Medihelp Dimension Prime 3 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 3
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R2,940 R2,490 R858
Cost 2017: (R2,730) (R2,316) (R798)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: Unlimited overall, with sub-limits
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 = R8,600
M1 = R13,700
M2= R16,000
M3+= R17,000
R R
Children: Pay for maximum 2 children
    In 2018, with this plan:
  • Has cover for non-PMB cancer
  • Lower scope co-payments if done in day hospital
  • Radiology and pathology benefit pooled into day-to-day benefit
See below for other changes
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Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family


IN HOSPITAL PROCEDURES:
Dimension Prime 3
2017 v 2018 benefits Gap benefits Notes
Payout Rate for Specialists: Fusion Gap:
  • Up to 600% scheme rate for specialists and other providers
  • 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
  • R350pm per family. More Info or download application below.

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Hospital Choice:
  • Unlimited
  • N/A
Specialised Radiology:
  • Co-payment: R1,550, unless PMB
  • Sublimit: none
  • Rate: 100% scheme rate
  • In and out of hospital
Fusion Gap:
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
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=R1,700 per person and M+=R2,300 per family
Fusion Gap:
  • Up to 600% scheme rate for specialists and other providers
Transplants:
  • Cornea implants: R26,100 per implant
  • Otherwise, unlimited
Co-payments:
  • Back and neck fusion: R8,250 co-payment
  • In-hospital dentistry for children younger than 5yrs and removal of impacted teeth: R840 co-payment
  • 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
Fusion Gap:
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals:
  • 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
Casualty:
  • 2 x 2D scans, paid by scheme
  • No benefit
Other:
  • Laparoscopic appendectomy: R15,800 per person
  • Robotic assisted laparoscopic procedure for prostatectomy: R100,400 per person
  • Neurostimulators: R101,200 per person
  • Up to 500% of scheme rate
  • Certain in-hospital sublimits increased by R44,000 per event, unlimited for the year
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OUT OF HOSPITAL BENEFITS:
Dimension Prime 3
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • Paid from day-to-day benefit, unless PMB
  • Out of hospital treatment for conditions that are PMBs is always paid for by the scheme (not out of savings), but according to protocols
",
  • No benefit
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  • Paid from day-to-day benefits
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  • No benefit
,,
  • Paid from day-to-day benefits
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  • No benefit
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  • Paid from day-to-day benefits
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  • No benefit
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  • R1
550 co-payment

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Childcare:
  • No benefit
  • No benefit
Specialists consultations: in or out of hospital unless PMB "
Pathology:
  • 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
General radiology:
  • Paid from day-to-day benefits
  • 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.
Specialised radiology:
  • 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
Supplementary Services: (Physio, etc)
  • 12 consults, paid by scheme
  • 2 paediatric consults, paid by scheme
  • No benefit
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MATERNITY BENEFITS:
Dimension Prime 3
2017 v 2018 benefits Gap benefits Notes
Hospital stay:
  • R150,000 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

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Consultations:
  • Standard Dentistry: paid by scheme.
  • Includes:
    • 2 annual checkups
    • X-rays. (Extra-oral 1 every 3 years)
    • 2 annual scale and polish treatments per person
    • Fissure sealants for under 16yr olds
    • Fluoride treatments for children 5-13yrs
    • One filling per tooth per year
    • Extractions and root canals
    • Plastic dentures, 1 set per person every 4 years
  • Specialised dentistry:
    • Partial metal frame dentures: 1 frame per person every 5 years
    • Crowns and bridges: 1 crown per family per year
    • Implants: No benefit
  • Conscious sedation in rooms: for extensive treatment only andimpacted wisdom teeth
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
  • Full cover for in-hospital co-payments
Scans:
  • R8,230 per person per lifetime, 9-18 yrs only. Paid by scheme.
  • No benefit
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CANCER (ONCOLOGY):
Dimension Prime 3
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital):
  • 100% scheme rate, paid by scheme
  • Dental reconstruction as result of trauma or oncology: R40,000 per event
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 3
2017 v 2018 benefits Gap benefits Notes
Dentistry:
  • PMBs chronic: paid by scheme
  • No benefit

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Orthodontics:
  • R8,230 per person per lifetime, 9-18 yrs only. Paid by scheme.
  • No benefit
Maxillo Facial Surgery:
  • Paid from day-to-day benefit
  • No benefit

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

MEDICATION:
Dimension Prime 3
2017 v 2018 benefits Gap benefits Notes
Chronic:
  • Paid from day-to-day benefit
  • No benefit

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Acute (presrcibed) medication:
  • See "Acute Medicine" benefit
  • No benefit
Over-the-counter: 2018 benefits coming soon!
  • Eye test: one every 2 years
  • Frames: R600 every 2 years
  • Lenses: Every 2 years
  • Contacts: R1,155 per person every 2 years
Birth Control:
  • No benefit
  • Psychiatry: See above
  • Psychology: paid from day-to-day benefit
On Discharge:
  • No benefit
  • R26,500 per person and R35,600 per family
  • Includes in and out of hospital treatment with psychiatrist
Biological:
  • R330 per admission
  • No benefit
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OPTOMETRY:
Dimension Prime 3
2017 v 2018 benefits Gap benefits Notes
Optometry:
  • Netcare 911 phoneline
  • No benefit

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MENTAL HEALTH:
Dimension Prime 3
2017 v 2018 benefits Gap benefits Notes
In-hospital:
  • Hospice and sub-acute facilities: paid by scheme, subject to authorisation
  • Private nursing: paid by scheme, subject to authorisation
  • No benefit

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Out-of-hospital:
  • Medical Appliances, hyperbaric oxygen: R1,150
  • Stoma products and urine bags: paid by scheme
  • CPAP apparatus: R8,850 per person every two years
  • R4,300 per family every 3 years
Trauma:
  • R4,300 per family every 3 years
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OTHER BENEFITS:
Dimension Prime 3
2017 v 2018 benefits Gap benefits Notes
General Appliances:
  • Oxygen out-of-hospital: Unlimited, at100% scheme rate
  • No benefit

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1.1. Hearing Aids:
  • Unlimited
  • No benefit
1.2. Wheelchairs:
  • 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.
  • No benefit
Dialysis:
  • Covered
  • Covered
HIV:
  • Transport by road outside RSA: R1,900 per event
  • Transport by air outside RSA: R12,400 per event
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • Covered
  • No benefit
Other:
  • Covered, 55yrs+
  • Covered
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WELLNESS/PREVENTATIVE BENEFITS:
Dimension Prime 3
2017 v 2018 benefits Gap benefits Notes
Flu vaccination:
  • Covered, 40yrs+
  • No benefit

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Pneumonia vaccines:
  • Covered, 40yrs+
  • No benefit
Back Rehabilitation Programme:
  • Covered
  • No benefit
Biometric Screening:
  • FOBT, 50yrs+
  • Bone density, 50yrs+
  • Tetanus vaccine
  • HPV vaccine, 10-26 yrs
  • No benefit
Child Immunisation:
  • Covered
  • No benefit
Pap Smear:
  • Covered
  • No benefit
Mammogram:
  • An additional R40,000 per sublimit, per event
  • 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

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

2017 v 2018 benefits Gap benefits Notes
Overal Limit:
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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