Primary Standard

Monthly Premiums

Our premiums may be reviewed and escalated on an annual basis.

Individual

R455 pm

Adult Dependant

R365 pm

Child Dependant

R115 pm

Primary Care Benefits

GP CONSULTATION

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

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 and Wesmart Formulary. All chronic medicine needs to be applied for by the prescribing medical expert.

RADIOLOGY

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

2 visits per beneficiary per annum managed according to the Wesmart Protocols.

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

R1 000 per policy per annum. Only available after hours and must be pre-authorised by Africa Assist.

Value Added Benefits

PERSONAL HEALTH ADVISOR

Clinically trained Personal Health Advisor available 24/7.

ACCIDENTAL DEATH BENEFIT

R10 000 principal member and adult dependant R8 000 per child dependant.

For all terms and conditions, benefits, limitations, and exclusions please refer to the
policy wording which forms part of your Schedule of Insurance or consult your broker.

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