Managed unlimited GP consultations through a Network GP Provider. These services include certain in-room procedures. In the event that the Network is not used, benefit is limited to R250, reimbursed directly to member on a pay and claim basis. Out of network benefits limited to 2 consultations per policy per annum.
Limited to 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 to a specialis
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
OVER THE COUNTER AND HEALTH Screening
Sub-limit of R150 per policy per month as per formulary. Limited to R600 per policy per annum.
CHRONIC MEDICATION (PER CDL)
Unlimited chronic medicine, restricted to 24 Chronic Diseases as listed. These benefits include anti-anxiety or anti-depression medication, limited to R100 per month.
Limited to 1 and 2 sided, black and white x-rays. Member must be referred by a Network GP Provider, directly linked and limited to the Wesmart Formulary.
Unlimited as per the Wesmart Formulary. Covers basic blood tests.
Limited to 2 consultations per beneficiary per annum, including cleaning, polishing, extractions and fillings. No specialised dental benefits available.
Network Service Provider, Specsavers, must be used. Alternatively contact us for a provider in your area. Optometry services including 1 annual eye test, limited to single vision spectacles, every 24 months per beneficiary.
Individual members have a sub-limit of R100 000 per event, limited to R200 000 per policy per annum. Families have a sub-limit of R200 000 per event, limited to R400 000 per policy per annum. All associated costs for follow-up treatments post discharge, also accumulate to the initial event sub-limit
Limited to R4 000 per policy per annum for all after-hour illness emergency-related events only. Must be pre-authorise
DAILY 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. Paid up to a maximum of the stated benefits, which includes all costs related to the admission.
Up to a maximum of R30 000 per confinement. Limited to 1 event per policy every 12 months.
Limited to R10 000 per policy per annum and is available if the sub-limit is reached. Must be authorised, illness-related admissions.
24 HOUR EMERGENCY MEDICAL SERVICES
Preauthorised by Africa Assistance. R50 000 per policy per annum
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 premium.The benefits mentioned are a summary and the full terms, conditions and limitations.Where we make mention of “Formulary”, we make reference to an approved list agreed to by Wesmart relating to the specific benefit.