WHAT YOU NEED TO KNOW
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In-Room Procedures Covered
ONLY AT A NETWORK DOCTOR
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Consultations for:
- A new or established patients
- An unscheduled for an emergency
- For an emergency consultation away from Dr rooms
- For elective after-hours services - Nebulisation
- Additional Wound Stitching at same session (each)
- Circumcision: Clamp Procedure
- Drainage of subcutaneous abscess onychia, paronychia, pulp space or avulsion of nail
- Each additional small procedure done at the same time stitching
- Excision and repair by direct suture; excision nail fold or other minor procedure of similar magnitude
- GP Ultrasound study of the pregnant uterus (1st & 2nd trimester)
- Limb Cast (excluding after care)
- Removal of foreign body superficial to deep fascia (except hands)
- Stitching of wound (with or without local anaesthesia) including normal after care
- Urine Dipstick
- Blood Sugar tests
- ECG without effort
- ECG with effort
Chronic Conditions Covered
- Addison disease
- Asthma
- Bronchiectasis
- Congestive cardiac failure (CCF)
- Cardiomyopathy
- Chronic renal failure
- Coronary artery disease (CAD)
- Chronic obstructive pulmonary disease (COPD)
- Crohn disease
- Diabetes Insipidus
- Diabetes Mellitus type 1
- Diabetes Mellitus type 2
- Dysrhythmias
- Epilepsy
- Glaucoma
- Haemophilia
- HIV meds R500 per policy per month max R6 000 per annum
- Hyperlipidaemia
- Hypertension
- Hypothyroidism
- Multiple sclerosis (MS)
- Parkinson disease
- Rheumatoid arthritis (RA)
- Systemic lupus erythematosus (SLE)
- Ulcerative colitis
GENERAL QUESTION
Frequently Asked Questions
GENRIC Health is an exempt medical insurance product, fully compliant with the Demarcation Regulations. Governed by the Insurance Act and Council of Medical Schemes.
The product is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a substitue for a medical scheme product.
Please find the link to our formulary here: https://secure.mediscor.co.za/adocs/schemeformularies/genric_formulary_lookup.html
Follow this link to find out which medication is covered.
1 month general waiting period will be applied on all out-of-hospital benefits unless otherwise stated.
3 months general waiting period will be applied on any in-hospital illness related benefits unless otherwise stated.
6 months general waiting period will be applied on dental benefits.
10 months waiting period will be applied on all pregnancy and confinement treatment.
12 months waiting period will be applied on all pre-existing conditions, diseases, or illnesses. These include any conditions which existed prior to inception, or for which an insured person has sought or received medical advice or received treatment by a Registered Medical Professional or exhibited symptoms before inception of the policy. Failure to disclose any pre-existing condition could render the policy being cancelled.
The prescribing doctor must contact our Chronic Medication department 0860 119 553 to register you.
You must fully complete and sign the claim form.
• Provide clear copies of all account statements.
• Hospital account, etc.
• All documents must be submitted within 90 days.
If you do not find a service provider in your area, please send an email to networks@pamc.co.za nominating your current service provider by providing us with:
1. Your name and contact details.
2. Recommended Service provider Name and Contact details
If you have visited your GENRIC Network GP and they believe that you require the treatment of a specialist, he/she must write a referral letter, you will then have to contact the GENRIC call centre at 010 599 1170 to obtain an authorization.
Yes, you can contact Africa Assist, the designated provider on 010 599 1172 or GENRIC call centre on 010 599 1170 in the event of an emergency or serious accident. Once you have been transported to the closest appropriate facility, the hospital should contact GENRIC.
Yes, you can use your GENRIC Health card to purchase over the counter medication stated by the GENRIC formulary and protocol’s and prescribed by your GP in the network provider.
All South African citizens can apply for GENRIC Health Insurance.
Application forms are available and ready to be competed online. You can also contact the call Centre on 0105991170 , should you require assistance with competing the form.
