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Medihelp Prime 2 (Netwerk) 2018

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Type of Medical Aid Plan: 
Hybrid
Medical Aid Year: 
2018
In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

 108 network facilities

Upfront Payments to hospitals: 

R9 500 for back and neck fusions. R3 550 for endoscopic procedures in hospital. R2 900 for dentistry. R1 550 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 550 co-payment per admission. In doctor's rooms no co-payment
MRI and CT scans: 
Unlimited 100 % of scheme rate subject to R1 550 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 500 co-payment per admission
Joint Replacements: 
PMB 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 R2900 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: 
Subect to pre-authorisation and prescribed by a medical doctor
HIV / AIDS: 
100 % of scheme rate
Ambulance Service: 
Netcare 911
International Travel Benefit: 
No Benefit
Day-to-day benefits
GP consultations: 

Limited to available medical savings account

Specialist consultations: 

Limited to available medical savings account

Acute medicine: 

Limited to available medical savings account

Over-the-counter (OTC) Medicine: 

Limited to available medical savings account

Optometry benefits: 
Limited to available medical savings account
Basic dentistry: 
Limited to available medical savings account
Specialised Dentistry: 
Limited to available medical savings account
Orthodontics: 

Limited to available medical savings account

MRI and CT Scans (Out of Hospital): 
Unlimited 100% of scheme rate subject to R1 550 co-payment
Radiology and Pathology: 
Limited to available medical savings account
Pregnancy benefits: 
8 pregnancy consultations. 2 2D scans and 2 baby consults under 1 year.
Physiotherapy and Occupational Therapy day to day: 
Limited to available medical savings account
Chronic Conditions
Provider: 
MobileMeds
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: 
1800.00
Total Contribution Adult: 
1476.00
Total Contribution Child*: 
534.00
Prime 2 network
Annual Medical Savings Account
Annual Medical Savings Main Member: 
3240.00
Annual Medical Savings Adult: 
2664.00
Annual Medical Savings Child*: 
936.00
Monthly Medical Savings
Savings Child*: 
78.00
Savings Adult: 
222.00
Savings Main Member: 
270.00
Risk Contributions
Risk Contribution Main Member: 
1530.00
Risk Contribution Adult: 
1254.00
Risk Contribution Child: 
456.00
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