Executive Plan – Comprehensive

Unlimited Managed Doctor Visits

Via a registered Day1 Health Network Provider. An upfront co-payment of R300.00 will apply for all additional visits after the 5^th visit per member per annum. Pre-authorisation is required. A 1 month waiting period applies.

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 R1,000 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 & Chronic Medication

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

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.

Radiology

Basic radiology according to the 1Doctor Health formulary via a 1Doctor Health network GP. Black and white diagnostic x-rays only. A 1 month waiting period applies.

Out-of-Area Visits

The Plan will allow 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.

In-hospital Illness Benefit

Covers up to R10,000 after the first 24 Hours in hospital, up to R10,000 for the second day in hospital, up to R10,000 for the third day in hospital. Thereafter R1,500 per day up to a maximum of 21 days. A 3 month waiting period applies and a 12 month pre-existing conditions exclusion applies.

In-Hospital Illness Breakdown:
2nd Day in Hospital – Up to R10,000, payable in units of R2,500 (every 6 hours)
3rd Day in Hospital – Up to R10,000, payable in units of R2,500 (every 6 hours)
Every subsequent day thereafter – R2,000
Max Benefit (21 days) – R66,000

Illness Top-up

Up to R25,000 per insured person per year subject to an overall limit of 2 events per family policy per annum. A 3 month waiting period applies.

Accident/Trauma Benefit

Up to R250,000 per single member per incident and up to R500,000 per family per incident. Immediate cover.

Critical Illness Benefit

1 Incident per family per annum. Up to R250,000, limited to R50,000 unless a short medical examination (at your own cost) is completed. Underwriter’s decision is final. A 3 month waiting period applies.

Accidental Permanent Disability Benefit

R250,000 for the Principal Member only. Single event only. Immediate cover.

Family Funeral Benefit

• Principal member & Spouse – R30,000
• Child > 14 years – R10,000
• Child > 6 years – R5,000
• Child > 0 years – R2,500
• Child > 28 weeks – R1,250

A 3-month waiting period applies. Benefit only available to plan members.

24 Hour Emergency Services & Pre-Authorisation (0861 144 144)

Medical Assistance and Guaranteed Private Hospital Admission via Africa Assist. Immediate cover. Preferred hospitals: Life Healthcare and Mediclinic.

Maternity Benefit

Covers up to R20,000 for the birth of a child in hospital. 12-month waiting period applies. Available to members 16 years and older.