We have 3 Options available only, starting from R299 per month.
- Day to Day
- Day to Day & Hospital combined
1st option: Day to Day covers the following.
1. Unlimited Dr’s visits and medication.
We have a network of Dr’s that we deal with, and the members need to chose from the network of Doctors. You may only nominate 1 Doctor but you may change the Doctor at anytime should you not be happy.
Should the member prefer to use their own Doctor we will still cover up to R220.00 per consultation unlimited, the member would then pay the Doctor and claim from Affinity which takes up to 14 working days.
Members may also put their Doctor’s details on the application, forward it to us and we will approach the Doctor in joining our network.
This is entirely up to the GP and could take up to a month as they are always extremely busy.
We have a GP Nomination form that needs to be completed and sent back to us.
We have dispensing Dr’s and non dispensing Dr’s.
Should the Doctor give the member a prescription you may go to any Pharmacy including Dischem, Clicks, or Mediscor for the medication, once again as long as it is prescribed according to our medicine formulary there will be no payment or dispensary fees.
Each medical aid company has their own formulary and the Doctor’s don’t always check as they have so many of them, this is why it is important for the member to remind the GP to prescribe off the Medical Health Insurance formulary – 1 month waiting period
2. Specialists – One specialist visit per year up to R500.00 per single member and R1000.00 per family per year – referred by the GP – 1 month waiting period
3. Acute and Chronic medication – Linked to the Doctor’s consultation – 30 day waiting period for Acute and 6 months waiting period for Chronic. There is a chronic medication form that must be completed.
4. Radiology – (X-rays) unlimited referred by the network GP from the Medical Health Insurance Radiology formulary ( basic black and white X-rays only) – 1 month waiting period
5. Pathology – (Blood tests) unlimited basic pathology referred by the network GP from the Medical Health Insurance Pathology formulary – 1 month waiting period
6. Out of area visits – should the member be on holiday and need to see a Doctor we will cover up to R220.00 for the consultation and you can then claim back from the Medical Health Insurance, this is also unlimited – 1 month waiting period
7. Dentistry – Full mouth assessment- Infection control – Two intra oral radiographs ( X-rays ) – Extractions three per year – Amalgam fillings ( silver fillings ) No braces, false teeth or anything cosmetic, we only cover what is mentioned here.
We have a huge network of dentists, members may nominate their own dentist – 3 month waiting period
8. Optometry – One eye test and one set of white standard frames and lenses per beneficiary per 24 months – 12 month waiting period
9. Death benefit – we have a separate benefit for each plan – 3 month waiting period
10. Post Hospital Private Nursing – covered up to R10 000.00 as recommended by the Medical Health Insurance specialist – If the member has been hospitalized after the 30 day waiting period.
2nd option: Hospital Plan
1. Accident – R150 000.00 per single member and R250 000.00 per family per event.
The member is covered for this from the 1st day of the debit order, there is no waiting period
Our 24 hour emergency services are Africa Assist and ER24 – the member will be taken to the nearest equipped hospital to get stabilized, they arrange everything for the member, by the time the member gets to the hospital everything is ready, there is no concern about signing papers and deposits.
2. Disability - Should the principle member be disabled, and not able to work and support the family they will be paid out R250.000.00
3. Daily illness hospital benefit.
The hospital is of your choice but our preferred hospitals are LifeHealthcare, and Mediclinic.
We pay the member and the member pays the hospital, should the member not have the funds to pay the hospital they may cede their benefit to the hospital and your Medical Health Insurance will guarantee payment according to the daily benefits which is as follows:
1st day R6500.00
2nd & 3rd day R4500.00
4th & 5th day R3000.00 and thereafter R1500.00 per day up to 21 days.
The member must be admitted for a minimum of 24 hours to be able to claim for this benefit.
5.Specific stated conditions benefit.
1. Appendix removal R30 000.00
2. Kidney stones theatre R30 000.00
3. Ectopic Pregnancy R20 000.00
4. Hernia R15 000.00
5. Gal bladder removal R35 000.00
6. Maternity natural R15000.00
7. Maternity C section R25 000.00 There is a 12 month waiting period for all of the above!
8. Hysterectomy R40 000.00 24 month waiting period
R9000.00 is payable upon diagnosis with an annual limit of R200 000.00 depending on severity, covering
- Heart attack
- Coronary heart disease.
- Brain tumor
- Kidney failure
- Major organ transplant
One incident per year per family – pre existing and 3 month waiting period applies.
- Post hospital private nursing.
There is a separate Family Death Benefit for each option.
Any inquiries regarding the product, membership cards etc. firstname.lastname@example.org, or call 083 566 9812
Once you have sent in the signed application it is sent in to be validated by our call center, this is taped and filed.
The member will receive their membership card within 21 days of the first debit order.
Port Elizabeth South Africa
Offices Tel. +27 (0) 41 379 5862
Cell +27 (0) 83 566 9812
Fax. 086 571 6726