User login

You are here

Home

Medihelp Prime 1 2017

Add to compare
Type of Medical Aid Plan: 
Hospital
Medical Aid Year: 
2017
In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
100 % of scheme rate
Hospitals: 

Any hospital

Upfront Payments to hospitals: 

R10 100 for back and neck fusions. R2900 for endoscopic procedures in hospital. R2900 for dentistry. R1500 for MRI scans.

Casualty / Emergency Visits: 
No benefit
Specialists: 
Unlimited 100 % of scheme rate
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Unlimited 100 % of scheme rate
Radiology and pathology: 
Unlimited 100 % of scheme rate
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
100 % of scheme rate subject to R2 800 co-payment per admission. In doctor's rooms member pays first R900
MRI and CT scans: 
Unlimited 100 % of scheme rate subject to R1500 co-payment per admission
ICU and High Care: 
Unlimited 100 % of scheme rate
Dialysis: 
Unlimited 100 % of scheme rate
Organ Transplants: 
Subject to pre-authorisation and clinical protocols Unlimited 100 % of scheme rate
Oncology / Cancer: 
100 % of scheme rate DSP ICON
Neck and Back Operations: 
100 % of scheme rate subject to R10 100 co-payment per admission
Joint Replacements: 
PMB's only
Prosthesis: 

All hospital admissions and prostheses are subject to pre-authorisation, protocols and case management. See brochure for full details. Benefits not applicable to wear and tear. PMB's only.

Medical and Surgical Appliances: 
Sub-limits apply subject to scheme protocols
Maternity Confinements: 
Unlimited 100 % of scheme rate
In Hospital Dentistry: 
100 % of scheme rate co-payment of R2 900 per admission for impacted wisdom teeth, extensive dental treatment for children younger than 5 years. Dentist's account for member's pocket
Take home Medicine: 
100 % of scheme rate R320 per admission
Rehabilitation, Hospice and Step-down facilities: 
Subect to pre-authorisation and prescribed by a medical doctor
Treatment for Mental Health: 
Subject to pre-authorisation and prescribed by a medical doctor R16 700 per beneficiary per year. Maximum R25 150 per family per year
HIV / AIDS: 
100 % of scheme rate
Ambulance Service: 
Netcare 911
International Travel Benefit: 
No Benefit
Day-to-day benefits
GP consultations: 

Limited to M = R 1050 per year M+ = R2 100 per year GPs, specialists, physiotherapy, acute and self-medication

Specialist consultations: 

Included in GP consultations M = R1 050 per year M+ = R2 100 per year GPs, specialists, physiotherapy, acute medicine and self-medication

Acute medicine: 

Included in GP and Specialist consultations

Optometry benefits: 
No benefit
Basic dentistry: 
No benefit
Specialised Dentistry: 
No benefit
Orthodontics: 

No benefit

MRI and CT Scans (Out of Hospital): 
Unlimited 100% of scheme rate subject to R1 500 co-payment
Radiology and Pathology: 
No benefit
Pregnancy benefits: 
12 pregnancy consultations, 2 2D sonars and 2 baby consults under 1 year.
Physiotherapy and Occupational Therapy day to day: 
No benefit
Chronic Conditions
Provider: 
Any pharmacy
Chronic Conditions: 

PMB only

Additional Chronic Conditions: 
No Benefit
Preventative Care Benefits
Preventative Benefits: 

One test per beneficiary per year. Blood glucose, cholesterol, BMI and HIV test at Clicks and Dis-Chem clinics. Mammogram, pap smear and prostate test. Bone density, Back treatment program, Flu vaccine, Tetanus vaccine, HPV vaccine. Standard kids immunisation under 7 years.

Total Contributions
Total Contribution Main Member: 
1608.00
Total Contribution Adult: 
1320.00
Total Contribution Child*: 
486.00
Prime 1
Risk Contributions
Risk Contribution Main Member: 
1608.00
Risk Contribution Adult: 
1320.00
Risk Contribution Child: 
486.00
Benefit: 
Subject to pre-authorisation and registration on the Medihelp Oncology Management Programme. Protocols and DSP (ICON) apply.
How many times per annum do you and your dependants visit a doctor?: 
2
How much do you spend on Acute medication per annum?: 
R1000 - R4999
How much do you spend on Chronic medication per annum?: 
R1000 - R4999
Will you or any of your dependants require specialised Dentistry: 
No