Comprehensive Advanced Plan

Home / Plan Details

Monthly Premiums

Our premiums may be reviewed and escalated on an annual basis.

Individual

R910 PM

Adult Dependent

R730 PM

Child Dependent

R330 PM

In-hospital Benefits

HOSPITAL FOOTPRINT

Access to all private hospitals accepting health insurance products. Pre-authorisation required.

MATERNITY BENEFIT

Up to a maximum of R30 000 per pregnancy. This limit includes 2 general practitioner ultrasounds, one in 1st trimester and one in 2nd trimester. Limited to 1 event per policy every 12 months.

 
 

ACCIDENT COVER

Single member: An amount of up to R200 000 per incident with an annual limit of R400 000.
Family: An amount of up to R400 000 per incident with an annual limit of R800 000.

ILLNESS BENEFIT

Day 1: R10 000
Day 2: R6 500
Day 3: R5 000
Day 4 Onwards: R3 000 Per Day.
Limited to 21 days per admission. Includes all associated costs to admission, procedure and treatment.

ICU BENEFIT

R15 000 per day for illness admissions. Limited to a maximum of 3 consecutive days in ICU.

SHORTFALL BENEFIT

Limited to R30 000 per policy per annum and is available available if the sub-limit is reached. Must be authorised and for illness related admissions.
(include any costs related to ward changes)

CASUALTY BENEFIT

Maximum of R6 000per policy per annum. Only available after hours and must be pre-authorised by Africa Assist.

 
 

SPECIFIC STATED CONDITIONS BENEFITS

Hernia: R20 000
Appendectomy, gallbladder and kidney stones: R35 000
Miscarriage: R10 000
Hysterectomy: R45 000

 
 

Primary Care Benefits

GP CONSULTATIONS

Managed unlimited general practitioner visits at a contracted network provider. Includes certain in-room procedures. All consultations after the 5th visit must be pre-authorised

SPECIALIST CONSULTATIONS

Up to a maximum of R2 000 per beneficiary per annum. Specialist benefits are available on a pay and claim basis. The member must be referred by a network

 
 

OUT-OF-NETWORK CONSULTATIONS

2 Consultations per policy per annum, refunded at a maximum of R350

ACUTE MEDICATION

Unlimited acute medication either at dispensing network GP or pharmacy. Subject to Wesmart Formulary

 
 

OVER-THE-COUNTER MEDICATION

R150 per policy per month as per Wesmart formulary. Limited to R600 per policy per annum.

 
 

CHRONIC MEDICATION

Unlimited. Restricted to 26 chronic diseases on the Chronic Disease List (CDL) and Wesmart Formulary. All chronic medicine needs to be applied for by the prescribing medical expert.

 
 

RADIOLOGY

Unlimited 1 and 2 sided x-rays. Member must be referred by a network GP provider. Services are directly linked and limited to Wesmart Protocols.

 
 

PATHOLOGY

Unlimited. Member must be referred by a network GP provider. Services are directly linked and limited to the Wesmart Protocols.

 
 

DENTISTRY

Managed according to Wesmart Protocols and limits

 
 

OPTOMETRY

Specsavers network only 1 consultation, 1 frame and single vision lenses per beneficiary every 24 months. The maximum value of these services is R1 249.

 
 

Value Added Benefits

24 HOUR EMERGENCY MEDICAL SERVICES

Unlimited, subject to pre-authorisation.

PERSONAL HEALTH ADVISOR

Clinically trained Personal Health Advisor available 24/7 .

ACCIDENTAL DEATH BENEFIT

R10 000 principal member and adult dependent R8 000 per child dependent


WANT TO KNOW MORE?

For more information relating to this option, and other options, download our brochure below.

Get Insured