Frequently Asked Questions

What hysterectomy benefits in hospital are covered by Day1 Health?

Platinum Plan Hysterectomy procedure – Day1 Health pays costs in hospital of up to a maximum of R20 000.00

How long after discharge should I send my claim form through to Day1 Health?

In order for hospital costs incurred to be paid after date of discharge, you will need to complete a claim form and submit it to the Day1 Health offices within 90 days of the admission.

What are the maternity benefits covered by Day1 Health?

Platinum Plan
Natural Birth & C-Sections – Day1 Health pays costs in hospital of up to a maximum of R20 000.00

What appendectomy benefits in hospital are covered by Day1 Health?

Platinum Plan Appendectomy procedure – Day1 Health pays costs in hospital of up to a maximum of R20 000.00

Can I go to any private hospital?

Day1 Health facilitates admission to most private hospitals and government hospitals. All hospital admissions must be pre-authorised via Africa Assist (A-A). The pre-authorisation number is on the back of your membership card (0861 144 144).

Can I go to any Dentist on the Network list?

Yes, you can make use of any dentist on the Network and remember; basic treatment includes preventative cleaning, pain control, fillings, emergency root canal and extractions from the chair only. Please refer to your Day1 Product Guide for covered procedure codes.

What is the procedure to follow should I get diagnosed with a Chronic Condition?

If you are diagnosed with a chronic condition, you must register on the 1Doctor Health Chronic Disease Management Programme via your 1Doctor Health Network GP in order to receive your chronic medication. Download the Chronic Medication Application Form from the downloads library and have your network GP complete it. Chronic medication may be collected from any Clicks, Dischem or Medirite pharmacy and is subject to pre-authorisation.

Can I buy my medication over the counter?

No, your 1Doctor Network GP has to prescribe medication in accordance to the medication formulary. Both acute routine and chronic medication are covered and are unlimited according to the 1Doctor Health formulary. The Network GP’s usually dispense the medication; however, if the GP is a scripting doctor, i.e. ‘does not dispense’, you may obtain your medication from any Clicks, Dischem or Medirite pharmacy.

What happens if I am ill and out of town?

If you are out of town and you cannot see your Network GP, the Day to Day Plan will allow 3 “out-of-area” visits per family per annum to an alternative Network GP or GP of your choice. Should you have to pay for these consultations, simply complete a Day1 Health Reimbursement Form and send it to Day1 Health together with a copy of the receipt and the agreed tariff will be reimbursed to you. (Please note if a GP visited is not on our preferred network, consultation should be settled on date of consultation)

When I see a GP/ Dentist, do I have to pay cash for the consultation?

No. By paying your monthly contribution in advance, you have already paid for your consultation. The accredited providers claim directly from Day1 Health.

Can I go to any Doctor?

The Day1 Health day to day benefits are made available through 1Doctor Health provider network. You must be allocated to a 1Doctor Health network doctor.

What is the waiting period for day to day benefits?

For most of our day to day healthcare benefits the waiting period is only 1 calendar month, the only exceptions are for optometry which is 12 calendar months, specialist and dentist which is 3 calendar months and chronic medication which have a waiting period of 3 calendar months for unknown conditions and a 12 months (calendar) waiting period for pre-existing chronic conditions.

Does health insurance have any tax benefits?

No. Unlike medical aid, health insurance offers no tax benefits to policyholders.

What is Health Insurance?

Health Insurance is governed by either the Long Term Insurance Act or the Short-Term Insurance Act.

What is a Medical Aid Scheme?

Medical aids are regulated by the Medical Schemes Act (1998). They are essentially non-profit organisations and belong to their members.

What is the waiting period for maternity benefits?

There is a 3 month waiting period applicable to the maternity benefit for unknown conditions from date of inception of policy and a 12 month waiting period for pre-existing conditions ie where the member is pregnant at inception date. Once the maternity benefit has been utilised by a member, a further 12 month waiting period will apply in respect of such member for maternity. (The maternity benefit is limited to R20 000.)

Does the hospital plan cover casualty?

Casualty consultations will only be covered under the Accident/Trauma Benefit i.e. any bodily injury as a result of an accident. Please refer to you hospital plan policy wording for detailed information.

Does the hospital plan cover day procedures?

Day1 Health products were designed to provide cover for procedures that require hospitalisation for 24 hours or more under the Illness Benefit. Therefore, hospitalisation for 24 hours or less will not be covered (E.g.: Scans/Scopes/Grommets/Tonsillectomy)

Will I be covered for pre-existing conditions?

If you are suffering from a pre-existing condition prior to taking out health cover, a 12 calendar month waiting period will apply. Thereafter underwriters will review.

What does Day1 Health classify as pre-existing conditions?

Pre-existing conditions are defined by a medical practitioner as, ‘any illness or ailment that existed at any time during the 12 months prior to joining Day1 Health or on upgrading your cover’, including any medical advice or treatment thereof within the specified waiting period. Day1 Health will not pay a claim on a pre-existing condition/ailment for the first 12 months of the plan / policy.

What will happen to my waiting periods if I upgrade my cover?

If you decide to upgrade your Day1 Health cover, you may be required to serve waiting periods for any increase in your limits, as well as any new services that you were not covered for previously.

Why does Day1 Health impose waiting periods?

Waiting periods protect you and Day1 Health from consumers joining for financial gain, as this can lead to increased premiums and/or loss of benefits.

Copyright 2015 Day1 Health (Pty) Ltd | All Rights Reserved
Day1 Health (Pty) Ltd is an authorised Financial Services Provider. FSP No: 11319
Hospital Plan Underwritten by African Unity Life Limited (FSP 8447)
Day1 Health is a B-BBEE level contributor: Level Two (125% B-BBEE procurement recognition level) (1)(2)
Day1 Health complies with the principles of open enrolment, community rating and cross-subsidisation and does not discriminate or refuse membership on the basis of
race, age, gender, marital status, ethnic or social origin, sexual orientation, pregnancy, disability, state of health, geographical location or any other means of discrimination.