Comprehensive Standard

Monthly Premiums

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

Individual

R575 pm

Adult Dependant

R460 pm

Child Dependant

R165 pm

In-hospital Benefits

HOSPITAL FOOTPRINT

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

ILLNESS BENEFIT

R2 500 per day. Limited to a max of 10 days per event and a max of 6 events per policy per annum

ACCIDENT BENEFIT

Single member: An amount of up to R50 000 per incident with an annual limit of R250 000. Family: An amount of up to R100 000 per incident with an annual limit of R500 000.

CASUALTY BENEFIT

R2 000 per policy per annum. Only available after hours and must be pre-authorised by Africa Assist.

Primary Care Benefits

GP CONSULTATION

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.

OUT-OF-NETWORK CONSULTATIONS

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

SPECIALIST CONSULTATIONS

R2 000 per beneficiary per annum. Specialist benefits are available on a pay and claim basis. The member must be referred by a network GP>

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

2 visits per beneficiary per annum managed according to the Wesmart Protocols.

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 dependant R8 000 per child dependant.

For all terms and conditions, benefits, limitations, and exclusions please refer to the
policy wording which forms part of your Schedule of Insurance or consult your broker.

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