Value Plus Plan – Comprehensive

Pathology
Basic 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.

Specialist Benefit
Specialist Benefit of up to R1000 per family per annum. Subject to pre-authorisation and referral from a 1Doctor Health Network GP. A 3 month waiting period applies.

Basic Dentistry
Basic treatment includes preventative cleaning, fillings, extractions and emergency pain and sepsis control via a Day1 Health Network Dentist. 2 visits per member per annum. Pre-authorisation is required for each visit. A 3 month waiting period applies.

Acute Medication
Acute medication covered according to the 1Doctor Health formulary. Linked to the 1Doctor consultation dispensed by the 1Doctor Health Network GP or obtained on script from a Network Pharmacy. A 1 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.

Chronic Medication
Covered according to the 1Doctor Health formulary. A 3 month waiting period applies on chronic medication for unknown conditions and 12 months for pre-existing conditions. All chronic medication is subject to pre-authorisation. An additional admin fee may be levied.

Out-of-Area Visits
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.

Radiology
Basic black and white diagnostic x-rays via a 1Doctor Health Network GP. A 1 month waiting period applies.

In-hospital Illness Benefit
Day 1: Up to R10,000 after 24h
Day 2: Up to R10,000 in R2,500 units
Day 3: Up to R10,000 in R2,500 units
Thereafter: R1,500/day, max 21 days
Max Benefit: R57,000
3 month waiting period and 12 month exclusion for pre-existing conditions apply.

Accident/Trauma Benefit
Up to R150,000 per single member and up to R300,000 per family incident. Immediate cover.

Family Funeral Benefit

• Principal Member: R20,000
• Spouse & Child > 14: R10,000
• Child > 6: R5,000
• Child > 0: R2,500
• Child > 28 weeks: R1,250

3 month waiting period applies.

24 Hour Emergency Services & Pre-Authorisation
Medical assistance via Africa Assist. Immediate cover. Guaranteed private hospital admission at Life Healthcare and Mediclinic hospitals.

Maternity Benefit
Covers up to R20,000 for hospital birth. 12 month waiting period. Available to plan members aged 16+.