Comprehensive Plus Plan

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Monthly Premiums

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

Principal

R860 PM

Adult Dependent

R695 PM

Child Dependent

R295 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

Individual members have a sub-limit of R125 000 per event, limited to R250 000per policy per annum.


Families have a sub-limit of R250 000 per event , limited to R500 000 per policy per annum. All associated costs for follow up treatments post discharge, also accumulate to the initial event sub-limit.

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.

SHORTFALL BENEFIT

Limited to R20 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)

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 the 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

24/7 Emergency Medical Services, 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.

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