Medihelp MedPrime Medical Aid Plan
Overall, the Medihelp MedPrime Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and in-hospital procedures to up to 3 Family Members. The Medihelp MedPrime Medical Aid Plan starts from R4,782 ZAR.
| 👤 Main Member Contribution | R4,782 |
| 👥 Adult Dependent Contribution | R4,044 |
| 💙 Child Dependent Contribution | R1,398 |
| 🌎 International Cover | None |
| 🔁 Gap Cover | None |
| 💳 Medical Savings Account | ☑️ Yes |
| 💶 Prescribed Minimum Benefits | ☑️ Yes |
| 📉 Screening and Prevention | ☑️ Yes |
| 🩺 Oncology Cover | R299,000 |
| ⚕️ Hospital Cover | Unlimited |
Medihelp MedPrime Plan – 10 Key Point Quick Overview
- ☑️ Medihelp MedPrime Plan Overview
- ☑️ Medihelp MedPrime Plan Contributions and Medical Savings
- ☑️ MedPrime Plan Benefits and Cover Comprehensive Breakdown
- ☑️ MedPrime Benefit Table
- ☑️ MedPrime Emergency Benefits
- ☑️ MedPrime Added Insured Benefits
- ☑️ Medihelp MedPrime Plan Exclusions and Waiting Periods
- ☑️ Medihelp MedPrime Plan vs. Similar Plans from other Medical Schemes
- ☑️ Our Verdict on The Medihelp MedPrime Plan
- ☑️ Medihelp MedPrime Plan Frequently Asked Questions
Medihelp MedPrime Plan Overview
The Medihelp MedPrime medical aid plan is one of 11, starting from R4,782 and includes clinical psychology and psychiatric nursing, medicine, radiology, pathology, in-hospital treatments and procedures, routine screening, wellness programs, and more. Gap Cover is not available on the Medihelp MedPrime Plan. However, Medihelp offers 24/7 medical emergency assistance. According to the Trust Index, Medihelp has a trust rating of 4.2.
MediHelp has the following 11 plans to choose from
Medihelp MedPrime Plan Contributions and Medical Savings
Contributions
| 🔎 Main Member | 👤 +1 Adult Dependent | 👥 +1 Child Dependent |
| R4,782 | R4,044 | R1,398 |
Medical Savings Account
| 👤 Main Member | 👥 +1 Adult Dependent | 🍼 +1 Child Dependent |
| R480 per month | R402 per month | R138 per month |
| R5,760 per year | R4,824 per year | R1,656 per year |
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MedPrime Plan Benefits and Cover Comprehensive Breakdown
MedPrime Accumulative Unused Savings Contributions
MedPrime’s 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.
- 10% of your annual premium is accessible as a lump payment through the credit facility once yearly.
- The accumulative savings account is a separate account from which surplus funds from the previous year can be withdrawn in one payment beginning on January 1.
How Medihelp pays claims on MedPrime
- The day-to-day benefits listed below are paid from the credit facility of the savings account until it is emptied, except for PMB services.
- Then, Medihelp pays your insured daily benefits until they are exhausted.
- The payment for PMB services is limited to day-to-day benefits until they are depleted, after which payment is unlimited from core benefits.
- Finally, once this is exhausted, payments will be made from the cumulative savings account.
- Co-payments that Medihelp does not cover from the credit facility, such as co-payments during hospitalization or day-to-day benefits, can be paid from your available savings account balance.
MedPrime Day-to-Day Benefits
Benefits are first paid from the available Medical Savings Account. Once funds are depleted, the following savings per year are available:
- Main Member – R5,760 per year.
- Adult Dependent – R4,824 per year.
- Child Dependent – R1,656 per year.
Once savings have been depleted, Medihelp pays medical expenses as follows:
- Up to 100% of the Medihelp Tariff (MT), with the following limits:
- Up to R6,600 for the main member.
- Up to R12,100 for the main member and dependents.
Day-to-day benefits cover the following:
Consultations:
- GP appointments and follow-up appointments.
- Specialists
- Telemedicine, virtual consultations, and visits from nurses at network pharmacies.
- Pharmacies providing primary care and emergency units, including primary care drug therapists, in terms of consultations and follow-ups.
Physiotherapy:
- Out-of-hospital
- Treatment and Materia
Clinical psychology and psychiatric nursing:
- Covered in and out of the hospital.
Other medical services:
- Occupational and speech therapy, dietitian services, audiometry, podiatry, massage, orthoptic, chiropractic, homeopathic, herbal, naturopathic, osteopathic, and biokinetic services
Standard radiology:
- Covered out-of-hospital
- Subject to clinical protocols
- Must be requested by a medical doctor
- Only standard black and white X-rays are covered if a chiropractor requests them.
Pathology and medical technologist services (With Ampath as the Pathology DSP):
- Covered out-of-hospital
- Subject to clinical protocols and must be requested by a medical doctor
- Must use Ampath as the Pathology DSP
Medicine:
- The medication obtained through the Medihelp Preferred Pharmacy Network and prescribed or given by a physician
- Acute and non-PMB chronic medication and self-medication, including emergency room drugs and immunizations.
- Generic medicine – 100% of the MMAP
- Original medicine if no generic equivalent is available – 80% of the MT
- Original medicine used voluntarily when a generic equivalent is available – 70% of the MMAP
- Homeopathic, naturopathic, and osteopathic medicine – 25% of the available day-to-day benefit
MedPrime Benefit Table
MedPrime Hospitalization and Advanced Treatment
| 1️⃣ Chronic Illness and PMB | Subject to protocols, pre-authorization, DSPs, and the specialist network.
Covered up to 100% of the cost or the contracted tariff.
Unlimited cover provided.
Co-payments can apply if not using a DSP or deviating from the code. |
2️⃣ Trauma Benefits
This applies to major trauma requiring hospitalization, for example:
Motor Vehicle Accidents
Stab Wounds
Gunshot Wounds
Head Trauma
Burns
Near-drowning | Subject to authorization, PMB protocols, and case management.
Covered up to 100% of the cost or the contracted tariff.
Unlimited cover provided. |
| 3️⃣ Post-Exposure Prophylaxis (HIV/AIDS) | Subject to authorization, PMB protocols, and case management.
Covered up to 100% of the cost or the contracted tariff.
Unlimited cover provided. |
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Emergency Transport Services via Netcare 911
The Beneficiary’s Country of Residence (RSA, Lesotho, Eswatini, Mozambique, Namibia, Zimbabwe, Botswana) includes road and air transport.
- Unlimited Cover.
- Covered up to 100% of the MT.
- If not pre-approved, a 50% co-payment applies.
Outside the beneficiary’s Country of Residence:
Road Transport
- Covered up to 100% of the MT.
- If not pre-approved, a 50% co-payment applies.
- Limited to R2,320 per case.
Air Transport
- Covered up to 100% of the MT.
- If not pre-approved, a 50% co-payment applies.
- Limited to R15,400 per case.
(Only MedPrime hospital and day procedure network can be used)
📌 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.
If not pre-approved, a 20% co-payment applies.
Additional co-payments on certain procedures may apply. |
📍 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, a 35% co-payment applies.
Additional co-payments on certain procedures may apply. |
| 💊 Hospital Medicine upon Discharge | Covered up to 100% of the MT.
There is an R500 limit per admission. |
🍼 Childbirth
Subject to pre-authorization, protocols, and case management | Unlimited Cover.
Covered up to 100% of the MT.
If not pre-approved, a 20% co-payment applies. |
🏠 Home Delivery
Includes the following:
Professional Nursing Fee
Equipment
Material and Medicine | Covered up to 100% of the MT.
Limited to R14,900 per event.
If not pre-approved, a 20% co-payment applies. |
📈 Radiology, Pathology, and Medical Technologist Services
In-Hospital cover only.
Subject to clinical protocols and approved hospital admission. | Members must use Ampath as the contracted Pathology DSP.
Covered up to 100% of the MT.
Unlimited cover provided. |
| 📉 Radiography | Covered up to 100% of the MT.
Limited to R1,210 per family yearly. |
| 📊 Specialized Radiography | MRI and CT scans
Subject to pre-authorization.
Covered up to 100% of the MT.
Unlimited Cover.
Member pays the first R2,400 per examination and R1,900 out of the hospital.
Angiography
Covered up to 100% of the MT.
Unlimited Cover. |
| ☑️ Clinical Technologist Services | Covered up to 100% of the MT.
Unlimited Cover. |
| ❤️ Organ Transplants | Covered up to 100% of the MT.
Unlimited Cover.
Subject to pre-authorization and clinical protocols.
Cornea implants
Covered up to 100% of the MT.
Limited to R32,600 per implant yearly. |
| ⚕️ In-hospital Oxygen | Covered up to 100% of the MT.
Unlimited Cover. |
| ➡️ Neurostimulators (Includes device and components) | Covered up to 100% of the MT.
Limited to R65,600 per beneficiary per year. |
🩺 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. |
🔎 Post-Hospital Care
Speech therapy, occupational therapy, and physiotherapy 30 days after discharge | Accessible day-to-day benefits cover prescription medication and medical equipment.
Covered up to 100% of the MT.
Limited to the following:
Main Member – R2,100 per year.
Main Member + Dependents – R3,000 per year. |
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. |
🧡 Psychiatry
Psychiatrist-provided hospital and outpatient treatments
General ward accommodations
Institution-supplied medication
Outpatient consultations | Covered up to 100% of the MT.
Limited to R33,100 per beneficiary per year, with a limit of R44,600 per family per year.
If not pre-approved, a 20% co-payment applies. |
| 📌 Oncology: PMB Cases | Pre-authorization and Medihelp Oncology Program registration are required.
Protocols, a DSP, and the MORP apply.
Covered up to 100% of the MT.
Unlimited Cover.
10% co-payment on non-DSP treatment.
20% co-payment for deviating from protocol. |
| 📍 Oncology: Non-PMB Cases | Covered up to 100% of the MT.
Limited to R299,000 per family per year.
10% co-payment on non-DSP treatment.
20% co-payment for deviating from protocol. |
| ☑️ Hospice Services and Subacute Care Facilities | Covered up to 100% of the MT.
20% co-payment if not pre-authorized
Unlimited cover. |
| ✅ Palliative Care | Covered up to 100% of the MT.
20% co-payment if not pre-authorized
Limited to R26,200 per family per year. |
| 👩⚕️ Private Nursing | Covered up to 100% of the MT.
20% co-payment if not pre-authorized
Unlimited cover. |
| 🅰️ Appendectomy: Conventional or Laparoscopic Procedure | Unlimited cover.
Covered up to 100% of the MT. |
| 🅱️ Conventional or Laparoscopic Procedure | Member pays the first R6,600 per admission.
Covered up to 100% of the MT. |
| 🤖 Robotic Laparoscopy | Covered up to 100% of the MT
Hospitalization is covered up to R126,100 per beneficiary. |
| ⚠️ Refractive Surgery | Subject to pre-authorization and clinical protocols.
Covered up to 100% of the MT.
Hospitalization is covered up to R13,100 per family for beneficiaries between 18 and 50.
A 20% co-payment applies if there is no pre-authorization. |
MedPrime Emergency Benefits
A medical emergency is a sudden and unexpected occurrence that necessitates quick medical or surgical treatment to safeguard a patient’s health. 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 individual’s life. Netcare 911 is the designated service provider for Medihelp’s emergency transport services, and you must contact them in an emergency. Phone 082 911.
Furthermore, you may also seek assistance at the nearby hospital’s emergency room. However, the following conditions apply:
- Emergency admissions must be reported to Medihelp on the following business day by calling 086 0200 678.
- If you visit an emergency facility but are not hospitalized, the care you receive will be covered by your regular plans.
- Facilities costs are not included.
Emergency Transport Services via Netcare 911
The Beneficiary’s Country of Residence (RSA, Lesotho, Eswatini, Mozambique, Namibia, Zimbabwe, Botswana) includes road and air transport.
- Unlimited Cover.
- Covered up to 100% of the MT.
- If not pre-approved, a 50% co-payment applies.
Outside the beneficiary’s Country of Residence:
Road Transport
- Covered up to 100% of the MT.
- If not pre-approved, a 50% co-payment applies.
- Limited to R2,320 per case.
Air Transport
- Covered up to 100% of the MT.
- If not pre-approved, a 50% co-payment applies.
- Limited to R15,400 per case.
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MedPrime Added Insured Benefits
- With a strong emphasis on preventative care, early diagnosis of potential health problems, and maternity benefits and childcare, these benefits are offered annually in addition to your insured benefits unless otherwise specified.
- Protocols and item codes may be applicable.
- Members can look for network provider information on Medihelp’s website or app using the provider search option.
- You can also sign up for HealthPrint, a free online health and fitness program offered by Medihelp, to activate the specified benefits.
| 🔍 Mammogram | For women 40 – 75 years old.
Every two years.
A medical doctor must request it. |
| ☑️ Pap Smear | For women 21 – 65 years old.
Every three years.
A medical doctor must request it. |
| 💉 Flu Vaccines | Once yearly.
It must be done at network pharmacy clinics. |
| ❎ Contraceptives | Oral, injectable, or implantable contraceptives
Female beneficiaries up to 50 years.
Covered up to R165 per month and up to R2,145 per beneficiary.
Intra-uterine devices for women up to 50 years
Every 60 months.
Covered up to R2,520 per beneficiary. |
🍼 Enhanced Maternity Benefits
HealthPrint’s Maternity and Infant program registration will activate these additional benefits per family per year. | Ten prenatal and postnatal consultations with a midwife, general practitioner, or gynecologist. However, a recommendation from a network GP to the gynecologist is not required.
Two prenatal and postnatal visits to a lactation consultant, dietician, or antenatal classes.
Two 2D ultrasound imaging.
Antenatal supplements:
Nine months’ iron supplements.
Nine months’ folic acid supplements. |
| 👶 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 are covered for up to seven years.
Vaccination of children against influenza at network pharmacy clinics. |
| 💻 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
A tetanus vaccine
A flu vaccination
Two HPV vaccinations for children between 10 – 14 years or three between 15 – 26 years |
| ☑️ Men’s Health | A prostate test (PSA level) was requested by a physician for men aged 40 to 75.
Flu vaccination is administered at network pharmacies. |
| ✅ 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. |
| 💖 Wellness Support | Back Treatment – this benefit covers back therapy at a 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 and whose BMI was determined by a BMI test.
An oncology schedule is provided in conjunction with Independent Clinical Oncology Network oncologists (ICON)
HIV program – Presented in partnership with LifeSense Disease Management |
| 🩺 Care Extender Benefit | Additional GP visit
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.
Self-Medication (R475)
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 R475 for self-medication. |
Medihelp MedPrime Plan Exclusions and Waiting Periods
Medihelp MedPrime Exclusions
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 legislation’s PMB treatment algorithms and Medihelp’s managed healthcare guidelines, which may include pharmaceutical formularies. Medihelp will cover the cost of a substitute treatment if a protocol or formulary drug is ineffective or hazardous. However, the Medihelp MedPrime plan excludes several items, including but not limited to the following.
- The treatment of infertility other than that specified in the Medical Schemes Act of 1998 Regulations
- The artificial insemination of a human, as defined in section 61 of the National Health Act of 2003
- Immunizations (including immunization processes and materials) required by an employer, excluding flu vaccinations and routine childhood immunizations
- Workout, coaching, and rehabilitation regimens
- The cost of extracting or conserving human tissues, including but not limited to stem cells, for future use in the treatment of an undiagnosed medical ailment in a beneficiary
- Pathology services requested by someone other than a physician
- Non-registered substances with the South African Health Products Regulatory Authority (SAHPRA).
- This does not apply to medicines exempted by section 21 of the Medicines and Related Substances Control Act (101 of 1965, as amended)
- Bandages, cotton wool, bandages, plasters, and similar items not utilized by a service provider during a treatment or procedure
- Food substitutes, food supplements, and prescription food, including infant food.
- Multivitamin and multimineral supplements alone or with stimulants (tonics)
- Appetite suppressants
- Cost of metal-based complete dentures, including laboratory fees
- Impact-resistant acrylic
- The expense of gold, precious metal, semi-precious metal, and platinum foil
- Laboratory delivery fees
- Blood pressure apparatus
- Commode
- Toilet seat raiser
- Home-use hospital beds
- Devices to improve vision, other than the stated eyeglass and contact lens benefits
Medihelp MedPrime Waiting Periods
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:
- The general waiting period is up to three months from the date of membership. During this time, you will not be eligible for benefits other than the minimum prescribed benefits (PMB). During this waiting period, the Scheme will not pay any claims you file.
- From the day you join, a condition-specific waiting period of up to 12 months applies. During this period, you will not be eligible for benefits related to a specific ailment for which you get medical advice, a diagnosis, care, or treatment (this excludes PMB).
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Medical Aid Comparisons : Medihelp MedPrime Plan vs. Similar Plans from other Medical Schemes
| 🔎 Medical Aid Plan | 🥇 Medihelp MedPrime | 🥈 Profmed ProSecure Savvy | 🥉 Bestmed Pace 1 |
| 🌎 International Cover | None | R8 million | R500,000 – R3 million |
| 👤 Main Member Contribution | R4,782 | R5,349 | R5,061 |
| 👥 Adult Dependent Contribution | R4,044 | R4,953 | R3,555 |
| 🍼 Child Dependent Contribution | R1,398 | R2,091 | R1,277 |
| 💶 Prescribed Minimum Benefits (PMB) | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 💻 Screening and Prevention | ✅ Yes | ✅ Yes | ✅ Yes |
| 👛 Medical Savings Account | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 👶 Maternity Benefits | ✅ Yes | ✅ Yes | ✅ Yes |
| 🏠 Home Care | ☑️ Yes | ☑️ Yes | ☑️ Yes |
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Our Verdict on The Medihelp MedPrime Plan
MedPrime offers several features that make it an attractive option for those seeking a comprehensive medical scheme. The plan covers hospitalization, chronic medication, and day-to-day medical expenses such as doctor visits and medication. Members of MedPrime also have access to a network of healthcare providers, including doctors, specialists, and hospitals. One of the advantages of MedPrime is that it offers a savings account that can be used to pay for day-to-day medical expenses. Members can choose the amount they wish to contribute to their savings account, and any unused funds at the end of the year are carried over to the next year. This means that members can build up significant savings over time, which can be used to pay for medical expenses not covered by the plan.
However, one drawback of MedPrime is that it is expensive compared to other plans offered by Medihelp. In addition, the plan’s comprehensive coverage and savings account to contribute to its higher cost, which may not be affordable for everyone. In comparison to Medihelp’s other plan, MedPrime Elect, MedPrime has a higher monthly contribution but comes with more comprehensive coverage, including day-to-day medical expenses. On the other hand, MedPrime Elect has a lower monthly contribution. However, it has a more limited day-to-day medical expense benefit.
In conclusion, MedPrime is an excellent option for those who value comprehensive medical coverage and are willing to pay a higher monthly contribution. The plan’s savings account is also a valuable feature that can help members build up savings for medical expenses. However, if affordability is a significant concern, Medihelp’s MedPrime Elect may be a more suitable option, although with fewer day-to-day benefits. Ultimately, choosing between the plans depends on individual medical needs and budget.
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Medihelp MedPrime Plan Frequently Asked Questions
What is Medihelp MedPrime?
Medihelp MedPrime is a comprehensive medical scheme plan offered by Medihelp, a medical scheme provider in South Africa. It provides cover for hospitalization, chronic medication, and day-to-day medical expenses.
What are the features of Medihelp MedPrime?
Medihelp MedPrime offers comprehensive medical cover, including hospitalization, chronic medication, and day-to-day medical expenses. It also has a savings account that can be used to pay for day-to-day medical expenses.
Does Medihelp MedPrime cover hearing aids for pensioners in South Africa ?
Yes, Medihelp MedPrime covers medical appliances like Speech and hearing aids up to the value of R5 200 per family per 3-year cycle
What are the advantages of Medihelp MedPrime?
The advantages of Medihelp MedPrime include comprehensive medical coverage, a savings account for day-to-day medical expenses, and access to a network of healthcare providers.
What does hospitalization coverage mean in a medical aid plan?
Hospitalization cover refers to the medical expenses associated with hospital admissions, such as doctor and specialist fees, hospital fees, and medication.
What are the drawbacks of Medihelp MedPrime?
The main drawback of Medihelp MedPrime is its higher cost than other plans offered by Medihelp, which may not be affordable for everyone.
How does medical aid in South Africa work?
Medical aid members pay a monthly contribution in exchange for medical cover. The type and level of cover depend on the plan chosen.
How does Medihelp MedPrime compare to other plans offered by Medihelp?
Medihelp MedPrime has more comprehensive coverage, including day-to-day medical expense coverage, but is more expensive than other plans offered by Medihelp. The choice between plans depends on individual medical needs and budget.
How are medical aid prices determined in South Africa?
Medical aid prices are determined by the level of coverage provided, the number of members on the plan, and the age and health status of the members.
Where can I find reviews of medical aid plans in South Africa?
You can find reviews of medical aid plans in South Africa on various online platforms. You can also ask for recommendations from friends and family members for medical aid schemes.
Can anyone join Medihelp MedPrime?
Anyone can join Medihelp MedPrime, provided they meet the eligibility criteria set out by Medihelp.
How can I apply for Medihelp MedPrime?
You can apply for Medihelp MedPrime online or by contacting Medihelp directly.
