Comprehensive Standard Plan

Home / Plan Details

Monthly Premiums

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

Individual

R575 PM

Adult Dependent

R460 PM

Child Dependent

R165 PM

In-hospital Benefits

HOSPITAL FOOTPRINT

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

ILLNESS BENEFIT

Limited to R2 500 (two thousand five hundred Rand) per day with a maximum of 10 (ten) days per event and a max of 6 (six) events per policy per annum.

ACCIDENT COVER

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.

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.

 
 

CASUALTY BENEFIT

R2 000 per day. Limited to a max of 10 days per event and a max of 6 events per policy per annum.

 
 

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