Medihelp MedPrime:
dentistry, optometry and wellness (2025)

What's on this page:

This page has information on: Costs, Dentistry , Optometry Wellness and Preventative and Other benefits for Medihelp MedPrime View all the Medihelp plans, with costs and brief summary.

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Terminology:

  • PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
  • DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
  • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
  • All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

Monthly Costs (2025)

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Medihelp:MedPrime (2025 prices)
Main member: Adult member: Child member:
Total Cost pm:
  • R5,304
  • R4,482
  • R1,548
  • Only pay for 2 children under 18yrs
Savings:
  • R6,336
  • R5,400
  • R1,872
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R7,200
  • Main+1= R13,300
Children Rates:
  • Up to age 26yrs
  • Only pay for 2 children under 18yrs

Dentistry benefits (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Medihelp: MedPrime
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child:
Savings:
  • R6,336
  • R5,400
  • R1,872
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R7,200
  • Main+1= R13,300
Standard Dentistry:
  • Paid by scheme
Specialised Dentistry:
  • Dentures: One frame per person, every 5 years
  • Crowns and bridges: One crown per family, every 5 years
  • Implants: No cover
  • Above is paid by scheme
In-Hospital Dentistry:
  • Impacted wisdom teeth: Dentist account paid by scheme, if done in-chair, otherwise R1,850 co-payment
  • Treatment for children <7yrs: R1,850 co-payment
  • Maxillofacial surgery: Unlimited
Orthodontics:
  • R11,160 per person, per lifetime

Optometry benefits (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Medihelp: MedPrime
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child:
Savings:
  • R6,336
  • R5,400
  • R1,872
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R7,200
  • Main+1= R13,300
Optometry:
    Every two years, paid by scheme
  • Eye test and lenses
  • Frame/lens enhancement: R910
  • Contact Lenses: R1,310
  • Refractive Surgery:
    • R14,300 per family, paid by scheme
Note:
  • This section does not apply to opthamology benefits, which fall under "in-hospital" benefits. Some of those are PMBs, and are paid for in full by your scheme. You can read more about PMBs here.

Wellness/Preventative benefits (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Medihelp: MedPrime
Assume scheme pays all these costs, unless otherwise stated
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • No benefit
Biometric Screening:
  • Covered
Child Immunisation:
  • Covered, up to 7yrs
Pap Smear:
  • Covered, every 3 years
Mammogram:
  • Covered, every 2 years
PAS Test:
  • Covered
HIV Test:
  • Covered
Other:
  • Tetanus injection
  • An FOBT test
  • A bone mineral density test
View other benefits for this plan:
In-hospital | Out-of-hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

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Other benefits for 2025:

MedPrime
International Insurance:
  • No benefit
Other:

    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • "Unlimited" benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised


What does a “PMBs only” restriction mean?
In this case, the scheme will only pay for diagnosis, treatment and management of a claim for one of 270 pre-defined conditions (PMBs). Read more, and see full list of PMB conditions. 

What does “From Risk” mean?
The scheme will pay for this claim from its own funds, not from your savings or other day-to-day benefits. 

What is a DSP?
A Designated Service Provider. The scheme has a network of providers, and will often only pay claims in full if you use a DSP. If you choose another provider, you might have a co-payment, or even no cover.