This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Medihelp MedPrime Elect.
In-hospital Procedures (2024):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
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Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated |
| non-Network Specialists: |
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| network Specialists: |
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| non-Network GPs: |
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| network GPs: |
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| Hospital Choice: |
- Long stay: Network hospital
- Day procedure: Network Day hospital
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| Day Hospitals: |
- Procedures requiring Day hospital use: Ophthalmological, dental, endoscopic and
ear, nose and throat procedures, removal of
skin lesions, circumcisions and other case-by-case pre-authorised procedures
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| Penalty for using other hospital: |
- Use of non--network: 35% penalty
- Use of non-Day hospital for certain procedures: 35% penalty
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| Other Co-payments: |
- Spinal Column surgery: R10,400 co-payment
- Endoscopic procedures, in day hospital (all scopes): R3,850 co-payment
- Endoscopic procedures, in rooms (all scopes): no co-payment
- Dental procedures: R1,750 co-payment
- Specialized radiology: R1,950 - R2,500 co-payment
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| Specialised Radiology: |
- MRI and CT scan: R2,500 co-payment, in and out of hospital. (R1,950 co-payment if out of hospital)
- Angiography: Unlimited, in and out of hospital
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| Scopes: |
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| Supplementary Services: (Physio, etc) |
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| Transplants: |
- PMBs only
- Cornea implants: R34,200 per implant
- Bone marrow/stem cell transplant: No benefit, unless PMB
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| Dialysis: |
- Scheme rate, in and out of hospital
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| Exclusions: |
Exclusions:
- Note: All schemes have extensive exclusions. We've tried to list the major ones here, but please consult your scheme or broker to get the full list.
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| Alternatives to hospitals: |
- Hospice as an alternative to hospitalisation: Covered
- Subacute care as an alternative to hospitalisation: Covered
- Private Nursing as an alternative to hospitalisation: Covered
- Palliative care: R27,500 per family
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| Casualty: |
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| Other: |
- Speech therapy, OT and physio, post hospital care: R2,200 per person and R3,150 per family
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| Note: |
- 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
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View all the other benefits for this plan:
In-hospital |
Out-of-hospital |
Medication |
Maternity
Cancer |
Mental Health |
Dentistry |
Optometry
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
Compare any two plans, side by side |
View all the Medihelp plans, with costs and brief summary.
Find all other open medical aid plans here.
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| . |
Out-of-hospital Procedures (2024):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
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Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
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- Main= R7,200
- Main+1= R13,300
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- All medical aids must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
- This can include consults with specialists, blood or other tests, radiology and medicine
- The benefit is paid by the scheme, and not out of your savings account
- If you have no day-to-day funds, you still have cover for PMBs
- Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
- See our Guide to PMBs for more information.
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- Care extender benefit: One GP consult for family once you complete any one Pap smear, mammogram, prostate test, faecal occult blood test (FOBT) or bone mineral density test
- Otherwise, from day-to-day benefit
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- Paediatrician/GP/ENT: 2 consults, 0-2yrs
- Immunisations: Covered, up to 7yrs
- Flu shot: Covered
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- MRI and CT scan: R2,500 co-payment, in and out of hospital. (R1,950 co-payment if out of hospital)
- Angiography: Unlimited, in and out of hospital
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| Scopes: |
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- Occupational and speech therapy, dietician services, audiometry, podiatry, massage, orthoptic, chiropractic, homeopathic, herbal and naturopathic, osteopathic, and biokinetic services: From day-to-day benefit
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- CPAP: R11,400 per person every 2 years
- Medical Appliances: R1,550 per family
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- R5,450 per family, every 3 years
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- R5,450 per family, every 3 years
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- PMBs: Prescribed Minimum Benefits. To read more about PMBs click here
- 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
|
View all the other benefits for this plan:
In-hospital |
Out-of-hospital |
Medication |
Maternity
Cancer |
Mental Health |
Dentistry |
Optometry
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
Compare any two plans, side by side |
View all the Medihelp plans, with costs and brief summary.
Find all other open medical aid plans here.
|
| . |
All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.
Medication Benefit (2024):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
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Assume scheme pays all these costs, unless otherwise stated |
|
Main Member: |
Adult: |
Child: |
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- Main= R7,200
- Main+1= R13,300
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| Chronic: |
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- Care extender benefit: R490 for over the counter meds once you complete a health screening
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- Oral, injectable: R170 per month up to R2,250 per year
- IUD: R2,600 every 60 months
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- Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
- Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
- PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
- 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
|
View all the other benefits for this plan:
In-hospital |
Out-of-hospital |
Medication |
Maternity
Cancer |
Mental Health |
Dentistry |
Optometry
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
Compare any two plans, side by side |
View all the Medihelp plans, with costs and brief summary.
Find all other open medical aid plans here.
|
| . |
All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.
|
