FAMILY MAX 3
FAMILY MAX 5
WHAT IT COVERS
8 consultations for an Individual, 12 consultations for a family of 3 and 15 consultations for a family of 5, provided the Designated Network is used. 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 R900) or Contact Lenses up to R900 every 24 Months per beneficiary.
Individual Option: 1 consultation refunded at R700. Family Option 3: 2 consultations refunded at R700. Family Option 5: 3 consultations refunded at R700.
INCLUDES ALL WARD FEE STRUCTURES
Day 1: R4 800 | Day 2: R4 000 | Day 3 – 6: R3 000 | Day 7 onwards: R1 750 per day to a limit of R22 500 per event.
MEDICATION (PER CDL)
Individual Option: R1 250 Family Option 3: R2 150 Family Option 5: Limited to R3 250 per policy per annum. Up to a max Of R230 per script.
Max of R10 000 per event. Paid out as R1 250 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 R15 000 per policy per annum for confinement, includes 2 Pre-natal consultations refunded at R700 (Private facility only)
R2 000 per policy per annum.
Max of R3 000 per event for anaesthetic practitioners.
Limited to R10 000 per policy per annum for Principal policyholder only.
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
Limited To R50 000 per policy per annum.
Max of R5 000 per event for Treating and Admitting Practitioners.
RADIOLOGY AND PATHOLOGY
(IN & OUT HOSPITAL)
Max of R5 000 per policy per annum for Specialised Radiology in hospital only, R3 000 for all Pathology tests in hospital only and Black and White X-Rays out of hospital only limited to R1 500 per policy per annum. R850 excess per Specialised Radiology Scan and R200 excess for Blood Tests.
hiv – EARLY DETECTION
HIV Elisa Blood Test. Pre and Post Testing for HIV. Symptomatic Treatment due to HIV Infection. Medicines available through State only
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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.