Senior Comprehensive Plan

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 5th 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.

Acute Medication
Acute medication covered according to the 1Doctor Health formulary. A 1 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.

Chronic Medication
Chronic medication is covered according to the 1Doctor Health formulary. A 3 month waiting period applies on chronic medication for unknown conditions and a 12 month waiting period on pre-existing conditions. (All chronic medication is subject to preauthorisation. 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
In the event that you cannot see your Network GP, 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.

• 1st Day: Up to R10,000
• 2nd Day: Up to R10,000 in units of R2,500
• 3rd Day: Up to R10,000 in units of R2,500
• Each day after: R1,500
• Max over 21 days: R57,000

Accident/Trauma Benefit
Up to R75,000 per single member and up to R150,000 per family incident. Immediate cover. (Limited to two events per annum)

24 Hour Emergency Services Ambulance & Pre-Authorisation
24 Hour Emergency Services, Medical Assistance and Pre-Authorisation provided by Africa Assist. Immediate Cover. Guaranteed private hospital admission with preference to all Life Healthcare and Mediclinic hospitals.

Funeral Benefit
Principal Member and spouse – R5,000. A 3-month waiting period applies. (Benefit only available to plan members.)

Practical Medical Insurance – Providing cover since 2003. Day1 Health (Pty) Ltd is an authorised Financial Services Provider – FSP Number 11319. Day1 Health (Pty) Ltd is duly approved and accredited by the Council for Medical Schemes – CMS Ref: 1074. Powered by Day1 Health – Underwritten by African Unity Life Ltd, a licensed Life Insurer and an authorised Financial Services Provider. FSP No: FSP 8447. Day1 Health offers Medical Insurance plans and is not a Medical Aid product.

Day1 Health complies with the principles of open enrollment, community rating and cross-subsidisation and does not discriminate or refuse membership on the basis of race, age, gender, marital status, ethnic or social origin, sexual orientation, pregnancy, disability, state of health, geographical location or any other means of discrimination.