User login

You are here

Home

Medihelp Prime 2 2017

Add to compare
Type of Medical Aid Plan: 
Hybrid
Medical Aid Year: 
2017
Co-payments: 
100% of the cost DSP: ICON
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: 

R9 000 for back and neck fusions. R3 400 for endoscopic procedures in hospital. R1 900 for dentistry. R1 500 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 R3 400 co-payment per admission. In doctor's rooms no co-payment
MRI and CT scans: 
Unlimited 100 % of scheme rate subject to R1 500 co-payment
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 R9 000 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 R1900 per admission for impacted wisdom teeth, extensive dental treatment for children younger than 5 years. Dentist's account from savings
Take home Medicine: 
Subject to savings
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 R21 000 per beneficiary per year. Maximum R28 750 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: 

100% of scheme rate M = 2 GP consultations per year M+ = 4 GP consultations per year. Further consultations from annual savings.

Specialist consultations: 

Subject to savings

Acute medicine: 

100% of scheme rate subject to savings

Over-the-counter (OTC) Medicine: 

Subject to savings

Optometry benefits: 
100% of scheme rate 1 composite examination per beneficiary per 24-month cycle. R200 per beneficiary for a frame and or lense enhancements
Basic dentistry: 
100 % of scheme rate 2 emergency visits consisting of 2 extractions per visit or 2 emergency root canal treatments
Specialised Dentistry: 
Subject to savings
Orthodontics: 

Subject to savings

MRI and CT Scans (Out of Hospital): 
Unlimited 100% of scheme rate subject to R1 500 co-payment
Radiology and Pathology: 
Subject to savings
Pregnancy benefits: 
6 pregnancy consultations. 2 2D scans and 2 baby consults under 1 year.
Physiotherapy and Occupational Therapy day to day: 
Subject to savings
Chronic Conditions
Provider: 
Any pharmacy
Chronic Conditions: 

26 Conditions on chronic disease list. 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: 
2136.00
Total Contribution Adult: 
1746.00
Total Contribution Child*: 
642.00
Prime 2
Annual Medical Savings Account
Annual Medical Savings Main Member: 
3096.00
Annual Medical Savings Adult: 
2620.00
Annual Medical Savings Child*: 
936.00
Monthly Medical Savings
Savings Child*: 
936.00
Savings Adult: 
2620.00
Savings Main Member: 
3096.00
Risk Contributions
Risk Contribution Main Member: 
2136.00
Risk Contribution Adult: 
1746.00
Risk Contribution Child: 
642.00
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?: 
4
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: 
Yes