COMPREHENSIVE ADVANCED

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Individual
R1 835
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FAMILY MAX 3
R2 452
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FAMILY MAX 5
R2 923

WHAT IT COVERS

Comprehensive Advanced page banner_GP consultation
GP CONSULTATION

5 consultations per beneficiary per annum. Dispensing GP reimbursement paid
at R330 per consultation
and non dispensing GP reimbursement paid at R300 per consultation.

Comprehensive Advanced page banner_Dentistry
DENTISTRY

R700 as a combined benefit for consultations, fillings, x-rays and extractions, including scale and polish, 2 emergency root canals at R400 each, 2 crowns at R500 each and in chair wisdom teeth at R750, per beneficiary per annum.

Comprehensive Advanced page banner_Optometry
OPTOMETRY

All activities for optometry services Including eye test, 1 consultation, frames and lenses up to R900 or contact lenses up to R900 every 24 months per beneficiary.

Comprehensive Advanced page banner_Specialist consultations
SPECIALIST
CONSULTATIONS

2 consultations refunded at R250 per policy.

Comprehensive Advanced page banner_Network providers
OUT OF NETWORK
CONSULTATIONS

2 consultations refunded at R250 per policy.

Comprehensive Advanced page banner_Chronic medication
CHRONIC
MEDICATION (PER CDL)

Individual option: R1 500, Family option 3, R2 000, Family option 5, limited to R3 000 per policy per annum. Up to a max of R300 per script

Comprehensive Advanced page banner_Hospital booster
HOSPITAL
BOOSTER

A sub-limit of R40 000. Paid out at R2 500 per day limited to 2 events per annum.

Comprehensive Advanced page banner_Hospital Footprint
HOSPITAL
FOOTPRINT

Access to private or state facilities, authorised by Africa Assist.

Comprehensive Advanced page banner_Personal health advisor
PERSONAL
HEALTH ADVISOR

Clinically trained consultant available 24 / 7.

Comprehensive Advanced page banner_Maternity Benefit
MATERNITY
BENEFIT

A sub-limit of R20 000 per policy per annum for confinement. Includes 3 pre-natal consultations refunded
at R900 each.

Comprehensive Advanced page banner_Casualty benefit
CASUALTY BENEFIT
(ACCIDENT ONLY)

R4 000 per policy per annum.

Comprehensive Advanced page banner_Anaesthetic benefit
ANAESTHETIC
BENEFIT

Max of R4 500 per event for anaesthetic practitioners.

Comprehensive Advanced page banner_Accidental death benefit
ACCIDENTAL
DEATH BENEFIT

R20 000 (principal and spouse) R5 000 per child

Comprehensive Advanced page banner_Acute medication
ACUTE
MEDICATION

Unlimited acute medication available, either through the dispensing GP or via the pharmacy network, these benefits are directly linked and limited to the Wesmart formulary.

Comprehensive Advanced page banner_Shortfall benefit
24 HOUR EMERGENCY
MEDICAL SERVICES

Pre-authorised by Africa Assist.

Comprehensive Advanced page banner_Premium waiver
PREMIUM
WAIVER

Actual premium held as a credit for 6 months.

Comprehensive Advanced page banner_Additional cover benefit
ADDITIONAL
COVER BENEFIT

R500 per beneficiary per annum for crutches, zimmer frame, moonboots and slings.

Comprehensive Advanced page banner_Treatment
TREATING AND
ADMITTING PRACTITIONERS

Max of R8 000 per event for treating and admitting practitioners.

Comprehensive Advanced page banner_Total permanent disability
TOTAL PERMANENT
DISABILITY

R25 000 (principal only).

Comprehensive Advanced page banner_Radiology & Pathology
RADIOLOGY AND PATHOLOGY
(IN & OUT HOSPITAL)

R8 000 per policy per annum. R1000 excess per scan. R1500 excess for blood tests.

Comprehensive Advanced page banner_Daily illness Benefit
ILLNESS BENEFIT
INCLUDES ALL WARD FEE STRUCTURES

This benefit limit incorporates all pre-authorised hospitilisation and treatments, related to the date of loss of the approved issued gop. Limited to R65 000 per event.

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Call Me Back!

Wesmart is a medical insurance product and therefore may review the premium on an annual basis. In the event of this occurring, we will notify you 30 days in advance of any changes to benefits or premiums. The benefits mentioned are a summary and not the full terms, conditions and limitations. The word “Formulary” refers to an approved list agreed to by Wesmart relating to the specific benefit.

Waiting periods, limitations and exclusions

MORE OPTIONS

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PRIMARY
LIMITED

The Entry Level Solution

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PRIMARY
STANDARD

The Day-to-Day Solution

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PRIMARY
PLUS

The Fundamental Solution

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COMPREHENSIVE
STANDARD

The Well-Prepared Choice

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COMPREHENSIVE
PLUS

The Confident Choice

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GOLDEN
HOUR

The Crisis Solution