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Medihelp MedPrime Medical Aid Plan 🇿🇦 (2025*)

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 R5,304 ZAR.

👤 Main Member Contribution	R5 304
👥 Adult Dependent Contribution	R4 482
💙 Child Dependent Contribution	R1 548
🌎 International Cover	None
🔁 Gap Cover	None
💳 Medical Savings Account	☑️ Yes
💶 Prescribed Minimum Benefits	☑️ Yes
📉 Screening and Prevention	☑️ Yes
🩺 Oncology Cover	R320 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 R5,304 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:

👉 Download the MedPrime Summary for 2025 from MediHelp.

Medihelp MedPrime Plan Contributions and Medical Savings

Contributions

🔎 Main Member	👤 +1 Adult Dependent	👥 +1 Child Dependent
R5 304	R4 482	R1 548

Annual Savings

👤 Main Member	👥 +1 Adult Dependent	🍼 +1 Child Dependent
R528 per month	R450 per month	R156 per month
R6 336 per year	R5 400 per year	R1,872 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 336 per year.
👉🏾 Adult Dependent – R5 400 per year.
👉🏾 Child Dependent – R1 872 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 336 for the main member.
👉🏾 Up to R12 882 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 / Lancet & PathCare Vermaak as the Pathology DSP):

👉🏾 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

💙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.

💙POLL: 5 Best Hospital Coverage Plans under R1500 in South Africa

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 R2,500 per case.

Air Transport

📌 Covered up to 100% of the MT.
📌 If not pre-approved, a 50% co-payment applies.
📌 Limited to R16,900 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 R540 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 R16,300 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 R1,300 per family yearly.
📊 Specialized Radiology	MRI and CT scans Subject to pre-authorization. Covered up to 100% of the MT. Unlimited Cover. R25 000 per family yearly. Member pays first R1 700 per examination in hospital and R1 200 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 R35,900 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 R72,200 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 300 per year M+ depedents = R3 300 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.
🧡 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. 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. R320 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 R27,500 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: R139 000 per beneficiary
⚠️ Refractive Surgery	Subject to pre-authorization and clinical protocols. Covered up to 100% of the MT. Hospitalisation and professional fee: R14 300 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.

Outside the beneficiary’s Country of Residence:

Road Transport

☑️ Covered up to 100% of the MT.
☑️ If not pre-authorized, a 50% co-payment applies.
☑️ Limited to R2,500 per case.

Air Transport

☑️ Covered up to 100% of the MT.
☑️ If not pre-authorized, a 50% co-payment applies.
☑️ Limited to R16,900 per case.

👉 READ more about Medical Insurance for South Africans

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 R180 per month and up to R2,350 per beneficiary. Intra-uterine devices, every 60 months. Covered up to R2,700 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 R510 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	🥈 Profmed ProSecure Savvy	🥉 Bestmed Pace 1
🌎 International Cover	None	R8 million	R500,000 – R3 million
👤 Main Member Contribution	R5,304	R3,803 – R5,287	R5,706
👥 Adult Dependent Contribution	R4,482	R3,803 – R4,895	R4,008
🍼 Child Dependent Contribution	R1,548	R1,724, R2,065	R1,440
💶 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.

You might also consider the following options of MediHelp:

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 700 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.

Adriaan Schoeman

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.