Key Benefits
OAL per beneficiary per annum:
R174 000
In-Hospital Benefits
Gap Cover
Co-payments
Penalty Fee Cover
Day Hospital/Clinic and/or In Room Surgical Procedures Cover
PMB Cover
For the younger generation.
OAL per beneficiary per annum:
R174 000
Gap Cover
Co-payments
Penalty Fee Cover
Day Hospital/Clinic and/or In Room Surgical Procedures Cover
PMB Cover
Will settle claims at an additional 200% above medical scheme rate or at the stated benefit value.
The excesses imposed by your medical scheme payable to a maximum rand limit for specified procedures or tests. Cover for co-payments imposed by medical schemes for hospital admissions, scans and surgical procedures. Co-payment benefits are subject to a sub-limit of R25 000 per policy per annum, limited to R5 500 per claim.
Subject to OAL.
A sub-limit of R4 000 is applicable. This benefit covers an emergency at any registered emergency facility when you require immediate medical treatment due to an accident or illness. The following benefits collectively accumulate to the sub-limit: Accident benefit: all costs related to the accidental event will be covered and paid to a maximum value of the sub-limit available, whether you are liable to pay the costs related to the emergency event out of your own pocket or if your medical scheme pays from your savings account. Illness benefit: when you visit an emergency room in a medical emergency as a result of illness, we will cover the Gap portion only if the medical scheme has paid a portion. We will cover a GP’s emergency facility where no hospital emergency is available within a 30km radius within the above stated benefit limits.
An instruction to add a new-born to the policy must be submitted within 31 days of the birth of the child. After confirmation of pregnancy, this benefit has a R2 000 sub-limit for claims for prenatal scans, childhood immunisations or pre- and post-birth tests (to limit) per child. In the event of twins, the benefit will be doubled, and in the event of triplets, the benefit will be tripled.
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