Monthly Premiums
Rates 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
R800 p/m
Age 60+
R1 130 p/m
Adult Dependent
Age 0 – 59
R680 p/m
Age 60+
R980 p/m
Child Dependent
Age 0 – 18
R275 p/m
Age 0 – 26 Students
R275 p/m
Benefits
| Description | Benefit Detail |
|---|---|
| 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, occupational therapy and home care / wound
care. Pre-authorisation required |
| Casualty Benefit — Accidents | R30 000 per policy per annum. Accumulates to overall Accident Cover limit. Pre-authorisation required |
| Casualty Benefit — Illness | R5 000 per policy per annum for after-hours treatment only. Accumulates to overall Illness
Cover. Pre-authorisation required |
| GP / Doctor Visits | Unlimited Unlimited GP visits at contracted network GPs. Pre-authorisation required from the 5th consultation onward. Network GPs only |
| Out-of-Network GP Visits | 2 visits per policy per annum, refunded at R500 per consultation. |
| In-Room Procedures | Defined list of procedures a network GP can perform in-rooms at no additional charge. |
| Pharmacy Clinic Nurse Care | Unlimited 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. Available on a pay-and-claim basis. |
| Acute Medication | Unlimited Medication cost is averaged per category per the approved generic medicine list. If you opt for 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 per the approved generic medicine list. Available from all networked pharmacies or dispensing GPs. |
| Radiology | Unlimited black-and-white X-rays only. Referred by a network GP. Subject to defined protocols. Available on pay-and-claim basis. |
| Pathology | Unlimited Referred by a network GP. Subject to defined protocols. Available on 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. Available 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.
24-Hour Emergency Medical Services
24-hour cover for private ambulances and emergency medical evacuation in the event of emergencies. Pre-authorisation required.
Accidental Death Benefit
A lump sum payout in the event of an unintentional accidental death of a member.
Value Added Benefits
Client Assistance Programme
- Personal Health Advisor: Clinically trained advisor available 24/7.
- Credit & Debit Assist: Debt management and financial planning services.
- Legal Assist: Telephonic legal advice from qualified attorneys.
- Trauma Counselling: Debriefing by qualified nurses with referral to higher-level counselling if needed.
Nurse-Based Pharmacy Care
Care from qualified nurses at over 700 pharmacy wellness clinics — in store or by appointment. Nurses provide medical referrals where necessary. Available at all contracted Mediscor pharmacies, including Dis-Chem, Clicks and Medirite.
Pre-authorisation may be required after the 10th visit.
General Member Wellness
- Glucose and cholesterol screening, testing and monitoring
- Treatment of wounds
- Administration of injections, including annual flu injection
- Hb, Malaria and Urine Screening
- Syringing of ears
- Advice on managing your health status
Women's Health
- Pregnancy testing
- Breast screening
- Pap smear testing
- Other female health assessments and screenings
Chronic Condition Management
- Diabetes HbA1c and foot screening
- Blood pressure and lipogram testing, BMI monitoring
- Peak flow and nebulisation — asthma rescue medication
- HIV screening, testing, counselling and post-test psychological support