FAQs

Please note that the benefit and amounts are dependent upon the cover you have selected. We will gladly assist you in increasing or adding additional benefits to ensure that you are receiving the best cover.

General

Yes, you may but you do need to understand that Medical Aid and Medical Insurance offer different benefits and cover.

Medical Insurance is based on events and stated benefits and is regulated by the Financial Services Board (FSB), Long Term and Short-Term Insurance acts. Medical aid is based on procedures and tariff codes and is regulated by the Council of Medical Schemes.

Yes, you may. We will contact you though to confirm bank account details and to obtain authorisation from you to debit your account.

If you have taken the casualty room benefit, please contact our pre-authorisation department which is available 24/7. They will assist you accordingly.

Cover is only available within the borders of South Africa, Lesotho and Swaziland. You will need to arrange to come back to South Africa to receive treatment

Cover is only available within the borders of South Africa, Lesotho and Swaziland. You will need to arrange to come back to South Africa to receive treatment

Primary Care

Yes, our Primary Care Policy fits in perfectly with a Hospital Plan and a Medical Aid.

We have an extensive GP Network which we encourage you to make use of. This will ensure that you are not expected to pay in any differences in charges and the treating GP prescribes medication and treatment that is within our extensive formulary.

We have a set list of blood tests, medicines and x-rays that we cover. If the required treatment is not on our formulary list, we most likely don’t cover it, unfortunately.

Have a look on our website and locate a Network GP where you are. In the event of you not being able to see a Network GP and are asked to pay up front, we will reimburse you up to R250 per visit

Let us know and we will gladly contact doctors in your area and get them onto the Wesmart Network. The same applies to Dentists

We understand that you sometimes don’t need to see a GP but need something medicinal to get you through until you are back in fighting condition. Because of this, there is an OTC benefit of up to R150 per policy per month with an overall annual limit of R600.

Hospital

Your newborn baby will be covered from birth if you have been on the Policy for more than 12 months. If you have been on the Policy for less than 12 months, the relevant waiting periods will apply.

If you have the relevant benefit option, such as accident or illness benefits on your Wesmart Policy, then yes you can be admitted to any private hospital for treatment. You will be required to phone our 24/7 pre-authorisation line and they can assist with finding the nearest, most appropriate medical facility as well as facilitate the admission process.

If you are currently receiving or have received treatment for a condition in the last 12 months, it will be considered a pre-existing condition and the relevant waiting periods may be applied.

There is a 12-month waiting period before you may access the Maternity Benefits

Should you require admission to hospital, contact our 24/7 call centre and we will assist you in obtaining a Guarantee for Admission.

All admissions must be pre-authorised by our 24/7 call centre. If the necessary criteria for admission is met, a Guarantee of Payment will be issued to the admitting facility.