What We Do
Critical Illness Treatment Extension:
If you are critically ill and require treatment that is covered by your medical aid, but there is a delay in the authorisation of such treatment, we will pay up to R25 000 per event to the medical practitioner or pharmaceutical company on your behalf so that you may commence treatment.
(The illness that will qualify are: Cancer, Kidney malfunction requiring dialysis and diabetes.)
Family Member Accommodation and Travel Expenses:
In the event that you or any member of your family are hospitalised more than 50km from your permanent home, we will pay up to R10 000 in any one annual period of insurance for your family member to travel to the hospital, as well as for accommodation in the hospital’s vicinity.
Care of Children under 18:
If you or your spouse are hospitalised and neither of you are able to care for your children under the age of 18, we will pay up to R5 000 in any one annual period of insurance for a family member to travel to your home and care for your children or for your children to travel to the home of a family member or friend.
Up to R35 000 per family per annual period of insurance for the following:
• In hospital procedures
• Out patient MRI, Scopes and CT Scans
• Hospitalisation pre-admin co-payment for any procedure including dental procedures
We will pay up to R250 000 per family per annual period of insurance for any treatment related to or as a result of cancer.
(The amount includes any 20% co-payment above the medical scheme’s sub-limit).
Policy Waiting Periods:
There is a General waiting period of 3 months.
WE WILL NOT PAY A CLAIM FOR or caused by any of the following conditions for the first 6 months from inception of your policy with us and for the following 6 months we will only pay 50% of the benefit:
• Pre-existing Conditions or re-occurrence of a pre-existing condition or illness unless you have advised us in writing and we have agreed to waive this exclusion for that condition or illness only.
• Hysterectomy (unless a life-saving emergency)
• Arthroscopic procedures (unless as a result of an accident)
• Joint replacement (unless as a result of an accident)
• Spinal surgery including spinal fusion (unless as a result of an accident)
• Dentistry limited to R6 000 per insured to a maximum of R10 000 per family (unless as a result of an accident)
• Nasal surgery (unless as a result of an accident)
• Cataract surgery
• Hernia operations (unless a life-saving emergency)
We will not pay a claim for or caused by pregnancy or childbirth for the first 10 months from inception of your policy with us.
This document does not form part of your policy wording and should be read in conjunction with your policy wording. If there is any conflict between this document and the policy wording, the policy wording will apply.
Insured Events and Extensions to Cover
WE WILL PAY FOR the following insured events in respect of the people insured by this policy:
2. Medical or surgical procedures or treatment that are performed in a hospital.
3. In hospital Doc and Spec Provider claims only – No Hospital Bills.
4. The following surgical or medical procedures performed on an out-patient basis:
(d) Carpal tunnel release
(e) Cataract removal
(f) Cervical laser ablation
(i) Closure of colostomy
(k) Coronary angiogram
(l) Coronary angioplasty
(n) Dilatation and curettage
(o) Direct laryngscopy
(q) Frontal, functional endoscopic or bilateral endoscopic sinus surgery
(r) Ganglion surgery
(v) Incision and drainage or marsupilisation of Bartholin’s cyst
(w) Inguinal, femoral, umbilica, epigastric or spigelian hernia repair
(x) Ischio-rectal abscess drainage
(y) Kidney dialysis
(z) Liver needle biopsy
(aa) Lymph node biopsy
(ee) Prostate biopsy
(ff) Pterygium removal
(gg) Surgical biopsy of breast lump
(hh) Surgical haemorrhoidectomy
(kk) Tubal ligation
This is NOT a medical scheme and the cover is not equivalent to that of a medical scheme.
This is NOT a substitute for medical scheme membership.
This document does not form part of your policy wording and should be read in conjunction
with your policy wording. If there is any conflict between this document and the policy wording, the policy wording will apply.