FAMILY MAX 3
FAMILY MAX 5
WHAT IT COVERS
5 consultations per beneﬁciary per annum. Dispensing GP reimbursement paid at R330 per consultation and non-dispensing GP reimbursement paid at R300 per consultation.
R700 as a combined benefit for consultations, Fillings, X-Rays and Extractions, including Scale and Polish, 2 Emergency Root Canal at R400 each, 2 Crowns at R500 each and In Chair Wisdom Teeth at R750, per beneficiary per annum.
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.
Individual Option: 1 consultation refunded at R850. Family Option 3: 2 consultations refunded at R850. Family Option 5: 3 consultations refunded at R850.
OUT OF NETWORK
2 consultations refunded at R250 per policy.
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.
A sub-limit of R40 000. Paid out at R2 500 per day limited to 2 events per annum. Limited to 2 events per annum.
National Private / State facilitated by Africa Assist.
Clinically trained consultant available 24 / 7.
A sub-limit of R20 000 per policy per annum for confinement. Includes 3 pre-natal consultations refunded
at R900 each.
R4 000 per policy per annum.
Max of R4 500 per event for anaesthetic practitioners.
R20 000 (principal and spouse) R5 000 per child
Individual Option: R1 000. Family Option 3: R1 800. Family Option 5: Limited to R2 500 per policy per annum. Up to a max of R220 per script.
24 HOUR EMERGENCY
Pre-authorised by Africa Assist.
Actual premium held as a credit for 6 months.
R500 per beneficiary per annum for crutches, zimmer frame, moonboots and slings.
Max of R8 000 per event for treating and admitting practitioners.
R25 000 (Principal only).
RADIOLOGY AND PATHOLOGY
(IN & OUT HOSPITAL)
R8 000 per policy per annum. R1000 excess per scan. R500 excess for blood tests.
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.
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.