme
    One back treatment programme per beneficiary per year at a DBC facility (subject to protocols and pre-authorisation)

    BMI-Body mass index
    COPD-Chronic obstructive pulmonary disease
    DBC-Document-Based Care
    FOBT-Faecal occult blood test
    HPV-Human papilloma virus
    * These benefits are not available if you have been registered for a chronic/ PMB condition, as it can no longer be considered as preventive care. 


    Core benefits

     Description Benefit
    Essential cover

    DIAGNOSIS, TREATMENT AND CARE COSTS OF 270 PMB AND 26 CHRONIC CONDITIONS ON THE CDL
    Subject to protocols, pre-authorisation and DSPs

    100% of the cost
    Unlimited
    Trauma

    BENEFITS FOR MAJOR TRAUMA THAT NECESSITATES HOSPITALISATION IN THE CASE OF:

    • Motor vehicle accidents
    • Stab wounds
    • Gunshot wounds
    • Head trauma
    • Burns
    • Near drowning

    Subject to authorisation, PMB protocols and case management

    100% of the cost
    Unlimited

    POST-EXPOSURE PROPHYLAXIS

    EMS

    EMERGENCY TRANSPORT SERVICES

    (Netcare 911)
    RSA, Lesotho, Swaziland, Mozambique, Namibia and Botswana
    Subject to pre-authorisation and protocols

    In beneficiary’s country of residence

    • Transport by road
    • Transport by air





    100% of the MT
    Unlimited

    Outside beneficiary’s country of residence

    • Transport by road


    100% of the MT
    R1 900 per case
    • Transport by air
    100% of the MT
    R12 400 per case

    24-HOUR HELPLINE AND TRAUMA COUNSELLING

    (Netcare 911)

    Phone 082 911

    HOSPITALISATION (state and private hospitals and day clinics)
    Subject to pre-authorisation, protocols and case management

    • Intensive and high-care wards
    • Ward accommodation
    • Theatre fees
    • Treatment and ward medicine
    • Consultations, surgery and anaesthesia

    100% of the MT
    Unlimited

    Dimension Prime 2 Network

    DSP applies

    POST-HOSPITAL CARE
    Professional services relating to a Medihelp authorised private hospital admission, required for up to 30 days after discharge

    • Speech therapy
    • Occupational therapy
    • Physiotherapy
    100% of the MT
    M = R1 700 per year
    M+ = R2 300 per year
    PROSTHESESClick here to see prostheses

    CONFINEMENT (childbirth)
    Subject to pre-authorisation, protocols and case management

    100% of the MT
    Unlimited

    HOME DELIVERY
    Subject to pre-authorisation

    • Professional nursing fees
    • Equipment
    • Material and medicine
    100% of the MT
    R11 900 per event

    STANDARD RADIOLOGY, PATHOLOGY AND MEDICAL TECHNOLOGIST SERVICES
    In hospital
    Subject to clinical protocols 

    100% of the MT
    Unlimited

    SPECIALISED RADIOLOGY
    In and out of hospital
    On request of a specialist and subject to clinical protocols

    • MRI and CT imaging (subject to pre-authorisation)



    100% of the MT

    Unlimited

    Member pays the first R1 550 per examination

    • Angiography

    100% of the MT

    Unlimited

    ORGAN TRANSPLANTS (PMB only) 
    Subject to pre-authorisation and clinical protocols

    100% of the cost
    Unlimited
    • Cornea implants
    100% of the MT
    R26 100 per implant per year

    SUPPLEMENTARY HEALTH SERVICES
    In hospital

    • Occupational and speech therapy, dietician services, audiometry, podiatry, massage, orthoptic, chiropractic, homeopathic, herbal and naturopathic, osteopathic and biokinetic services
    100% of the MT
    Unlimited
    • Physiotherapy on referral by the attending medical doctor
    OXYGEN
    In hospital
    100% of the MT
    Unlimited

    NEUROSTIMULATORS
    Subject to pre-authorisation and clinical protocols

    • Device and components
    100% of the MT
    R101 200 per beneficiary per year

    RENAL DIALYSIS
    In and out of hospital
    Subject to pre-authorisation and clinical protocols

    100% of the MT
    Unlimited

    APPLICABLE PRESCRIPTION MEDICINE DISPENSED AND CHARGED BY THE HOSPITAL ON DISCHARGE FROM THE HOSPITAL (TTO) (Excluding PMB chronic medicine) 

    100% of the MT

    Savings account

    PSYCHIATRIC TREATMENT OF A MENTAL HEALTH CONDITION
    Subject to pre-authorisation, services rendered in an approved/ network hospital/ facility and prescribed by a medical doctor

    • Professional services rendered in and out of hospital by a psychiatrist
    • General ward accommodation
    • Medicine supplied during the period of the treatment in the institution
    • Outpatient consultations


    100% of the MT
    R22 100 per beneficiary per year
    (maximum R30 300 per family per year)

    ONCOLOGY
    Subject to pre-authorisation and registration on the Medihelp Oncology Management Programme. Protocols, DSP and MORP apply

    • PMB cases
      • Hospital and related cancer treatments and services, including bone marrow/ stem cell transplants (subject to PMB legislation)
    100% of the MT
    Unlimited
    • Non-PMB cases
      • Hospital and related cancer treatments, including radiotherapy, brachytherapy, chemotherapy and associated adjuvant medicine
    100% of the MT
    R100 000 per family per year

    HOSPICE SERVICES AND SUB-ACUTE CARE FACILITIES AS AN ALTERNATIVE TO HOSPITALISATION
    Subject to pre-authorisation, and services rendered in an approved facility and prescribed by a medical doctor

    100% of the MT
    Unlimited

    PRIVATE NURSING AS AN ALTERNATIVE TO HOSPITALISATION
    Subject to pre-authorisation
    (Excluding general day-to-day care) 

    100% of the MT

    APPENDECTOMY
    Subject to pre-authorisation

    • Conventional procedure
    100% of the MT
    Unlimited
    • Laparoscopic procedure

    100% of the MT
    Hospitalisation:
    R15 800 per beneficiary

    PROSTATECTOMY
    Subject to pre-authorisation

    • Conventional or laparoscopic procedure

    100% of the MT
    Unlimited

    • Robotic assisted laparoscopic procedure

    100% of the MT
    Hospitalisation:
    R100 400 per beneficiary

    CDL-Chronic Diseases List
    CT-Computerised tomography
    DSP-Designated service provider
    EMS-Emergency medical services
    M-Member
    MORP-Medihelp Oncology Reference Price
    MRI-Magnetic resonance imaging
    PMB -Prescribed minimum  benefits 
    TTO -To take out (medicine) 
    MT-Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price as defined in the Medihelp Rules

    Internally implanted prostheses

    DescriptionBenefit
    INTERNALLY IMPLANTED PROSTHESES
    All hospital admissions and prostheses are subject to pre-authorisation, protocols and case management

    • EVARS prosthesis

    100% of the MT


    R118 100 per beneficiary per year
    • Vascular/ cardiac prosthesis
    R50 600 per beneficiary per year
    • Health-essential functional prosthesis
    R56 000 per beneficiary per year
    • Hip, knee and shoulder replacements (non-PMB)*
      • In case of acute injury where replacement is the only clinically appropriate treatment modality
    Hospitalisation:
    100% of the MT

    Prosthesis:
    Health-essential functional prosthesis benefits apply
    • Intra-ocular lenses
    Sub-limit subject to health-essential functional prosthesis benefit
    2 lenses per beneficiary per year
    R3 800 per lens
    • Prosthesis with reconstructive or restorative surgery
      In and out of hospital
    R8 750 per family per year
    • External breast prostheses
      In and out of hospital
    Savings account
    EVARS-Endovascular aortic replacement surgery
    PMB -Prescribed minimum benefits 
    MT-Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price
     
    *Benefit not applicable to wear and tear

    Day-to-day benefits

    DescriptionBenefit
    GPs AND SPECIALISTS
    • Consultations and follow-up consultations

    100% of the MT

    Savings account

    PHYSIOTHERAPY

    • Treatment and material
    CLINICAL PSYCHOLOGY AND PSYCHIATRIC NURSING
    SUPPLEMENTARY HEALTH SERVICES
    Occupational and speech therapy, dietician services, audiometry, podiatry, massage, orthoptic, chiropractic, homeopathic, herbal and naturopathic, osteopathic and biokinetic services

    PATHOLOGY AND MEDICAL TECHNOLOGIST SERVICES
    Out of hospital

    Subject to clinical protocols and requested by a medical doctor

    STANDARD RADIOLOGY
    Out of hospital

    Subject to clinical protocols and requested by a medical doctor or chiropractor (black and white X-rays only)

    MEDICINE

    Medicine obtained in the Medihelp Preferred Pharmacy Network

    • Acute generic medicine (including medicine dispensed at an emergency unit and self-medication, immunisations, contraceptives and homeopathic, herbal, naturopathic and osteopathic medicine)
    Please note:
    • Original medicine when no generic equivalent is available – 80% of the MT will apply
    • Voluntary use of original medicine when generic equivalent is available – 70% of the MMAP will apply
    • Non-PMB generic chronic medicine
      Subject to pre-authorisation and registration on Medihelp’s chronic medicine management programme
      • Original medicine when no generic equivalent is available – 80% of the MT will apply
      • Voluntary use of original medicine when generic equivalent is available – 70% of the MMAP will apply
    • PMB chronic medicine
      Subject to pre-authorisation and registration on Medihelp’s PMB medicine management programme
    100% of the MHRP

    Dimension Prime 2 Network
    DSP & formulary apply
    OXYGEN
    Out of hospital
    Subject to pre-authorisation, clinical protocols and services prescribed by a medical doctor
    100% of the MT
    Unlimited
    OPTOMETRY
    • Optometric examinations
    • Spectacles and/or contact lenses
    100% of the MT
    Savings account
    EXTERNAL PROSTHESES, MEDICAL, SURGICAL AND ORTHOPAEDIC APPLIANCES
    Services in and out of hospital
    • Artificial eyes
    • Speech and hearing aids
    • Artificial limbs
    • Wheelchairs
    • Medical appliances
    100% of the MT
    Savings account
    • Hyperbaric oxygen treatment
      In and out of hospital
    R580 per family per year
    • Stoma components
    • Incontinence products/supplies
    100% of the MT
    Unlimited
    • CPAP apparatus
      Prescribed by a medical doctor
    100% of the MT
    Savings account
    DENTAL SERVICES 
    Subject to DSP's managed care protocols 

    Conservative dental services

    • Routine check-ups

    100% of the MT
    Savings account
    2 per beneficiary per year (once in 6 months)

    • Oral hygiene
      • Fluoride treatment for children >5 and <13 years
      • Fissure sealants for children younger than 16 years only
    100% of the MT
    Savings account
    2 scale and polish treatments per beneficiary per year (once in 6 months)
    • Fillings (treatment plans and X-rays may be requested for multiple fillings)
    100% of the MT
    Savings account
    1 filling per tooth in 365 days
    • Tooth extractions and root canal treatment in the dentist’s chair

    100% of the MT

    Savings account

    • Laughing gas (in the dentist’s chair)

    100% of the MT

    Savings account

    • Dental procedures under conscious sedation in the dentist’s chair (sedation cost)
      Subject to pre-authorisation and DSP's managed care protocols
    100% of the MT
    Removal of impacted teeth only
    (Dentist’s account only for item codes 8941/ 8943/ 8945)
    • Plastic dentures
    100% of the MT
    Savings account
    • X-rays
      • Intra-oral X-rays
    100% of the MT
    Savings account
    • Extra-oral X-rays
    100% of the MT
    Savings account
    1 per beneficiary in a 3-year period
    Specialised dental services
    Subject to pre-authorisation and DSP's managed care protocols
    • Partial metal frame dentures
    100% of the MT
    Savings account
    • Maxillofacial surgery and oral pathology
      • Surgery in the dentist’s chair
        Benefits for temporomandibular joint (TMJ) therapy are limited to non-surgical interventions/ treatment
    100% of the MT
    Savings account
    • Crowns and bridges
      Subject to pre-authorisation
    100% of the MT
    Savings account
    Once per tooth in a 5-year period
    • Implants
      Subject to pre-authorisation
    100% of the MT
    Savings account
    • Orthodontic treatment (only one beneficiary per family may begin orthodontic treatment per calendar year)
      Subject to pre-authorisation and orthodontic needs analysis
    100% of the MT
    Savings account
    Beneficiaries from >9 and <18 years old per lifetime
    Payment from date of authorisation
    • Periodontal treatment (conservative non-surgical therapy only)
      Subject to pre-authorisation and a treatment plan
    100% of the MT
    Savings account
    CPAP-Continuous positive airway pressure
    DSP-Designated service provider
    GP-General practitioner
    MHRP-Medihelp Reference Price
    MMAP-Maximum Medical Aid Price
    PMB -Prescribed minimum benefits 
    MT-Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price

    Deductibles

    Visiting network service providers, following the correct pre-authorisation process and negotiating tariffs with your doctor are just some of the ways you can manage or reduce out-of-pocket medical expenses.

    DIMENSION PRIME 2 NETWORK
    • Members of Dimension Prime 2 Network should use network hospitals for all planned admissions. A 65% benefit applies when an out-of-network hospital is used by choice.
    • 40% of the Medihelp Reference Price is paid if PMB chronic medicine is obtained outside the formulary and/ or DSP on the network option. It is advisable for chronic medicine users to rather choose the alternative non-network option.

    PRE-AUTHORISATION IS IMPORTANT 
    The following services and procedures are paid at 100% of the Medihelp tariff if pre-authorised:
    • All planned hospital admissions (protocols and case management apply)
    • Oxygen for out-of-hospital use (protocols and case management apply)
    • Dental procedures under conscious sedation (sedation cost) in the dentist’s chair (managed care protocols apply)
    • Specialised dental services
    • Crowns and bridges
    • Implants
    • Periodontal treatment (conservative non-surgical therapy only and subject to registration on the Perio Programme)
    Should these services not be pre-authorised, an 80% benefit will apply

    Emergency transport services (Netcare 911) in and outside the country of residence (air and road transport) should be pre-authorised to qualify for the applicable benefit. If not pre-authorised, 50% of the benefit applies except in the case of emergency medical conditions.

    Oncology is subject to pre-authorisation and registration on the Medihelp Oncology Management Programme, use of the designated service provider and treatment protocols to avoid deductibles. The Medihelp Oncology Reference Price applies to oncology medicine.

    MEDICINE BENEFITS 
    Ask your pharmacist for the generic equivalent of prescribed medicine to avoid unnecessary out-of-pocket expenses. The only difference between an original medicine item and its generic equivalent is the price.

    Medicine benefits are applied as follows:
    • Generic medicine – 100% of the MMAP
    • Original medicine if no generic equivalent is available – 80% of the MT
    • Original medicine if a generic equivalent is available – 70% of the MMAP

    PROCEDURE-SPECIFIC DEDUCTIBLES 
    There are a limited number of low-incidence procedures that require a procedure-specific payment.

    DescriptionBenefit
    BACK AND NECK FUSION
    Member pays the first R9 500 
    Balance paid at 100% of the MT

    ENDOSCOPIC PROCEDURES
    There are only four endoscopic procedures where a member is required to contribute to the cost. If the procedure is performed in the doctor’s rooms or a day clinic it will significantly reduce or eliminate that expense. These benefits apply to non-network and network options.

    DescriptionBenefit
    • In the doctor’s rooms
      • Gastroscopy
      • Colonoscopy
    Medihelp pays 100% of the MT
    • In a day clinic
      • Gastroscopy
      • Colonoscopy
      • Arthroscopy
      • Sigmoidoscopy
    Member pays the first R2 550 per admission
    Balance paid at 100% of the MT
    • In hospital
      • Gastroscopy
      • Colonoscopy
      • Arthroscopy
      • Sigmoidoscopy
    Member pays the first R3 550 per admission
    Balance paid at 100% of the MT 

    DENTAL PROCEDURES UNDER GENERAL ANAESTHESIA
    These benefits rendered in hospital are subject to pre-authorisation and DSP's managed care protocols.  Procedures are paid at 100% of the Medihelp Tariff (MT).  These benefits apply to non-network and network options.

    DescriptionBenefit

    In hospital

    • Removal of impacted teeth (Dentist's account covered for item codes 8941, 8943 and 8945)
    • Extensive dental treatment for children younger than 5 years – once per lifetime (Dentist’s account: available funds in savings account)


    Member pays the first R2 900 per admission
    Balance paid at 100% of the MT


    SPECIALISED RADIOLOGY 
    Services rendered in and out of hospital must be requested by a specialist.  Benefits are subject to clinical protocols and the deductibles below.

    DescriptionBenefit
    • MRI and CT imaging (subject to pre-authorisation)
    Member pays the first R1 550 per examination 
    Balance paid at 100% of the MT


    MMAP-Maximum Medical Aid Price
    PMB -Prescribed minimum benefits 
    MT-Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price
    CT-Computerised tomography
    MRI-Magnetic resonance imaging

    Important notes:

    • If a beneficiary joins during the course of a financial year, the medical aid benefits are calculated pro rata according to the remaining number of months per year.
    • This is a summary of the available benefits. In the event of a dispute the registered Rules of Medihelp will apply, subject to approval by the Registrar of Medical Schemes. Phone Medihelp on 086 0100 678 if you have any enquiries about the Rules of Medihelp Medical Scheme.

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