Primary Standard & Hospital 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
ADULT DEPENDENT
CHILD DEPENDENT
|
BENEFITS | DESCRIPTIONS |
|---|---|
| IN-HOSPITAL ACCIDENT BENEFIT |
R475 000 per member per event. Limited to R1 500 000 per policy per annum. Pre-authorisation required. |
| ICU BENEFIT | Included in Hospital Illness Benefits |
| IN-HOSPITAL ILLNESS BENEFIT |
R70 000 per member per event inclusive of all costs. Conditions with gradual progression are excluded. Limited to R500 000 per policy per annum. |
| POST-HOSPITAL ACCIDENT REHABILITATION |
R10 000 per member per event for Physiotherapy and Occupational therapy and home care/wound care. Pre-authorisation required. |
| CASUALTY BENEFIT FOR ACCIDENTS |
R30 000 per policy per annum and accumulates to overall Accident Cover limit. Pre-authorisation required. |
| CASUALTY BENEFIT FOR ILLNESS |
R5 000 per policy per annum for after-hour treatment only. Accumulates to overall Illness Cover. Pre-authorisation required. |
| GENERAL PRACTITIONER VISITS (GP/DOCTOR) |
Unlimited GP visits at contracted Network GP’s. Pre-authorisation required for every GP visit from the 5th consultation onward. |
| OUT-OF-NETWORK GENERAL PRACTITIONER VISITS (GP) |
2 visits per policy per annum refunded at R500 per consultation. |
| IN-ROOM PROCEDURES | Defined list of procedures a network GP can perform in their rooms at no additional charge |
| 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. If you opt for the more expensive medication, you will be liable for the additional costs. |
| OVER-THE-COUNTER MEDICATION (OTC) |
R250 per policy per month, limited to R850 per policy per annum. 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. If you opt for the more expensive medication, you will be liable for the additional costs. Available from all networked Pharmacies or Dispensing GP’s. |
| RADIOLOGY |
Unlimited Black and White X-Ray’s only. Referred by a Network GP. Subject to defined protocols. Benefit available on 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 550. |
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.