Medihelp Prime 1 Hospital Plan

    August 3, 2020

    Medihelp Prime 1 hospital plan cover caters for your hospitalisation expenses as well as some defined kinds minor of treatment that you can receive as an outpatient. With this medical aid cover you can be hospitalised in 120 private hospitals that are in Medihelp’s network of healthcare providers.

    Medihelp Prime 1 Benefits

    There are many benefits members and beneficiaries stand to reap from this Medihelp plan. They are detailed below:

    Ambulance: If you suffer severe symptoms that necessitate you being ferried to the hospital by an ambulance, this cost will be covered in your policy. However, you will be limited to transport by Netcare 911.

    Hospitalisation: There are many costs that go into you spending a night in the hospital. They range from the bed you will occupy to the check-ups you will need from doctors and nurses. These will all be taken care of without you having to reach back into your pocket.

    Specialised procedures: If you, or any of the beneficiaries specified in your policy, area cancer patient, you will have access to oncological treatment both as an inpatient and outpatient. Your cover will take care of the costs 100% under the PMB, or prescribed minimum benefits. You will also get treatment for the types of cancer not covered under PMB up to a maximum of R210,800.

    Organ transplants will be completely covered under this plan but not that for cornea implants, treatment will be covered up to R28,800 per implant.

    Prosthetics: You will be able to get prosthetic limbs and other forms of prostheses. There are different limits for different kinds of prosthetics. Shoulder, hip or knee replacements will be taken care of up to a limit of R23,000. Intra-ocular lenses are included in this category and the limit for these is R4,150 per lens. Cardio-vascular prosthetics will be provided to a limit of R34,600.

    Note that the prostheses benefit does not include replacement or repair of worn out prosthetics.

    Outpatient treatment: Your cover will cater for consultation costs when you visit a specialist or your GP. It will also cover the cost of medicines, including those for PMB conditions. However, the coverage will only be 100% for healthcare providers in the plan’s network.

    Things to note

    • With this Medihelp plan only hospitalisations in network hospitals is fully covered. If you choose to go for treatment outside the prescribed 120 hospitals, your plan will only cover 65% of the hospitalisation costs.
    • Emergency medical transport is covered both in and out of the country (only by Netcare 911). You can get emergency transportation in South Africa, Lesotho, Swaziland, Namibia, Botswana and Mozambique. Transport services should be pre-authorised for you or your beneficiaries to obtain the full benefit without having to cover it partly out of pocket. If the claim is not pre-authorised, you will need to cover 50% of this cost yourself. However, claims which have not been pre-authorised will still be honoured in full in the case of an emergency medical condition.
    • Pre-authorisation is also required for you to get 100% benefit for planned admissions, out-of-hospital oxygen use and dental procedures in which the patient is partially sedated. If your claim is not pre-authorised, only 80% of the benefit will be provided.

     

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    All info was correct at time of publishing