Medihelp Dimension Prime 1 medical aid plan: 2017 v 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

COSTS and OVERVIEW:
Dimension Prime 1
2018 costs Gap
In brief: On Dimension Prime 1 in 2018: See full benefits below For this plan, our recommended Gap Cover:
  • increases payout for in-hospital claims to 500% scheme rate
  • pays for ER treatment,
  • covers the 20% co-payment for cancer claims and
  • covers other in-hospital co-payments
See more benefits below, or full benefits here.
What’s new in 2018?
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Contributions:
Main: Adult: Child:
Cost 2018: R1,728 R1,422 R522
Cost 2017: (R1,608) (R1,320) (R486)
Overal Limit:
  • Unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Savings: No savings option on this plan
Extended Fund: RM = R1,100
M1 = R2,200
R R
Children: Pay for maximum 2 children
2018 Gap prices are to be confirmed, will be about R300 per family of under 65yrs, and R400 per family with a member who is 65yrs+.
Find out more
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IN HOSPITAL PROCEDURES:
Dimension Prime 1
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Payout Rate for Specialists:
  • 100% scheme rate
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice: Unlimited
Specialised Radiology:
  • R1,550 co-payment, in or out of hospital
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Professional services for up to 30 days after discharge following hospital admission: speech therapy, occupational therapy and physiotherapy. M=R1,700yr and M+=R2,300yr
Transplants:
  • Cornea implants: R26,100 per implant
  • Otherwise, unlimited
Co-payments:
  • Back and neck fusion: R10,600 co-payment
  • In-hospital dentistry for children younger than 5yrs and removal of impacted teeth: R2,900 co-payment, with dentist's account paid out of pocket
  • Gastroscopy and Colonoscopy:
    • in doctor's rooms: no co-payment
    • in day hospital: R1,950 co-payment
    • in-hospital: R2,950 co-payment
  • Specialised radiology (MRIs and CT Scans): R1,550 co-payment
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals:
  • Hospice and sub-acute facilities: paid by scheme, subject to authorisation
  • Private nursing: paid by scheme, subject to authorisation
  • No benefit
Casualty:
  • No benefit, unless PMB
  • Casualty costs not covered by medical aid, in case of emergency treatment: R12,800 per incident. Cover also applies to costs covered by savings account.
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OUT OF HOSPITAL BENEFITS:
Dimension Prime 1
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
GP consultations:
  • M =R1,100 and M+ =R2,200
  • Shared with GPs, specialists, physio, acute meds, otc meds, contraceptives, immunisations, herbal and homeopathic meds
  • No benefit
Childcare:
  • No benefit
Specialists consultations:
  • See GP benefit, above
  • No benefit
Pathology:
  • No benefit, unless PMB
  • No benefit
General radiology:
  • No benefit, unless PMB
  • No benefit
Specialised radiology:
  • R1,550 co-payment, in or out of hospital
Supplementary Services: (Physio, etc)
  • Physiotherapy: shared with GP consult benefit
  • Also, speech therapy, occupational therapy and physiotherapy for up to 30 days after discharge following hospital admission. Limited to R1,700 per person and R2,300 per family
  • No benefit
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MATERNITY BENEFITS:
Dimension Prime 1
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Hospital stay:
  • Hospital delivery: 100% scheme rate
  • Home delivery: R11,900
  • Premature birth, more than 6 weeks:R12,000 lump payment
  • In case of admission related to premature birth:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Consultations:
  • 12 consults, paid by scheme
  • 2 paediatric consults, paid by scheme
  • No benefit
Scans:
  • 2 x 2D scans, paid by scheme
  • No benefit
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CANCER (ONCOLOGY):
Dimension Prime 1
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overall coverage (in and out of hospital):
  • R80,000 per family per year for non-PMB cases
  • PMBs covered in full
  • Oncology Booster: Once the oncology limit is reached, gap pays for full cover thereafter
All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.
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DENTISTRY:
Dimension Prime 1
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Dentistry:
  • No benefit, unless PMBs
  • Removal of impacted wisdom teeth: in dentist's chair, paid by scheme
  • Full cover for in-hospital deductibles
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
Orthodontics:
  • No benefit
  • No benefit
Maxillo Facial Surgery:
  • No benefit, unless PMB
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MEDICATION:
Dimension Prime 1
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Chronic:
  • PMBs chronic: paid by scheme
  • No benefit
Acute (presrcibed) medication:
  • M =R1,100 and M+ =R2,200
  • Shared with GPs, specialists, physio, acute meds, otc meds, contraceptives, immunisations, herbal and homeopathic meds
  • No benefit
Over-the-counter:
  • M =R1,100 and M+ =R2,200
  • Shared with GPs, specialists, physio, acute meds, otc meds, contraceptives, immunisations, herbal and homeopathic meds
  • No benefit
Birth Control:
  • M =R1,100 and M+ =R2,200
  • Shared with GPs, specialists, physio, acute meds, otc meds, contraceptives, immunisations, herbal and homeopathic meds
  • No benefit
On Discharge:
    > R330 per admission
  • No benefit
Biological:
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OPTOMETRY:
Dimension Prime 1
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Optometry:
  • No benefit
  • No benefit
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MENTAL HEALTH:
Dimension Prime 1
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
In-hospital:
  • R17,600 per person and R25,150 per family
  • Includes in and out of hospital treatment with psychiatrist
  • No benefit
Out-of-hospital:
  • Psychiatry: See above
  • Psychology: No benefit
  • No benefit
Trauma:
  • Netcare 911 phoneline
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OTHER BENEFITS:
Dimension Prime 1
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
General Appliances:
  • Medical Appliances, hyperbaric oxygen: No benefit
  • Stoma products and urine bags: paid by scheme
  • CPAP apparatus: R8,850 per person every two years
  • No benefit
1.1. Hearing Aids:
  • R4,300 per family every 3 years
  • No benefit
1.2. Wheelchairs:
  • R4,300 per family every 3 years
  • No benefit
Dialysis:
  • Unlimited
HIV:
  • Post exposure prophylaxis in the event of sexual assault or accidental exposure to HIV
  • Paid by scheme
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • Transport by road outside RSA: R1,900 per event
  • Transport by air outside RSA: R12,400 per event
  • No benefit
Other:
  • Oxygen out-of-hospital: Unlimited, at100% scheme rate
  • Death or permanent disability: R12,000. If cause of death was accidental: R24,000.
  • If Principal member of medical aid passes away or becomes disabled: Medical aid contributions will be paid for six months, up to R4,400 per month. Gap premium is also waived for 6 months
  • In event of vehicle accident where policy holder was not at fault: Gap will provide all legal assistance, fully covered.
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WELLNESS/PREVENTATIVE BENEFITS:
Dimension Prime 1
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Flu vaccination:
  • Covered
  • No benefit
Pneumonia vaccines:
  • Covered, 55yrs+
  • No benefit
Back Rehabilitation Programme:
  • Covered
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation:
  • Covered
  • No benefit
Pap Smear:
  • Covered
  • No benefit
Mammogram:
  • Covered, 40yrs+
  • No benefit
PAS Test:
  • Covered, 40yrs+
  • No benefit
HIV Test:
  • Covered
  • No benefit
Other:
  • FOBT, 50yrs+
  • Bone density, 50yrs+
  • Tetanus vaccine
  • HPV vaccine, 10-26 yrs
  • No benefit
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2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overal Limit:
Sub-limits:

    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised