User login

You are here

Home

Prime 2 Network 2021

Add to compare
Type of Medical Aid Plan: 
New Generation
Medical Aid Year: 
2021
Day to day Benefits: 

Day-to-day medical expenses such as GP and specialist consults, acute medicine, radiology, pathology, optometry and dentistry are paid from the available funds in your savings account, which is 15% of your monthly contribution. There is an added INSURED DAY-TO-DAY BENEFITS of; M= R1 250 per annum; M+ = R2 500 per annum, which is available after depletion of savings account. This benefit is limited to GP and specialist consultations, acute and self-medication and physiotherapy only

In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
Hospital Rate of Payment: 
Unlimited at 100% of Medihelp Tariff (MT)
Hospitals: 

Prime Network hospital only for planned procedure admissions. Certain procedures must be performed in the Day Surgery network

Upfront Payments to hospitals: 

If you choose to be admitted to an out-of-network hospital, or if you use a facility outside of the Day Surgery network for certain procedures, Medihelp will only cover 65% of the cost. You will be responsible for the other 35%. Procedural co-payments may apply to admissions; full details in the 2021 brochure

Casualty / Emergency Visits: 
Covered from risk for PMB emergency only. No benefit for facility fee. Payable from Savings account
Specialists: 
Unlimited at 100% of MT
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Unlimited at 100% of MT
Radiology and pathology: 
Unlimited at 100% of MT
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
Subject to protocols and pre-authorisation and the use of the day surgery network. Co-payment of R4 050 in a day clinic, no co-payment if procedure is done in the doctor's rooms
MRI and CT scans: 
Subject to protocols, pre-authorisation and requested by a specialist. Co-payment of R2 500 per examination, in or out of hospital
ICU and High Care: 
Unlimited at 100% of MT
Dialysis: 
Subject to pre-authorisation and clinical protocols. Unlimited at 100% of MT
Organ Transplants: 
PMB only. Subject to pre-authorisation and clinical protocols. Unlimited at 100% of MT
Oncology / Cancer: 
Subject to pre-authorisation and registration on the Medihelp Oncology Programme. Protocols and DSP's apply. Unlimited at 100% of MT for PMB's. Non-PMB's limited to R240 840 per family
Neck and Back Operations: 
Subject to pre-authorisation, protocols and completion of a back treatment programme. Co-payment of R10 850 applies
Joint Replacements: 
PMB cover only
Prosthesis: 

Subject to pre-authorisation, protocols and case management. Internal: EVARS prosthesis R135 600 per beneficiary per annum; Vascular or cardiac prosthesis R58 000 pbpa
Health-essential functional prosthesis R64 300 pbpa
Intraocular lenses 2 lenses pbpa at R4 300 per lens; Implantable hearing devices No benefit;
Reconstructive or restorative surgery prosthesis R9 900 per family per annum in or out of hospital

Medical and Surgical Appliances: 
Subject to scheme protocols and sub-limits. Payable from savings account
Maternity Confinements: 
Subject to pre-authorisation, protocols and case management. Unlimited at 100% of MT
In Hospital Dentistry: 
Subject to pre-authorisation and managed care protocols. Limited to removal of wisdom teeth and extensive treatment for children younger than 7 years. Subject to a co-payment of R3 430
Take home Medicine: 
100% of the MT up to R350 per admission
Rehabilitation, Hospice and Step-down facilities: 
Subject to pre-authorisation in an approved facility and prescribed by a medical doctor
Treatment for Mental Health: 
Subject to pre-authorisation, protocols and services rendered in or out of hospital by a psychiatrist. 100% of MT. Limited to R25 300 pbpa with a max of R34 800 pfpa
HIV / AIDS: 
Subject to registration on Medihelp's HIV/AIDS programme with LifeSense. 100% of cost
Ambulance Service: 
Subject to pre-authorisation and protocols. Unlimited with Netcare 911
International Travel Benefit: 
No Benefit
Day-to-day benefits
GP consultations: 

Subject to available savings or additional INSURED DAY-TO-DAY BENEFITS after depletion of savings account. Network GP and specialist referrals apply

Specialist consultations: 

Subject to available savings or additional INSURED DAY-TO-DAY BENEFITS after depletion of savings account. Network specialist and GP referrals apply

Acute medicine: 

Subject to available savings or additional INSURED DAY-TO-DAY BENEFITS after depletion of savings account. 100% of MT for generic medicine.

Over-the-counter (OTC) Medicine: 

Subject to available savings or additional INSURED DAY-TO-DAY BENEFITS after depletion of savings account. 100% of MT for generic medicine

Optometry benefits: 
Subject to available savings
Basic dentistry: 
Subject to available savings. 2 routine check-ups with scale and polish treatments per annum. Fillings, x-rays, tooth extractions, root canal treatments and plastic dentures
Specialised Dentistry: 
Subject to available savings, pre-authorization and managed care protocols. 100% of MT
Orthodontics: 

Subject to available savings, pre-authorization and orthodontic needs analysis. Once per lifetime for beneficiaries <18 years

MRI and CT Scans (Out of Hospital): 
Subject to protocols, pre-authorisation and requested by a specialist. Co-payment of R2 500 per examination, in or out of hospital
Radiology and Pathology: 
Subject to available savings
Pregnancy benefits: 
Subject to registration on HealthPrint's Maternity and Baby programme, 10 ante- and postnatal consultations at a GP, midwife or gynae, 2 ante- and postnatal consultations at a dietician/ lactation specialist and 2 x 2D scans
Physiotherapy and Occupational Therapy day to day: 
Subject to available savings or additional INSURED DAY-TO-DAY BENEFITS after depletion of savings account
Chronic Conditions
Provider: 
MobileMeds and collection from a MediLogistics network provider
Chronic Conditions: 

Diagnosis, treatment and care costs of 26 chronic conditions that fall under the Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL), issued by the Council for Medical Schemes. Subject to pre-authorisation, protocols, and DSPs

Additional Chronic Conditions: 
None
Preventative Care Benefits
Preventative Benefits: 

Health screening, HIV testing, counselling and support, tetanus and flu vaccine at Clicks or Dischem. Oral/injectable or implantable contraceptives for woman up to 50 years: R125 per month to max of R1 500 per annum or intra-uterine device R2 200 per 60 months. Age and frequency specific tests for pneumovax vaccine and faecal occult blood test, Women: pap smear, mammogram and bone mineral density scan; Men: prostate specific antigen. Babies < 1 yr receive 2 visits to a GP or specialist. 2 x HPV vaccines for boys and girls 10-14 yrs or 3 x between 15-26 yrs. Standard child immunisations up to 7 yrs at Clicks or Dischem clinics and child flu vaccines

Total Contributions
Total Contribution Main Member: 
2286.00
Total Contribution Adult: 
1884.00
Total Contribution Child*: 
684.00
Prime 2 network
Annual Medical Savings Account
Annual Medical Savings Main Member: 
4104.00
Annual Medical Savings Adult: 
3384.00
Annual Medical Savings Child*: 
1224.00
Monthly Medical Savings
Savings Child*: 
102.00
Savings Adult: 
282.00
Savings Main Member: 
342.00
Risk Contributions
Risk Contribution Main Member: 
1944.00
Risk Contribution Adult: 
1602.00
Risk Contribution Child: 
582.00
Medical Aid Plan Name Term: 
Prime 2