Comprehensive Advanced Plan
Monthly Premiums
The rates below are for Individuals, per member per month.
If you are a member as part of a Group/ Company, your rate may be different.
PRINCIPAL
Age 0-59 R1230 pm
Age 60+ R1700 pm
ADULT DEPENDENT
Age 0-59 R965 pm
Age 60+ R1350 pm
CHILD DEPENDENT
R430 pm
|
BENEFITS | DESCRIPTIONS |
|---|---|
| IN-HOSPITAL ACCIDENT BENEFIT | R275 000 per member per event. Maximum of R1 000 000. |
| ICU BENEFIT | Included in Hospital Illness Benefits |
| SHORTFALL BENEFIT | Included in Hospital Illness Benefits |
| IN-HOSPITAL ILLNESS BENEFIT | R100 000 per member per event. Overall limit of R1 000 000. Cataract Surgery is limited to R30 000 per member. |
| POST-HOSPITAL ACCIDENT REHABILITATION | R10 000 per member per event for physiotherapy and occupational therapy only |
| MATERNITY BENEFIT | R35 000 for birth. Includes 2 out-of-hospital ultra-sounds at a Network GP. Limited to 1 event every 12 months. |
| CASUALTY BENEFIT FOR ACCIDENTS | R10 000 per policy |
| CASUALTY BENEFIT FOR ILLNESS | R6 000 for after-hours treatment only |
| GENERAL PRACTITIONER VISITS (GP/DOCTOR) | Managed unlimited GP consultations at a network doctor. Pre-authorisation required for every GP visit from the 5th consultation onwards. |
| OUT-OF-NETWORK GENERAL PRACTITIONER VISITS (GP) | 2 consultations refunded at R475 per visit |
| IN-ROOM PROCEDURES | Defined list of procedures a network GP can perform in their rooms at no additional charge |
| PHARMACY CLINIC NURSE CARE | Unlimited care for a defined list of procedures available from nurses at Mediscor pharmacies with contracted clinics |
| SPECIALIST BENEFIT | R2 600 per member. Referral by network GP required. Members must pay cash and claim from Wesmart. |
| ACUTE MEDICATION | Unlimited Acute Medication available only from a Mediscor pharmacies. Subject to Formulary. |
| OVER-THE-COUNTER MEDICATION (OTC) | R210 per month. R850 per year. Subject to Formulary. |
| CHRONIC MEDICATION | Unlimited. Approval must be obtained from Chroniline. Chronic Medication may be obtained from a Mediscor pharmacy or from a Network Dispensing Doctor. Subject to Formulary. |
| RADIOLOGY |
Unlimited. Referred by a Network GP. Subject to defined protocols. Benefit available on a pay and claim basis. |
| PATHOLOGY |
Unlimited. Referred by a Network GP. Subject to defined protocols. Benefit available on a pay and claim basis. |
| DENTISTRY | Basic dentistry only. Treatment available based on Genric‘s Protocols and limits. |
| OPTOMETRY | Only available at Specsavers branches. 1 consultation, 1 set of frames with single vision lenses per member, every 24 months. Maximum of R1 450. |
Additional Benefits
Hospital Footprint
Access to all private hospitals accepting health insurance products. Pre-Authorisation is required for all hospital admissions on 086 000 2402.
Value Added Benefits
24 Hour Emergency Medical Services
24-hour cover for private ambulances and emergency medical evacuation in the event of emergencies. Pre-authorisation required.
Client Assistance Programme Benefits
- Personal Health Advisor: Clinically trained Personal Health Advisor available 24/7.
- Credit and Debit Assist: Debt management and financial planning services.
- Legal Assist: Telephonic legal advice from qualified attorneys.
- Trauma Counselling: Trauma debriefing by qualified nurses, who can refer the insured to higher-level counseling if needed.
Accidental Death Benefit
A lump sum payout in the event of the death of a member that results in an unintentional death.
Nurse Based Pharmacy Care
Pharmacy Clinic Nurse Care
Care from qualified nurses at over 700 pharmacy Wellness Clinics.
Visit them in store at your convenience or book an appointment for a consultation. Nurses will give you a medical referral if necessary.
Available at all contracted Mediscor Pharmacies, including Dischem, Clicks, Medirite etc. Pre- authorisation may be required after the 10th visit.
General Member Wellness
- Glucose and Cholesterol screening / testing / monitoring
- Treatment of wounds
- Administration of injections, including annual flu injection
- Hb, Malaria and Urine Screening
- Syringing of ears
- Advice on how to best manage your status and health
Women's Health
Caring advice women can rely on, offering all types of female health assessments such as pregnancy testing, breast screening, pap smear testing and other female screenings
Assistance Managing Chronic Condition
Nurses will help you manage your chronic condition and assist you with monitoring and advice, including but not limited to:
- Diabetes Hba1C and foot screening
- Blood pressure and lipogram testing, BMI monitoring
- Peak flow and nebulization. Control asthma by getting rescue medication directly into the lungs.
- HIV screening, testing and counselling: Learn your HIV status and get psychological help after testing positive. A counselling session is offered pre-testing as well.