Comprehensive Plus Plan

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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 R1125 pm

Age 60+ R1550 pm

ADULT DEPENDENT

Age 0-59 R865 pm

Age 60+ R1210 pm

CHILD DEPENDENT

R360 pm

BENEFITS	DESCRIPTIONS
IN-HOSPITAL ACCIDENT BENEFIT	R200 000 per member per event. Maximum of R1 000 000.
ICU BENEFIT	Included in Hospital Illness Benefits
IN-HOSPITAL ILLNESS BENEFIT	R75 000 per member per event inclusive of all authorized associated costs. Cataract Surgery is limited to R30 000 per member per annum Limited to R1 000 000 per policy per annum. Pre-authorisation required.
POST ACCIDENT REHABILITATION	R10 000 per member per event for physiotherapy and occupational therapy only
MATERNITY BENEFIT	R30 000 for the birth per pregnancy. Limited to 1 event per policy every 12 months. Includes out-of-hospital scans.
CASUALTY BENEFIT FOR ACCIDENTS	R10 000 per policy per annum and accumulates to overall Accident Cover limit.
CASUALTY BENEFIT FOR ILLNESS	R4 000 per policy per annum for after-hour treatment only. Accumulates to overall Illness Cover.
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	Included. Refer to approved list of procedures.
PHARMACY CLINIC NURSE CARE	Unlimited visits per member at all networked Pharmacies with contracted clinics, providing clinic services for a defined list of procedures.
SPECIALIST BENEFIT	Referral by Network GP. Limited to R2 600 per member per annum. Benefit available on a pay and claim basis.
ACUTE MEDICATION	Unlimited. Medication cost is averaged per category defined by the approved generic medicine list. Co-payment maybe required if you opt for a more expensive medication.
OVER-THE-COUNTER MEDICATION (OTC)	R210 per month. R850 per year. Subject to Formulary.
CHRONIC MEDICATION	Unlimited as per Chronic Disease List. Subject to approval by ChroniLine. Medication cost is averaged per category defined by the approved generic medicine list. Co-payment maybe required if you opt for a more expensive medication. Available from all networked Pharmacies or Dispensing GP’s.
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 at contracted Network Dentists. Subject to defined protocols.
OPTOMETRY	1 Consultation, 1 set of frames with single vision lenses. Cover is available for the members every 24 months from Specsavers limited to 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.