Medihelp Dimension Prime 2

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					                                  In Hospital Expenses
                     Benefits
                     Hospitalisation Overall Annual Limit

Medihelp Dimension   100% of AT
Prime 2

                     General Ward Accommodation

Medihelp Dimension   100% of AT
Prime 2
                     ICU & High Care
Medihelp Dimension   100% of AT
Prime 2
                     Surgical Procedures

Medihelp Dimension   100% of AT
Prime 2




                     Internal Surgical Appliances/Prosthesis


Medihelp Dimension   100% of AT
Prime 2




                     External Surgical Appliances

Medihelp Dimension   100% of AT
Prime 2
                     GP & Specialist Consultation

Medihelp Dimension   100% of AT
Prime 2
                     Blood Transfusion/Blood Products


Medihelp Dimension   100% of AT
Prime 2
                     Mental Health
Medihelp Dimension   100% of AT
Prime 2



                     Organ Transplants
Medihelp Dimension   100% of AT
Prime 2
                     HIV/AIDS
Medihelp Dimension   100% of AT
Prime 2
                     Renal Dialysis Treatment

Medihelp Dimension   100% of AT
Prime 2
                     Radiology - X-rays/MRI & CT Scans & Angiography

Medihelp Dimension   100% of AT
Prime 2



                     Oncology - Chemo & Radiotherapy

Medihelp Dimension   100% of AT
Prime 2
                     Pathology & Medical Technology


Medihelp Dimension   100% of AT
Prime 2
                     Medicine on discharge - TTO

Medihelp Dimension   100% of AT
Prime 2

                     Secondary facilities

Medihelp Dimension   100% of AT
Prime 2
                     Emergency Services

Medihelp Dimension   100% of AT
Prime 2




                     Maternity
Medihelp Dimension   100% of AT
Prime 2
                     Physiotherapy
Medihelp Dimension   100% of AT
Prime 2




                                 Out of Hospital Expenses
                     Benefits
                     Pre-authorisation
Medihelp Dimension
Prime 2
                     Day to Day Limit
Medihelp Dimension
Prime 2


                     Savings
Medihelp Dimension
Prime 2




                     Threshold
Medihelp Dimension
Prime 2
                     Chronic Medication

Medihelp Dimension   100% of AT
Prime 2


                     Acute Medication
Medihelp Dimension   100% of AT
Prime 2
                     Over the Counter Medication

Medihelp Dimension   100% of AT
Prime 2




                     GP Consultations
Medihelp Dimension   100% of AT
Prime 2




                     Specialist Consultations

Medihelp Dimension   100% of AT
Prime 2




                     Occupational therapy, speech therapy, etc.


Medihelp Dimension   100% of AT
Prime 2




                     Physiotherapy
Medihelp Dimension   100% of AT
Prime 2




                     Appliances wheelchairs, etc.

Medihelp Dimension   100% of AT
Prime 2




                     Radiology
Medihelp Dimension   100% of AT
Prime 2




                     Pathology
Medihelp Dimension   100% of AT
Prime 2




                     Basic Dentistry
Medihelp Dimension   100% of AT
Prime 2




                     Advanced Dentistry

Medihelp Dimension   100% of AT
Prime 2




                     Optometry
Medihelp Dimension   100% of AT
Prime 2




                     Other Excesses or Limitations

Medihelp Dimension
Prime 2
                     Special Add-ons
Medihelp Dimension
Prime 2




Total Contributions: Dimension Prime 2 - 2010
Income               Description
All                  Principal Member
All                  Adult Dependant


All                  Child Dependant
ital Expenses
             Annual Limits
nual Limit

             Unlimited - subject to pre-authorisation
             and R850 co-payment on all admissions
             except where other co-payments apply
tion

             Unlimited


             Unlimited



             Unlimited
             The following procedures require co-
             payments per admission:
             Dental procedures for patients 8 years
             and older = R1 200
             Circumcision = R1 650,
             Hymenectomy = R1 650,
             Neck and back fusion R11 000

es/Prosthesis


             Vascular/cardiac prostheses: R31 400 per
             beneficiary per year/savings account
             EVARS prostheses: R73 300 per beneficiary
             per year/savings account
             Health-essential functional prostheses:
             R34 800 per beneficiary per year/savings
             account /savings account . Joint replacements -
             shoulder, hip & knee non-PMB's = no benefit.
             Prostheses with reconstructive or restorative
             surgery: R5 500 per family per year
             (above benefits subject to pre-
             authorisation)
es

             Artificial eyes, speech, hearing aids, artificial
             limbs and wheelchairs: R3 000 per family per
             3 year period for services rendered in and out
             of hospital/savings account                  Other
             Aplliances payable from savings account
on

           Unlimited

roducts


           Unlimited


           R13 800 per beneficiary to a maximum of
           R18 900 per family per year for services
           rendered in and out of hospital/savings
           account (excluding services rendered by a
           clinical psychologist and psychiatric nurse.)

           Unlimited - subject to pre-authorisation


           Unlimited - subject to pre-authorisation



           Unlimited - subject to pre-authorisation

CT Scans & Angiography

           General radiology: unlimited
           Specialised radiology: R12 200 per family per
           year for services rendered in and out of
           hospital account - subject to pre-authorisation

otherapy

           Subject to the OncoPrime protocols and pre-
           authorisation (PMB's only)
nology


           Unlimited

TO

           R 230 per discharge




           Unlimited - subject to pre-authorisation
       Unlimited, Netcare 911, within the bordes of
       SA, Lesotho, Swaziland, Mozambique and
       Namibia
       Outside of these borders:
       Transport by road = R1 200 per case/savings
       account
       Transport by air = R7 800 per case/savings
       account

       Limited to R18 000 per confinment/savings
       account

       Unlimited




spital Expenses
       Annual Limits




       None




       Savings Account:
       Member = R2 592                        Adult
       Dependant = R2 160                   Child
       Dependant = R792                    Two or
       more child dependants = R1 584   Pooled per
       family

       None



       PMB's only (CDL conditions)




       Paid from Savings Account
       Member = R2 592                        Adult
       Dependant = R2 160                   Child
       Dependant = R792                    Two or
       more child dependants = R1 584   Pooled per
       family
on

          Paid from Savings Account
          Member = R2 592                            Adult
          Dependant = R2 160                       Child
          Dependant = R792                        Two or
          more child dependants = R1 584       Pooled per
          family

          Paid from Savings Account
          Member = R2 592                            Adult
          Dependant = R2 160                       Child
          Dependant = R792                        Two or
          more child dependants = R1 584       Pooled per
          family


           Paid from Savings Account
           Member = R2 592                           Adult
           Dependant = R2 160                      Child
           Dependant = R792                       Two or
           more child dependants = R1 584      Pooled per
           family
ech therapy, etc.


          Paid from Savings Account
          Member = R2 592                            Adult
          Dependant = R2 160                       Child
          Dependant = R792                        Two or
          more child dependants = R1 584       Pooled per
          family

          Paid from Savings Account
          Member = R2 592                            Adult
          Dependant = R2 160                       Child
          Dependant = R792                        Two or
          more child dependants = R1 584       Pooled per
          family
c.

          Artificial eyes, speech, hearing aids, artificial
          limbs and wheelchairs: R3 000 per family per
          3 year period for services rendered in and out
          of hospital/savings account
          Other appliances: Paid from savings Account
      Paid from Savings Account
      Member = R2 592                            Adult
      Dependant = R2 160                       Child
      Dependant = R792                        Two or
      more child dependants = R1 584       Pooled per
      family

      Paid from Savings Account
      Member = R2 592                            Adult
      Dependant = R2 160                       Child
      Dependant = R792                        Two or
      more child dependants = R1 584       Pooled per
      family

      Paid from Savings Account
      Member = R2 592                            Adult
      Dependant = R2 160                       Child
      Dependant = R792                        Two or
      more child dependants = R1 584       Pooled per
      family




      Paid from Savings Account
      Member = R2 592                            Adult
      Dependant = R2 160                       Child
      Dependant = R792                        Two or
      more child dependants = R1 584       Pooled per
      family




      Test: one composite consultation including
      refraction test,tonometry and visual fields test

      Lenses: One pair of Clear Single vision OR
      Clear Aquity Bifocal lenses OR Clear Aquity
      Multifocal lenses at the cost of bifocal lenses -
      per beneficiary per 24-month cycle
      frame: Frame within the PPN range to the
      value of R 150 - per 24 month cycle
      Contact Lenses: R 950 - per beneficiary per 24-
      month cycle (one pair of spectacles or contact
      lenses)
ons
       Preventative Care:
       Pregnancy consultations: 12 per family per
       year
       Pregnancy scans: 2x2D scans per family per
       year                                    Pediatric
       consultations: 2 visits in baby's 1st year
       Standard immunisation for children younger
       than 6 years: Unlimited
       Pap smear: 1 per female beneficiary per year
       Mammogram: 1 per beneficiary, 40 years and
       older, per year
       Prostate test: 1 per beneficiary, 40 years and
       older, per year                     Cholestrol
       test: 1 test per beneficiary 40 years and older
       Blood sugar test: 1 test per year per
       beneficiary 40 years and older
       immunisation against flu: 1 immunisation per
       beneficiary per year
       Know your status - HIV test: 1 test per
       beneficiary per year - 15 years and older
       Conservative back treatment programme:
       subject to protocols and pre-authorisations (as
       an alternative to spinal column surgery)



Prime 2 - 2010
       Savings                                             Contribution
       R 216                                               R1 098
       R 180                                               R 912
                                                           R 336 (pay
                                                           for a max of
       R 66                                                2 children)

				
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posted:4/10/2012
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