Unlimited Managed Doctor Visits
Via a registered 1Doctor Health Network Provider. A co-payment of R75.00 will apply for all additional visits after the 5th visit. A 1 month waiting period applies.
Acute medication is covered according to the 1Doctor Health formulary. A 1 month waiting period applies.
Chronic medication is covered according to the 1Doctor Health formulary. A 3 month waiting period applies on chronic medication for unknown conditions and a 12 month waiting period on pre-existing conditions. A standard 12 month waiting period applies for persons aged 65 and over for chronic medication. (All chronic medication is subject to preauthorisation. An additional administration fee is levied on all approved chronic medication).
Basic radiology according to the 1Doctor Health formulary via a 1Doctor Health Network GP. Black and white diagnostic x-rays only. A 1 month waiting period applies.
Diagnostic blood tests on referral by a 1Doctor Health Network GP and subject to a list of basic pathology tests approved by Day1 Health. A 1 month waiting period applies.
Basic treatment includes preventative cleaning, pain control, fillings, one emergency root canal treatment and extractions via 1Doctor Health Network Dentist. A 3 month waiting period applies.
Optometry (Iso Leso Optics)
One eye test and one set of glasses every 24 months per the specific Iso Leso Optics agreed protocol range. A 12 month waiting period applies.
In the event that you cannot see your Network GP, the Plan will allow 3 “out of area” visits per family per annum to an alternative Network GP or GP of your choice, subject to pre-authorisation. A 1 month waiting period applies.
Day To Day Benefits Via 1Doctor Health Provider Network
In-hospital Illness Benefit
Covers up to R10,000 after the first 24 Hours in hospital, up to R10,000 for the second day in hospital, up to R10,000 for the third day in hospital. Thereafter R1,500 per day up to a maximum of 21 days. a 12 month pre-existing conditions exclusion applies.
Up to R75 000 per single member per incident and up to R150 000 per family per incident. Immediate cover. (Limited to two events per annum).
R5 000 for the principal member and spouse only.
24 Hour Emergency Services & Pre-Authorisation (0861 144 144)
24 Hour Emergency Services, Medical Assistance and Pre-Authorisation provided by Africa Assist. Guaranteed hospital admission.