MedPrime
About this plan
🥇 Best suited for those seeking comprehensive private hospital cover with strong everyday healthcare benefits.
Principal Member
From
R5,790
per month
Adult Dependant
From
R4,896
per month
Child Dependant
From
R1,692
per month
What's covered
Hospital cover
Savings account
Day-to-day
Chronic cover
Dental
Optical
Maternity
Mental health
Waiting periods
- General
- 3 months
- Pre-existing conditions
- 12 months
MedPrime
Medihelp MedPrime Medical Aid Plan 🇿🇦 (2026*)
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 its members. The Medihelp MedPrime Medical Aid Plan starts from R5,790 ZAR.| 👤 Main Member Contribution | R5 790 |
| 👥 Adult Dependent Contribution | R4 896 |
| 💙 Child Dependent Contribution | R1 692 |
| 🌎 International Cover | None |
| 🔁 Gap Cover | None |
| 💳 Medical Savings Account | ☑️ Yes |
| 💶 Prescribed Minimum Benefits | ☑️ Yes |
| 📉 Screening and Prevention | ☑️ Yes |
| 🩺 Oncology Cover | R336 000 per family per year |
| ⚕️ 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 R5,790 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.
Overall, Medihelp offers 11 medical aid plans:
- ✅ MediHelp Medprime
- ✅ MediHelp MedPrime Elect
- ✅ MediHelp MedPlus
- ✅ MediHelp MedElite
- ✅ MediHelp MedVital
- ✅ MediHelp MedVital Elect
- ✅ MediHelp MedSaver
- ✅ MediHelp MedMove Student
- ✅ MediHelp MedReach
- ✅ MediHelpMedAdd
- ✅ MediHelp MedAdd Elect
Medihelp MedPrime Plan Contributions and Medical Savings
Contributions
| 🔎 Main Member | 👤 +1 Adult Dependent | 👥 +1 Child Dependent |
| R5 790 | R4 896 | R1 692 |
Annual Savings
| 👤 Main Member | 👥 +1 Adult Dependent | 🍼 +1 Child Dependent |
| R582 per month | R492 per month | R168 per month |
| R6 984 per year | R5 904 per year | R2,016 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 – R6 984 per year.
- 👉🏾 Adult Dependent – R5 904 per year.
- 👉🏾 Child – R2 016
- 👉🏾 Up to 100% of the Medihelp Tariff (MT), with the following limits:
- 👉🏾 Up to R7 550 for the main member.
- 👉🏾 Up to R13 900 for the main member and dependents.
- 👉🏾 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.
- 👉🏾 Out-of-hospital
- 👉🏾 Treatment and Materia
- 👉🏾 Covered in and out of the hospital.
- 👉🏾 Occupational and speech therapy, dietitian services, audiometry, podiatry, massage, orthoptic, chiropractic, homeopathic, herbal, naturopathic, osteopathic, and biokinetic services
- 👉🏾 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.
- 👉🏾 Covered out-of-hospital
- 👉🏾 Subject to clinical protocols and must be requested by a medical doctor
- 👉🏾 Must use Ampath / Lancet & PathCare Vermaak as the Pathology DSP
- 👉🏾 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.
- 📌 Covered up to 100% of the MT.
- 📌 If not pre-approved, a 50% co-payment applies.
- 📌 Limited to R2,600 per case.
- 📌 Covered up to 100% of the MT.
- 📌 If not pre-approved, a 50% co-payment applies.
- 📌 Limited to R17,700 per case.
Hospitalization
(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 R570 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 R17,100 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 Contracted Pathology DSP. Covered up to 100% of the MT. Unlimited cover provided. |
| 📉 Radiography | Covered up to 100% of the MT. Limited to R1,365 per family yearly. |
| 📊 Specialized Radiology | MRI and CT scans Subject to pre-authorization. Covered up to 100% of the MT. Unlimited Cover. R35 000 per family yearly. Member pays first R1 900 per examination in hospital and out of hospital. (Including Angiography) PET Scans excluded. |
| ☑️ 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 R37,600 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 R75,800 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. 30% co-payment if not obtained from a DSP. |
| 🔎 Post-Hospital Care Speech therapy, occupational therapy, and physiotherapy 30 days after discharge | 100% of the MT. Member = R2 415 per year M+ depedents = R3 465 per year. Including after a procedure in a day procedure facility. |
| 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. |
| 🧡 PSYCHIATRIC TREATMENT Psychiatrist-provided hospital and outpatient treatments General ward accommodations Institution-supplied medication Outpatient consultations | Covered up to 100% of the MT. Limited to R38,200 per beneficiary per year, with a limit of R51,500 per family per year. 20% co-payment per admission if not pre-authorised. 35% co-payment for voluntary admission to non-network hospital (network plans only). |
| 📌 Oncology: PMB Cases & Non-PMB | Covered up to 100% of the MT. All services relating treatment and care In and out of hospital Subject to pre-authorisation and registration on Medihelp Cancer Programme protocols, DSP, and MORP apply. 20% co-payment if not pre-authorised. R336 000 per family per year. Deviation from protocols may result in a co-payment. 30% co-payment for voluntary use of non-network services. |
| ☑️ 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 R30,200 per family per year. |
| 👩⚕️ Private Nursing | Covered up to 100% of the MT. 20% co-payment if not pre-authorized Unlimited cover. |
| 🅰️ PROSTATECTOMY: Conventional or Laparoscopic Procedure | Unlimited cover. Covered up to 100% of the MT. |
| 🅱️ Conventional or Laparoscopic Procedure | Subject to pre-authorisation. Covered up to 100% of the Medihelp tariff. |
| 🤖 Robotic Laparoscopy | Covered up to 100% of the MT. Subject to pre-authorisation. Hospitalisation: R145 900 per beneficiary |
| ⚠️ Refractive Surgery | Subject to pre-authorization and clinical protocols. Covered up to 100% of the MT. Hospitalisation and professional fee: R15 000 per family yearly. Subject to pre-authorisation and clinical protocols. 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). |
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.
- ☑️ Covered up to 100% of the MT.
- ☑️ If not pre-authorized, a 50% co-payment applies.
- ☑️ Limited to R2,600 per case.
- ☑️ Covered up to 100% of the MT.
- ☑️ If not pre-authorized, a 50% co-payment applies.
- ☑️ Limited to R17,700 per case.
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 R190 per month and up to R2,470 per beneficiary. Intra-uterine devices, every 60 months. Covered up to R2,835 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 midwife, general practitioner, or gynecologist. However, recommendation from network GP to gynecologist is not required. Two prenatal and postnatal visits to lactation consultant, dietician, or antenatal classes. Two 2D ultrasound imaging. Antenatal supplements: Nine months’ iron & 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. Flu vaccination of children 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. Available at Network Pharmacy Clinics. |
| ☑️ Men’s Health | A prostate test (PSA level) 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 | One 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. Per 12-month cycle. One dietitian consultation with each registered HealthPrint member whose BMI is greater than 30. 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 | 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. Self-medication dispensed at network pharmacy – additional R1000 will be activated for the family to use for non-prescribed medicine once a combo health screening has been claimed from the added insured benefits. |
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 (2026) | 🥈 Profmed ProSecure Savvy (2026) | 🥉 Bestmed Pace 1 (2026) |
| 🌎 International Cover | YES | R8 million | Yes |
| 👤 Main Member Contribution | R5,790 | R3,803 - R5,287 | R5,934 |
| 👥 Adult Dependent Contribution | R4,896 | R3,803 - R4,895 | R4,289 |
| 🍼 Child Dependent Contribution | R1,692 | R1,724,- R2,065 | R1,541 |
| 💶 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 |
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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