1. WAITING PERIODS
1.1 General Waiting Period (GWP) is applicable on any new incepted policies and/or additional dependents to the current policy.
1.2. A 3 (three) month waiting period applies to any illness-related admission to hospital for treatment.
1.3. A 12 (twelve) month waiting period on all pre-existing conditions for admission to hospital for treatment.
1.4. A 1 (one) month waiting period on the following benefits are applicable:
· 1.4.1. GP Consultations;
· 1.4.2. Acute Medication;
· 1.4.3. Over the counter health and screening;
· 1.4.4. Radiology;
· 1.4.5. Pathology;
· 1.4.6. Casualty Benefit;
1.5. A 3 (three) month waiting period on specialist consultations apply.
1.6 A 6 (six) month waiting period on all dentistry-related benefits.
1.7 A 12 (twelve) month waiting period on all optometry-related benefits.
1.8 A 6 (six) month waiting period on chronic medication
2. POLICY SPECIFIC WAITING PERIODS
We will not compensate you for any illness, condition, disease or injury, or the consequences of treatment of, or resulting from, or associated with: Out-patient treatment other than specifically defined as covered. Diagnostic procedures and admissions. The following conditions, if pre-existing, within the first 12 (twelve) months of the policy inception:
2.1 Myringotomy and Grommets;
2.4 Pregnancy and Confinement;
2.5 Hysterectomy; (except where malignancy can be proven);
SUMMARY OF POLICY TERMS AND CONDITIONS
GENERAL POLICY EXCLUSIONS · An event not covered that falls outside of the policy’s intention.
· Any pre-existing condition, disease, disorder or illness, for 12 months.
· Claims for regular or routine medical treatment of a diagnostic nature.
· Illness or injury resulting from alcohol or drug abuse.
· Any psychiatric or psychological condition.
· Suicide or attempted suicide.
· Medication, drugs, prescriptions, consumables and equipment used, unless it forms part of the benefit entitlement
· Cosmetic surgery unless defined as part of the benefit entitlement of this policy.
· Elective procedures
· Diagnostic investigations, treatment or surgery related to eating disorders, obesity or weight management.
· Investigations, treatment, medication or surgery related to any condition where the policyholder seeks advice, diagnosis and / or treatments outside the border of South Africa.
· BMI (Body Mass Index), unless defined as part of the benefit entitlement of this policy. Diagnostic Investigations, treatment or surgery relating to any form of assisted reproduction.
STANDARD SHORT-TERM POLICY EXCLUSIONS
No benefits will be paid for claims arising from:
· Participation in war, invasion, act of a foreign enemy, hostilities, civil war, rebellion, revolution, insurrection or political risk of any kind, terrorism or violence.
· Any riot, strike, public or domestic disorder, civil commotion, labour disturbances or lock-out.
· Active military duty, police duty, police reservist duty, civil commotion, labour disturbances, riot, strike or the activities of locked out workers.
· Preventing authorities from dealing or controlling any of the above activities.
· Compensation in terms of the War Damage Insurance Act 85 of 1976.
· Nuclear weapons, nuclear material or ionizing radiation
· Committing unlawful activities in the Republic of South Africa
· Loss arising from any contractual liability.
· Consequential loss or damage.
DISCLAIMER The above is a summary of terms and conditions, for a concise list please refer to the policy wording which forms part of your Schedule of Insurance. WESMART and GENRIC have been granted exemption in terms of Section 8(h) of the Medical Schemes Act 131 of 1998 for this product. This policy does not discriminate or refuse membership on the basis of race, age, gender, marital status, ethical or social origin, sexual orientation, pregnancy, disability, state of health, geographical location or any other means. We may however charge a different premium dependent on your age at the time of inception.