Primary Standard Plan

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Monthly Premiums

Rates below are for Individuals, per member per month. If you are a member as part of a Group/ Company, your rate may be different.

Principal

R399 PM

Adult Dependent

R380 PM

Child Dependent

R140 PM

Primary Care Benefits

GP CONSULTATIONS

Managed unlimited general practitioner visits at a contracted network provider. Includes certain in-room procedures. All consultations after the 5th visit must be pre-authorised.

OUT-OF-NETWORK CONSULTATIONS

2 Consultations per policy per annum, refunded at a maximum of R350

SPECIALIST CONSULTATIONS

Up to a maximum of R1 000 per beneficiary per annum. Specialist benefits are available on a pay and claim basis. The member must be referred by a network general practitioner.

 
 

ACUTE MEDICATION

Unlimited acute medication either at dispensing network GP or pharmacy. Subject to Wesmart Formulary

 
 

OVER-THE-COUNTER MEDICATION

R150 per policy per month as per Wesmart formulary. Limited to R600 per policy per annum.

 
 

CHRONIC MEDICATION

Unlimited. Restricted to 26 chronic diseases on the Chronic Disease List (CDL) and Wesmart Formulary. All chronic medicine needs to be applied for by the prescribing medical expert.

 
 

RADIOLOGY

Limited 1 and 2 sided x-rays. Member must be referred by a network GP provider. Services are directly linked and limited to Wesmart Protocols.

 
 

PATHOLOGY

Unlimited. Member must be referred by a network GP provider. Services are directly linked and limited to the Wesmart Protocols.

 
 

DENTISTRY

Managed according to Wesmart Protocols and limits

 
 

OPTOMETRY

Specsavers network only 1 consultation, 1 frame and single vision lenses per beneficiary every 24 months. The maximum value of these services is R1 249.

 
 

CASUALTY BENEFIT

R1 000 per policy per annum. 

 
 

Value Added Benefits

24 HOUR EMERGENCY MEDICAL SERVICES

Unlimited, subject to pre-authorisation.

ACCIDENTAL DEATH BENEFIT

R10 000 principal member and adult dependent R8 000 per child dependent


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