Overall, the Medihelp MedPrime Elect Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance to its members. The Medihelp MedPrime Elect Medical Aid Plan starts from R4 344 ZAR.
π€ Main Member Contribution | R4 344 |
π₯ Adult Dependent Contribution | R3 666 |
π Child Dependent Contribution | R1 266 |
π International Cover | None |
π Gap Cover | None |
β‘οΈ Annual Limit | Unlimited Hospital Cover |
π₯ Hospital Cover | Unlimited |
πΆ Prescribed Minimum Benefits | β Yes |
π³ Medical Savings Account | β Yes |
πΌ Maternity Benefits | β Yes |
The Medihelp MedPrime Elect medical aid plan is one of 11, starting from R4 344 and includes physiotherapy, consultations, basic radiology, medicine, care extender, and more.Β Gap Cover is not available on the Medihelp MedPrime Elect Plan. However, Medihelp offers 24/7 medical emergency assistance. According to the Trust Index, Medihelp has a trust rating of 4.2.
πMediHelp has the following 11 plans to choose from:
π Download the MedPrime Summary for 2025 from MediHelp
π€ Main Member | π₯ +1 Adult Dependent | π +1 Child Dependent |
R4 344 | R3 666 | R1 266 |
π€ Main Member | π₯ +1 Adult Dependent | π +1 Child Dependent |
R432 per month | R366 per month | R126 per month |
R5,184 per year | R4,392 per year | R1,512 per year |
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MedPrime Electβs flexible credit facility provides instantaneous access to all your HSA balance for the year. Any remaining balance is carried over to the following year and earns interest.
How Medihelp pays claims on MedPrime Elect:
πBenefits are first paid from the available Medical Savings Account.Β Once funds are depleted, the following savings per year are available:
πOnce savings have been depleted, Medihelp pays medical expenses as follows:
Day-to-day benefits cover the following:
Consultations:
Clinical psychology and psychiatric nursing:
Standard radiology:
Pathology and medical technologist services (With Ampath/ Lancet / PathCare Vermaak as the Pathology DSP):
Medicine:
π
°οΈ Care Extender: One additional GP Consultation | First of either a Pap smear, mammogram, prostate test, faecal occult blood test (FOBT) or bone mineral density test activates one-off GP consultation for the family yearly. |
π
±οΈ Care Extender: Self-medication dispensed at network pharmacy | Additional R510 will be activated for family to use for non-prescribed medicine once a combo health screening has been claimed from added insured benefits. |
π PMB Chronic Medicine | Pre-approval and registration on Medihelpβs PMB drug management program are required. Covered up to 100% of the MHRP. The unlimited cover is provided. Formulary and DSPs will apply. A 60% co-payment applies if there is non-compliance with the protocols. |
π DSPs PMB Chronic β Medipost and Elect Oncology β Dis-Chem/Medipost HIV/AIDS β Dis-Chem/Medipost | Pre-approval and registration on Medihelpβs PMB drug management program are required. Covered up to 100% of the MHRP. The unlimited cover is provided. Formulary and DSPs will apply. A 60% co-payment applies if there is non-compliance with the protocols. |
π Oxygen | Covered out-of-hospital. Covered up to 100% of the MT. Unlimited cover. Benefits for oxygen out of hospital are subject to pre-authorisation, clinical protocols, and a prescription by medical doctor. 20% co-payment if not pre-authorised |
π€ Optometry | Subject to pre-authorization by a PPN. Services must be via a PPN provider. There is a limit of 1 composite consultation, including refraction test, tonometry, and visual field test per 2-year cycle. Covered up to 100% of the MT. Eye examination a non-network optometrist covered at R400 per beneficiary per 24-month cycle. |
π Spectacles or Contact Lenses | Spectacles β Frames or lens enhancement R910 per beneficiary per 24-month cycle. At a non-network optometrist R683 per beneficiary per 24-month cycle. Lenses at a PPN network optometrist One pair of standard clear lenses. Single vision or bifocal lenses (multifocal lenses paid at cost of bifocal lenses) per beneficiary per 24-month cycle. Multifocal lenses are covered at the cost of bifocal lenses. Contact lenses (benefits at network and non-network optometrist). R1 310 per beneficiary per 24-month cycle. |
πͺ₯ Conservative Dental Services | Benefits are subject to Dental Risk Company (DRC) protocols, contracted to Medihelp as a DSP. Benefits are subject to protocols and are limited to certain item codes. |
π¦· Dentistry:Β Routine Check-ups | Covered up to 100% of the MT. One in six months from date of service. Subject to DRC protocols β Cover 100% of MT |
βοΈ Oral Hygiene | Scale and polish treatments for beneficiaries >12 years. Fluoride treatment for children >5 & <13 years: One in six months from date of service. Fissure sealants for children >5 & <16 years only (permanent teeth): First and second permanent molars once per tooth. Subject to DRC protocols β Cover 100% of MT. |
β Fillings | Treatment plans and x-rays might be requested where multiple fillings are necessary. One filling per tooth in 12 months from date of service. Subject to DRC protocols β Cover 100% of MT. |
π Tooth Extractions and Root Canals on permanent teeth in the Dentistβs chair | Pre-authorization for more than 4 fillings per year, 2 fillings on front teeth per visit and 4 extractions per visit. Unlimited. Subject to DRC protocols β Cover 100% of MT. |
π Laughing Gas (Dentistβs Chair) | Covered up to 100% of the MT. |
π΄ Dentistry under conscious sedation (Dentistβs chair) | The benefit is only available for removing impacted teeth (3rd molars) Covered up to 100% of the MT Extensive dental treatment is only offered for children <12 years. 20% co-payment for no authorization. |
π€ Dentistry under general anesthesia in a day procedure facility, including the removal of impacted teeth | Covered up to 100% of the MT Removal of impacted teeth (3rd molars) Extensive dental treatment for children <7 (only once per beneficiary yearly) 35% co-payment for procedures not performed in a day procedure network. 20% co-payment for no authorization. R1 850 co-payment per admission |
π€ Special Needs Patients β dentistry in hospital (pre-authorisation by Medihelp and protocols apply), | Covered up to 100% of the MT Unlimited cover provided. 35% co-payment for procedures not performed in a day procedure network. 20% co-payment for no authorization. R1 850 co-payment per admission |
β‘οΈ Plastic Dentures | Covered up to 100% of the MT. Limited to one set per beneficiary/4 years. |
β X-Rays | Intra-Oral X-Rays.: Pre-authorisation for more than six per year. Unlimited. Covered up to 100% of the MT. Extra-Oral X-Rays: Covered up to 100% of the MT. One per beneficiary every three years. |
π¦· Specialized Dentistry | Subject to pre-authorization and DRC protocols. |
π© Partial Metal Frame Dentures | Covered up to 100% of the MT. One partial frame (upper or lower) per beneficiary every 5 years. 20% co-payment for no authorization. |
π Maxillofacial Surgery and Oral Pathology | Benefits for temporomandibular joint (TMJ) benefit limited to non-surgical treatment or interventions. Covered up to 100% of the MT. |
π Crowns and Bridges | Covered up to 100% of the MT. Subject to pre-authorisation. One crown per family yearly, once per tooth every five years. 20% co-payment for no authorization. |
πͺ₯ Orthodontic Treatment | Covered up to 100% of the MT. Limited to R11,160 per beneficiary lifetime. Limited to once per beneficiary <18. Payment is made from the authorization date until the patient turns 18. |
π Periodontal Treatment | Covered up to 100% of the MT. Conservative non-surgical therapy only. 20% co-payment for no authorization. Pre-authorisation and treatment plan required. |
π¦Ύ External Prostheses and Medical Appliances | Covered up to 100% of MT. R5 700 per family per three-year cycle for: – Artificial Eyes – Speech & hearing aids – Wheelchairs – Artificial limbs Covered up to 100% of MT. R1 600 per family per year for: – Medical appliances – Hyperbaric oxygen treatment Prescribed by a medical doctor (in & out of hospital). – Glucometers (per 5-year cycle). Consultations and follow-up consultations subject to available day-to-day benefits/savings |
𦡠Medical Appliances (back, leg, neck, and arm supports, crutches, orthopedic footwear, nebulizers, etc. | Covered up to 100% of the MT. Limited to R1,600 per family per year. |
π Stoma Components: – Incontinence Products or Supplies | Covered up to 100% of the MT. Unlimited cover provided. |
β CPAP Apparatus | A doctor must prescribe it. Covered up to 100% of the MT. Limited to R11,900 per beneficiary every 2 years. |
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1οΈβ£ Chronic Illness and PMB: (Diagnosis, treatment, and care costs of 271 PMB & 26 chronic conditions on CDL Protocols.) | Subject to protocols, pre-authorization, DSPs, and the specialist network. Covered up to 100% of the cost or the contracted tariff. Unlimited cover provided. 60% co-payment for not using DSP/medicine formulary. Network plans: Formulary and use DSP (Medipost) may apply. |
2οΈβ£ Trauma Benefits This applies to major trauma requiring hospitalization, for example: – Motor Vehicle Accidents – Stab Wounds – Gunshot Wounds – Head Trauma – Burns | Subject to authorization, PMB protocols, and case management. Covered up to 100% of the cost or the contracted tariff. Unlimited cover provided. |
3οΈβ£ Post-Exposure Prophylaxis (HIV/AIDS) | Subject to authorization, PMB protocols, and case management. Covered up to 100% of the cost of contracted tariff. Unlimited cover provided. |
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Emergency Transport Services via Netcare 911
The Beneficiaryβs Country of Residence (RSA, Lesotho, Eswatini, Mozambique, Namibia, Zimbabwe, Botswana) includes road and air transport.
Outside the beneficiaryβs Country of Residence
Road Transport
Air Transport
(Only MedPrime Elect hospital and day procedure network can be used)
π₯ HospitalizationΒ – Intensive Care and high-care wards – Ward Accommodation – Theatre fees – Treatment and medicine in the ward – In-hospital consultation with GPs and specialists – Surgery – Anesthesia | Unlimited Cover. Covered up to 100% of the MT. MedPrime Elect Hospital network. If not pre-approved, a 20% co-payment applies. 35% co-payment applies if members use non-network facilities for treatment. Additional co-payments on certain procedures may apply. |
π Day Procedures (Including Ophthalmological, endoscopic, ear, nose, and throat procedures, dental procedures, removal of skin lesions, circumcisions, and procedures as pre-authorized) | Unlimited Cover. Covered up to 100% of the MT. If not admitted to a hospital/day procedure facility in the network, 35% co-payment applies. Additional co-payments on certain procedures may apply. Non-network plans: 35% co-payment applies to procedures not performed in day procedure facility. |
π Hospital Medicine upon Discharge | Covered up to 100% of the MT. There is an R540 limit per admission. PMB/chronic medicine excluded. |
πΌ Childbirth (Subject to pre-authorization, protocols, and case management) | Covered up to 100% of the MT. Unlimited. 20% co-payment per admission if not pre-authorised. 35% co-payment for voluntary admission to non-network hospital (for network plans only) |
π Home Delivery Includes: – Professional Nursing Fee – Equipment – Material and Medicine | Covered up to 100% of the MT. Limited to R16,300 per event. If not pre-approved, a 20% co-payment applies. |
π Radiology, Pathology, and Medical Technologist Services | Members must use contracted Pathology DSP. (if you use another provider, you will pay the cost difference) Covered up to 100% of the MT. Unlimited cover provided. In-Hospital cover only. Subject to clinical protocols and approved hospital admission. |
π Radiography | Covered up to 100% of the MT. Limited to R1,300 per family yearly. |
π Specialized Radiology | 100% of the MT. Subject to pre-authorisation, clinical protocols, and on request of specialist. MedVital Elect, MedAdd Elect, and MedElect – prescribed by specialist on referral by network GP. – MRI and CT imaging (subject to pre-authorisation) – Angiography R25 000 per family per year. Member pays first R1 700 per examination in hospital and R1 200 out of hospital. |
π Clinical Technologist Services | Covered up to 100% of the MT. Unlimited Cover. |
β€οΈ Organ Transplants | Covered up to 100% of the cost. Subject to pre-authorization and clinical protocols. Cornea implants: Covered up to 100% of the MT. Limited to R35,900 per implant yearly. |
βοΈ In-hospital Oxygen | Covered up to 100% of the MT. Unlimited Cover. Benefits for oxygen out of hospital subject to pre-authorisation, clinical protocols, and prescription by a medical doctor. 20% co-payment if not pre-authorised. |
β³οΈ Neurostimulators (Includes device and components) | Covered up to 100% of the MT. Limited to R72,200 per beneficiary per year. |
π
°οΈ Renal Dialysis – Acute Renal Dialysis – Chronic/Peritoneal Renal Dialysis | Covered up to 100% of the MT. Unlimited Cover. Subject to pre-authorization and clinical protocols. 20% co-payment if not pre-approved. 30% co-payment if not obtained from a DSP. |
π
±οΈ Post-Hospital Care (Speech therapy, occupational therapy, and physiotherapy 30 days after discharge) | 100% of the MT M = R2 300 per year M+ = R3 300 per year Including after a procedure in a day procedure facility. |
π Other Medical Services – Dietitian services, physiotherapy, and occupational therapy – Speech therapy – Audiometry and orthoptic services – Podiatry | In-hospital protocols might apply. Covered up to 100% of the MT. Unlimited Cover. Must be pre-authorised and requested by attending medical doctor. |
π§ Psychiatry – Psychiatrist-provided hospital and outpatient treatments – General ward accommodations – Institution-supplied medication – Outpatient consultations | Covered up to 100% of the MT. Limited to R36,400 per beneficiary per year, with a limit of R49,100 per family per year. If not pre-approved, a 20% co-payment applies. 35% co-payment for voluntary admission to non-network hospital (network plans only). |
π Oncology: PMB and non-PMB cases | Pre-authorization and Medihelp Oncology Program registration are required. Protocols, a DSP, and the MORP apply. R320 000 per family per year Deviation from protocols may result in co-payment. Cover is 100% of the MT. 20% co-payment if not pre-authorised. 30% co-payment for voluntary use of non-network services. |
βοΈ Hospice Services and Subacute Care Facilities: Services rendered in an approved facility & prescribed by medical doctor | Covered up to 100% of the MT. 20% co-payment per admission if not pre-authorized. Unlimited cover. Pre-authorisation, programmes, and protocols apply. |
β Palliative Care | Covered up to 100% of the MT. 20% co-payment if not pre-authorized Limited to R28 800 per family yearly. Pre-authorisation, clinical protocols, services prescribed by medical doctor, a treatment plan, programmes, protocols, and formularies apply. |
π©ββοΈ Private Nursing | Covered up to 100% of the MT. 20% co-payment per case if not pre-authorised, except for MedElect, where 35% co-payment per case will apply if not pre-authorised. Unlimited cover. Subject to programmes and protocols. General day-to-day care is excluded. |
π©Ί Prostatectomy Conventional or Laparoscopic Procedure | Unlimited cover. Covered up to 100% of the MT. Pre-authorisation required. |
π€ Robotic Laparoscopy | Covered up to 100% of the MT Hospitalization is covered up to R139,000 per beneficiary. |
π§ͺ Refractive Surgery | Subject to pre-authorization and clinical protocols. Covered up to 100% of the MT. Hospitalization & professional fee is covered up to R14,300 per family for beneficiaries between 18 and 50. 20% co-payment per admission if not pre-authorised. 35% co-payment for voluntary admission to non-network hospital/day procedure facility (for network plans only). |
A medical emergency is a sudden and unexpected occurrence that necessitates quick medical or surgical treatment to safeguard a patientβs health.Β Failure to offer medical or surgical treatment would result in severe impairment of bodily functioning or severe dysfunction of a bodily organ or portion or jeopardize the individualβs life.
Netcare 911 is the designated service provider for Medihelpβs emergency transport services, and you must contact them in an emergency. Phone 082 911.Β Furthermore, you may also seek assistance at the nearby hospitalβs emergency room.
πHowever, the following conditions apply:
Emergency Transport Services via Netcare 911
The Beneficiaryβs Country of Residence (RSA, Lesotho, Eswatini, Mozambique, Namibia, Zimbabwe, Botswana) includes road and air transport.
Outside the beneficiaryβs Country of Residence
Road Transport
Air Transport
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π Mammogram | For women 40 β 75 years old. Every two years. A medical doctor must request it. |
π Pap Smear | For women 21 β 65 years old. Every three years. A medical doctor must request it. |
π Flu Vaccines | Once yearly. It must be done at network pharmacy clinics. |
π Contraceptives | Oral/injectable/implantable contraceptives β R180 per month, up to R2 350 per year. Intra-uterine device β R2 700 every 60 months. |
β
Enhanced Maternity Benefits – HealthPrintβs Maternity and Infant program registration will activate these additional benefits per family per year. | – Ten prenatal and postnatal consultations with midwife, general practitioner, or gynecologist. However, recommendation from network GP to the gynecologist is not required. – Two prenatal and postnatal visits to lactation consultant, dietician, or antenatal classes. – Two 2D ultrasound imaging. – Antenatal supplements: 9 monthsβ iron and folic acid supplements. |
βοΈ Child Benefits | – Babies <2 years receive two additional visits to a general practitioner, pediatrician, or ear, nose, and throat specialist. However, a network Physician reference is not required to see these specialists. – In network pharmacy clinics, the full series of regular child immunizations covered for up to seven years. – Child flu vaccination at network pharmacy clinics, |
π Routine Screening and Immunization | – A combo test, including blood glucose, cholesterol, BMI & blood pressure measurement. – Individual tests, including blood glucose or cholesterol. – HIV testing, counseling & support – Tetanus vaccine – Flu vaccination – Two HPV vaccinations for girls and boys between 10 β 14 years or three between 15 β 26 years |
π Menβs Health | A prostate test (PSA level) was requested by a physician for men aged 40 to 75. Flu vaccination is administered at network pharmacies. |
π Screening and Immunization for beneficiaries 45> | – An FOBT test for recipients 45-75 years – Women aged 65 and older can access one bone mineral density test every two years if requested by a physician. – A Pneumovax vaccine on a 5-year cycle for each 55-year-old with asthma or COPD who is registered. |
π Wellness Support | – One back Treatment: covers back therapy at DBC facility as an alternative to surgery for eligible patients. Moreover, treatment is a precondition for spinal surgery. – One dietitian consultation with each registered HealthPrint member whose BMI is greater than 30 upon indication. – An oncology schedule is provided in conjunction with Independent Clinical Oncology Network oncologists (ICON). – HIV program: Presented in partnership with LifeSense Disease Management. |
𧑠Care Extender Benefit | One additional GP visit for the family per year. Once your increased insured benefits pay for a Pap smear, mammography, prostate test, FOBT, or bone mineral density test, the family will receive a one-time GP visit benefit. Test protocols will apply to this benefit. Once your enhanced insured benefits pay for a combo health screening (blood glucose, cholesterol, BMI, and blood pressure), the family will receive a one-time R510 for self-medication. |
As medical research advances, new medical services are introduced each year. However, Medihelp covers life-saving medical treatment first. The Medical Schemes Act requires medical schemes to cover the diagnostic, treatment, and care costs of the mandated minimum benefits (PMB) without co-payments or limits.
Furthermore, services must follow legislationβs PMB treatment algorithms and Medihelpβs managed healthcare guidelines, which may include pharmaceutical formularies.Β Medihelp will cover the cost of a substitute treatment if a protocol or formulary drug is ineffective or hazardous. However, the Medihelp MedPrime Elect plan excludes several items, including but not limited to the following:
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During waiting periods, members are eligible for membership but not for benefits. For example, Medihelp could implement either a general or condition-specific waiting period as follows:
π Medical Aid Plan | π₯ Medihelp MedPrime Elect | π₯ Discovery Classic Saver | π₯ Bonitas BonSave Plan |
π International Cover | None | R5 million | R10 million |
π€ Main Member Contribution | R4 344 | R4,535 | R3,782 |
π₯ Adult Dependent Contribution | R3 666 | R3,577 | R2,859 |
πΌ Child Dependent Contribution | R1 266 | R1,817 | R1,132 |
π₯ Hospital Cover | Unlimited | Unlimited | Unlimited |
π Oncology Cover | R320,000 | R250,000 | R200,000 |
πΆ Prescribed Minimum Benefits | βοΈ Yes | βοΈ Yes | βοΈ Yes |
π Screening and Prevention | β Yes | β Yes | β Yes |
β‘οΈ Medical Savings Account | βοΈ Yes | βοΈ Yes | βοΈ Yes |
π Medihelpβs MedPrime Elect is a comprehensive medical aid plan offering its members a range of benefits. One of the standout features of this plan is its unlimited hospital cover, which means that members are covered for all hospital-related expenses, including accommodation, theatre, and specialist fees. In addition, the plan offers generous benefits for chronic medication. It covers day-to-day medical expenses such as GP consultations, dentistry, and optometry.
π One of the advantages of the MedPrime Elect plan is that it is more affordable than the MedElect plan while still offering comprehensive coverage. Additionally, the plan allows for some customization, with members able to choose between different levels of chronic medication coverage and dental and optical benefits.
π The plan also offers various value-added benefits, such as a wellness program, health assessments, and chronic disease management.Β However, the plan has a few drawbacks, including certain exclusions and limitations, such as limited coverage for certain procedures, waiting periods for pre-existing conditions, and a maximum limit on some benefits.Β Overall, the MedPrime Elect plan is a great choice for individuals or families who are looking for comprehensive medical aid coverage at an affordable price.
ππΎ You might also consider the following options of MediHelp:
Yes, MedPrime Elect covers blood tests that are medically necessary, subject to the schemeβs rules and protocols. The scheme may limit the number of blood tests covered, depending on the memberβs benefit option and specific needs.
Yes, MedPrime Elect covers MRI (Magnetic Resonance Imaging) scans as part of its hospitalization and radiology benefits, subject to pre-authorization by the scheme. However, the amount of cover may depend on the memberβs benefit option, and any co-payments or deductibles may apply.
MedPrime Elect is R4,344Β for the main member, R3,666 per adult, and R1,266 per child dependent.
Yes, MedPrime Elect covers hip replacement surgery as part of its hospitalization benefits, subject to pre-authorization and scheme protocols.
MedPrime Elect is a healthcare technology company that provides healthcare providers with electronic health records, telemedicine, and practice management software. The companyβs services are designed to help providers deliver high-quality patient care and improve operational efficiency.
Yes, MedPrime Elect covers maternity benefits, including antenatal consultations, childbirth, and postnatal care. The plan also covers certain tests and scans related to pregnancy.
Yes, MedPrime Elect covers chronic medication for a defined list of chronic conditions. The plan has a Chronic Disease List (CDL) that specifies the chronic conditions covered and the medication and treatment options available.
Yes, MedPrime Elect covers refractive eye surgery, a surgical procedure that corrects vision problems such as nearsightedness, farsightedness, and astigmatism. The plan covers a limited amount of refractive eye surgery every two years.
Yes, MedPrime Elect covers internal and external prostheses, which are devices that replace missing body parts or functions. This includes artificial limbs, hearing aids, and pacemakers, among others.
Yes, MedPrime Elect has waiting periods for certain benefits. For example, there is a 12-month waiting period for maternity benefits and a three-month waiting period for chronic medication benefits. Furthermore, the waiting periods ensure that members cannot claim certain benefits immediately after joining the plan.
To join MedPrime Elect, visit the Medihelp website or contact their call center to request a quote. You will need to provide personal and medical information. The scheme will assess your application and determine your premium based on age, health status, and other factors.
MedPrime Elect has a co-payment of 20% – 50% for unauthorized hospitalization, meaning you will need to pay 20 to 50% of your hospitalization out of pocket. However, depending on the hospital and the treatment received, this co-payment is capped at a maximum amount.
Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.
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