• Medihelp Plan, Scheme Plans

Medihelp MedPrime:
prosthetic benefits (2025)

Contents:

This page has information on: Costs and Prosthetics for Medihelp MedPrime

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 Providers. Where stipulated, you must use 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 (2026)

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

Medihelp:MedPrime (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R5,790
  • R4,896
  • R1,692
Savings:
  • R6,984
  • R4,896
  • R1,692
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R7,550
  • Main+1= R13,900
Children Rates:
  • Up to age 26yrs
  • Only pay for 2 children under 18yrs
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Prosthetics 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
Overall Limit:
  • Internal: R77,400 per person
  • External: see above
    • Prosthetics required for PMB conditions are always paid in full by scheme, with no co-payment, if you follow the protocols. More info here
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Sub-limits:
  • EVARS prosthesis: R163,300 per person
  • Vascular/cardiac prosthesis: R69,800 per person
  • Prosthesis with reconstructive surgery: R11,800 per family, in and out of hospital
  • Intraocular lenses: R5,260 per lens 2 lenses per person
  • External breast prostheses: R11,800 per family
  • Artificial eyes: R5,700 per family
  • Artificial limbs: R5,700 per family
Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Note:
  • PMBs: Prescribed Minimum Benefits. PMBs cannot have sublimits or co-payments if protocols are followed. You can read more about PMBs here.
  • DSPs: Designated Service Providers. Where stipulated, you must use 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.
    Important!
  • Unless specified, assume that all benefits 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.
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