FAMILY MAX 3
FAMILY MAX 5
WHAT IT COVERS
3 consultations per beneﬁciary per annum. Dispensing GP reimbursement paid at R330 per consultation and non-dispensing GP reimbursement paid at R300 per consultation.
R600 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 R750) or Contact Lenses up to R750 every 24 months per beneficiary.
Individual Option: 1 consultation refunded at R650. Family Option 3: 2 consultations refunded at R650. Family Option 5: 3 consultations refunded at R650 provides the policyholder and or Insured with access to Specialist consultations.
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.
Max of R15 000 per event. Paid out at R1 750 per day. Limited to 2 events per annum.
National Private / State facilitated by Africa Assist.
Clinically trained consultant available 24 / 7.
A sub-limit of R18 000 per policy per annum for confinement, includes 3 Pre-natal consultations refunded at R750.
R3 000 per policy per annum as a result of Trauma and Accident only.
Max of R4 000 per event for anaesthetic practitioners.
R15 000 (principal and spouse).
Individual Option: R900. Family Option 3: R1 500. Family Option 5: Limited to R2 200 per policy per annum. Up to a max of R200 per script.
24 HOUR EMERGENCY
Pre-authorised by Africa Assist. Limited to R50 000 per policy per annum
Actual premium held as a credit for 6 months.
INCLUDES ALL WARD FEE STRUCTURES
Day 1: R6 000 | Day 2: R5 000 | Day 3 – 6: R3 000 | Day 7 onwards: R1 500 per day to a limit of R37 000 per event.
Max of R6 500 per event for treating and admitting practitioners.
R15 000 (Principal only).
RADIOLOGY AND PATHOLOGY
(IN & OUT HOSPITAL)
R6 000 per policy per annum. R1 000 excess per scan and R500 excess for blood tests.
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.