Comprehensive Plus Plan
Monthly Premiums
The rates below are for Individuals under the age of 60, per insured per month.
If you are a member as part of a Group/ Company, your rate may be different.
Principal
R1 155 PM
Adult Dependent
R930 PM
Child Dependent
395
The rates below are for Individuals over the age of 60, per insured per month.
Principal
R1 610 PM
Adult Dependent
R1 305 PM
| Benefits |
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In-hospital Maternity Benefit |
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In-Hospital Accident Benefit |
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In-Hospital Illness Benefit |
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ICU Benefit |
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in-hospital specialised radiology (mri scans, ct scans) |
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Post-Hospital Accident Rehabilitation |
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casualty benefit for accidents |
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casualty benefit for illness |
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out-of-hospital maternity benefit |
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general practitioner consultations (GP/doctor) |
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in-room procedures |
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out-of-network general practitioner consultations (gp) |
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pharmacy clinic nurse care |
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specialist benefit |
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acute medication |
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over-the-counter medication (OTC) |
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chronic medication. refer to our chronic disease list (CDL) |
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radiology |
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pathology |
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dentistry |
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optometry |
| DESCRIPTIONS |
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R30 000 per pregnancy for the birth. Limited to 1 event per policy every 12 months. Includes out-of-hospital scans. |
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R350 000 per member per event, inclusive of all costs. Maximum of R1 500 000 per policy per annum. Pre-authorisation required. |
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R95 000 per member per event, inclusive of all costs. Overall limit of R1 000 000 per policy per annum. Cataract Surgery is limited to R30 000 (thirty thousand Rand) per member per annum. Pre-authorisation required. |
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Included in Hospital Benefits. |
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Included in Hospital Benefits. |
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R10 000 per member per event for physiotherapy and occupational therapy – home care/wound care. Pre-authorisation required. |
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R10 000 per policy per annum. Cover accumulates to the initial event and overall In-Hospital Accident Cover benefits. Pre-authorisation required. |
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R5 000 per policy per annum for after-hours treatment only. Cover accumulates to the initial event and overall In-Hospital Illness Cover benefits. Pre-authorisation required. |
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2 Ultra-sounds at Network GP (first trimester & second trimester). Limited to 1 event per policy every 12 months. |
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Managed unlimited GP visits at a Network GP doctor. |
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Consult our list of procedures a Network GP can perform in their rooms at no additional charge. |
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2 Consultations per policy per annum refunded at R500 per visit. |
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Unlimited care for a defined list of procedures available from nurses at Network pharmacies with contracted clinics. |
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R2 600 per member per annum. Referral by Network GP required. Members must pay cash and claim from GENRIC. GENRIC protocols and limits apply. |
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Unlimited Acute Medication available only from a Network pharmacies. Subject to Formulary and to a maximum price based on the average price of generic drug in that category. If your medicine costs more you will have to pay a co-payment. |
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R250 per policy per month with a maximum of R850 per policy per annum. Subject to Formulary. |
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Unlimited Chronic Medication for diseases on our CDL. All Chronic Medication needs to be approved by us. Chronic Medication may be obtained from a Network pharmacy or from a Network Dispensing Doctor. Subject to Formulary and to a maximum price based on the average price of generic drug in that category. If your medicine costs more you will have to pay a co-payment. |
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Unlimited Black and white x-rays only. Members must be referred by a Network GP. |
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Unlimited blood tests according to our list of tests. Members must be referred by a Network GP. |
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Basic dentistry only. Treatment available based on GENRIC’s Protocols and limits. |
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Glasses are only available at Specsavers branches. This benefit included 1 consultation, 1 set of frames with single vision lenses per member, every 24 months. Maximum value of R1 550. |
ADDITIONAL BENEFITS
Hospital Footprint
Access to all private hospitals accepting health insurance products. Pre-authorisation required.
VALUE ADDED BENEFITS
24-hour Emergency Medical Services
Unlimited 24/7 Private Emergency Medical Services. Pre-authorisation required.
MediClub Client Assistance Programme
Personal Health Advisor – Clinically trained Personal Health Advisor available for telephonic consultations and advice 24/7.
Credit and Debt Assist – a full range of debt management and financial planning services.
Legal Assist – telephonic legal advice from qualified attorneys.
Trauma Counselling – Trauma debriefing by a qualified nurses who are, where necessary able to refer the insured to the next level of counselling.
Accidental Death
Benefit
Principal: R15 000
Adult Dependant: R10 000
Child Dependant: R8 000
PHARMACY CLINIC NURSE-BASED CARE
Nurse-Based Care
Care from qualified nurses at over 700 pharmacy Wellness Clinics. Visit them in store at your convenience or book an appointment for a consultation. Nurses will give you a medical referral if necessary. Available at all Network Pharmacies with contracted Clinics.
• General Member Wellness
• Women’s Health
• Assistance Managing Chronic Conditions
General Member Wellness
- Glucose and Cholesterol screening / testing / monitoring.
- Treatment of wounds.
- Administration of injections, including annual flu injection.
- Hb, Malaria and Urine Screening.
- Syringing of ears.
- Advice on how to best manage your status and health.
Women's Health
Caring advice women can rely on, offering all types of female health assessments such as pregnancy testing, breast screening, pap smear testing and other female screenings.
Assistance Managing Chronic Conditions
Nurses will help you manage your chronic condition and assist you with monitoring and
advice, including but not limited to:
• Diabetes Hba1C and foot screening.
• Blood pressure and lipogram testing, BMI monitoring.
• Peak flow and nebulization. Control asthma by getting rescue medication directly into the lungs.
• HIV screening, testing and counselling: Learn your HIV status and get psychological help after testing positive. A counselling session is offered pre-testing as well.
