Medical Insurance is based on events and stated benefits and is regulated by the Financial Services Board (FSB), Long Term and Short-Term Insurance acts. Medical aid is based on procedures and tariff codes and is regulated by the Council of Medical Schemes.

Yes, you may but you do need to understand that Medical Aid and Medical Insurance offer different benefits and cover.

Yes, you may. We will contact you though to confirm bank account details and to obtain authorisation from you to debit your account.

Yes, you may.

Cover is only available within the borders of South Africa, Lesotho and Swaziland. You will need to arrange to come back to South Africa to receive treatment.

Yes, our Primary Care Policy fits in perfectly with a Hospital Plan and a Medical Aid. However, the basis of insurance is to put the Policyholder back in the same position they found themselves in prior to the event occurring. Therefore, claims will not be paid if it is deemed as enriching the Policyholder. If a Policyholder claims from both a medical scheme and Genric, we will not pay for claims that have already paid or catered for by the medical scheme.

Check your policy to see if waiting periods apply. Waiting periods may be applicable on all newly incepted policies and/or additional dependants added to the current policy, except in the event of an accident. They are a period when you can’t claim for certain benefits.

Your newborn will be covered from the moment of birth, provided you complete registration within 90 days.

Certain options allow 2 out-of-network GP Benefits. You will need to pay cash for these and claim back from us. Remember to complete a Claim Form.

If your plan has the casualty room benefit, please contact our pre-authorisation department on 031 303 3928 (office hours), or on 086 000 0246 (24/7 emergency support). They will provide you with pre-authorisation to ensure you get the best care.

Have a look on our website and locate a Network GP where you are. In the event of you not being able to see a Network GP and are asked to pay up front, we will reimburse you up to R475 per visit depending on your selected product option.

Let us know by sending an email to admin@medsureglobal.com with full details of your doctor, name, practice number and contact details and we will gladly contact them and request they sign up to the Genric network. The same applies to Dentists. Remember however, it is up to the providers whether they want to join or not.

If you have visited your Genric Network GP and they believe that you require the treatment of a specialist, he/she must write a referral letter for a specialist. No pre-authorisation is required (subject to benefit entitlement). There is no specialist network.

No application forms are needed to obtain authorisation. Your pharmacist or doctor will contact ChroniLine for authorisation of the application on behalf of the patient.

Chronic Medication: If your GP is a dispensing GP, you can get your chronic medication from the practice. Alternatively, you may go to any pharmacy contracted with Mediscor, which most pharmacies in the country are. Ask your pharmacist if they are on the Mediscor system.

Acute Medication: You may only get your acute medication from a Mediscor pharmacy, even if your doctor is a dispensing doctor. Ask your pharmacist if they are on the Mediscor system.

We understand that there are instances when you may not require a GP visit but instead need medication to manage your symptoms until you recover. To address this, we offer an Over-The-Counter (OTC) benefit. However, we advise you to consult your pharmacist to ascertain which medicines are covered by the formulary.

How do I know what medication is on the Formulary?
You can view the formulary at https://secure.mediscor.co.za/adocs/schemeformularies/wesmart_formulary_lookup.htmlsecure.mediscor.co.za

Should you require admission to hospital, contact our call centre on 031 303 3928 (office hours), or on 086 000 2402 (24/7 in an emergency), and we will assist you in obtaining the required authorisation for your admission.

An Accident is a sudden, unexpected, unusual, specific event occurring at a particular moment and a particular place, which event the Member could not foresee, anticipate or envisage, and which results in visible, violent, external and traumatic physical injury to the body, during the period of the Policy. The Policyholder must have sought medical care within 12 (twelve) hours of the event and the event needs to be reported to the Underwriter within 30 (thirty) days of occurrence.

• Applicable only to the following Plans:
  • Hospital Plan
  • Comprehensive Standard
  • Combined Primary Standard and Hospital Plan
• Definition of “Gradual Progression Illness” in our Policy Wording:
  “Any condition or Illness that is not ‘Acute’ i.e., it has been present, or signs and symptoms have been present, over an extended period of time.”.
• So, what are examples of conditions Genric will not cover as we define them as having a “Gradual Progression”:
  • All treatment for Degenerative join treatments, repair or replacement
  • Cataracts
  • Bunions
  • Carpel tunnel Syndrome
• The “Gradual Progression” clause, only relates to In-hospital admissions for Illness:
  The benefit for 2025 on these 3 plans with this clause, is R 50 000 per member per event, Limited to R 500 000, per policy per annum.
• What does this practically mean in terms of what I am covered for In-hospital?
  At Genric, we evaluate every case on its merit. We value and respect individual circumstances and treat each patient with kindness and caring. However, we at all times are guided by the policy intentions and governing legislation.
• What if I have a Chronic Condition that is on your CDL, can I get medicine from Genric every month?
  If you have a disease that is covered on our Chronic Disease List (CDL), we would generally not exclude you for In-Hospital treatment.
• What if I suffer from a Dread Disease?
  If you have a condition that is considered to be a Dread Disease, for example a Stroke, Heart Attack or Cancer, we will cover you under the In-Hospital Illness Benefit.

There is a 12-month waiting period before you may access the Maternity Benefits. You can however visit your GP, specialist (if you have a benefit) and access your 2 ultra-sounds.

Yes, you can contact us on 031 303 3928 (office hours), or on 086 000 2402 (24/7 after hours) in the event of an emergency or serious accident. Once you have been transported to the closest appropriate facility, the hospital should contact Genric. This benefit is not available on the Primary Standard Option as there is no hospital benefit on this option.

National HealthCare Group was founded in 2017 with the goal of providing affordable and reliable healthcare services to low-income employer groups. Since then, the group has launched innovative healthcare solutions, positioning itself as a leading service provider in the emerging healthcare market. With a vast network of doctors strategically located across South Africa and a hands-on approach to business, National HealthCare has gained deep insight into the market’s needs.

The group has steadily expanded its managed care services, now serving over 40,000 beneficiaries. Its mission is to enhance access to reliable and affordable healthcare services for millions of South Africans who have not previously had access to private healthcare services.

National HealthCare’s team brings together more than 100 years of collective experience in the South African healthcare sector and various business disciplines, ensuring a well-rounded approach to service delivery. In 2023, the group partnered with Genric Insurance Company, who provide underwriting services for products offered by Standard Bank and Old Mutual.

DENIS has been a leader in dental managed-care services since 1996. With extensive experience in dental risk management combined with cutting-edge technology Denis offers a world-class service relevant to the South African market.

Through the management of individual dental care, DENIS keeps dental costs under control at a realistic, sustainable level while maximising appropriate care for the benefits offered. Not only does this lead to member satisfaction, it also improves the oral health well-being of those members.

Constantly strengthening and enhancing quality healthcare delivery, designing services to ensure maximum outcomes for every client.

At DENIS, modern science and technology combine with clinical and actuarial expertise to offer a world-class dental benefit management service where benefits are optimally designed and appropriately used.

DENIS’s dental management team has provided benefit risk management services for over 20 years, proving highly effective in:

• Adapting benefits to address priority needs
• Optimising the use of benefits
• Minimising fraud and abuse
• Operating within overall benefit limits

DENIS is accredited by the Council for Medical Schemes as a Managed Care Organisation (MCO: 54)

Mediscor is a South African pharmaceutical benefits management (PBM) organisation. Specialising in electronic claims processing and the management of medicine benefits, covering more than 2 million lives and processing in excess of 150 000 transactions per day. Their main offering is the ability to electronically adjudicate a medicine provider’s claim in real-time against complex financial, clinical and pharmaceutical utilisation rules. They have received three Diamond Arrow awards for being the highest rated managed care organisation in three specialist service categories; namely Technology Services and Electronic Medicine Management, Chronic Medicine Management, and Pharmacy Network Management.

Specsavers is the leading Optometry Group in South Africa. The continued success of the organisation is based on a dynamic business concept that capitalizes on the price benefits of collective sourcing of products and a common marketing strategy. The brand is committed to ensuring a combination of professional standards and quality eyewear, available at affordable prices.

A History of Growth

The first Spec-Savers franchise was started in May 1993 in Port Elizabeth. The Spec-Savers formula proved to be a phenomenal success ensuring this exciting and innovative approach to professional eye care grew rapidly. By August 1995 the franchise operation had grown to 24 stores. The Group now proudly partners with over 270 franchise outlets throughout South Africa, Namibia, Lesotho and Botswana. 

The following conditions are excluded within the first 6 months of the policy cover inception:

• Myringotomy and grommets
• Adenoidectomy
• Tonsillectomy
• Hysterectomy (except where malignancy can be proven)
• Spinal, back, neck and joint related procedures or treatment except in the case of an accident

12 month waiting period will be applied on all pre-existing conditions, diseases, or illnesses. These include any conditions which existed prior to inception, or for which an insured person has sought or received medical advice or received treatment by a Registered Medical Professional or exhibited symptoms before inception of the policy.

Failure to disclose any pre-existing condition could render the policy being cancelled.

• 12 month waiting period will be applied on all pregnancy and confinement treatment.

• 12 month waiting period for pregnancy and confinement.
• 12 month waiting period on all pre-existing cancer-related treatments.
• 3 month waiting period is applicable on the Accidental Death Benefit.