DOCSURE simunye

Wesmart Home Page Elements-19
Individual
R837
Wesmart Home Page Elements-20
FAMILY MAX 3
R1 317
Wesmart Home Page Elements-21
FAMILY MAX 5
R1 528

WHAT IT COVERS

Comprehensive Advanced page banner_GP consultation
GP CONSULTATION

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.

Comprehensive Advanced page banner_Dentistry
DENTISTRY

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.

Comprehensive Advanced page banner_Optometry
OPTOMETRY

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.

Comprehensive Advanced page banner_Specialist consultations
SPECIALIST
CONSULTATIONS

Individual Option: 1 consultation refunded at R700. Family Option 3: 2 consultations refunded at R700. Family Option 5: 3 consultations refunded at R700.

Comprehensive Advanced page banner_Daily illness Benefit
ILLNESS BENEFIT
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.

Comprehensive Advanced page banner_Chronic medication
CHRONIC
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.

Comprehensive Advanced page banner_Hospital booster
HOSPITAL
BOOSTER

Max of R10 000 per event. Paid out as R1 250 per day. Limited to 2 events per annum

Comprehensive Advanced page banner_Hospital Footprint
HOSPITAL
FOOTPRINT

National Private / State facilitated by Africa Assist.

Comprehensive Advanced page banner_Personal health advisor
PERSONAL
HEALTH ADVISOR

Clinically trained consultant available 24 / 7.

Comprehensive Advanced page banner_Maternity Benefit
MATERNITY
BENEFIT

A sub-limit of R15 000 per policy per annum for confinement, includes 2 Pre-natal consultations refunded at R700 (Private facility only)

Comprehensive Advanced page banner_Casualty benefit
CASUALTY BENEFIT
(ACCIDENT ONLY)

R2 000 per policy per annum.

Comprehensive Advanced page banner_Anaesthetic benefit
ANAESTHETIC
BENEFIT

Max of R3 000 per event for anaesthetic practitioners.

Comprehensive Advanced page banner_Accidental death benefit
ACCIDENTAL
DEATH BENEFIT

Limited to R10 000 per policy per annum for Principal policyholder only.

Comprehensive Advanced page banner_Acute medication
ACUTE
MEDICATION

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.

Comprehensive Advanced page banner_Shortfall benefit
24 HOUR EMERGENCY
MEDICAL SERVICES

Limited To R50 000 per policy per annum.

Comprehensive Advanced page banner_Treatment
TREATING AND
ADMITTING PRACTITIONERS

Max of R5 000 per event for Treating and Admitting Practitioners.

Comprehensive Advanced page banner_Radiology & Pathology
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.

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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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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.

Waiting periods, limitations and exclusions