Executive Health Insurance Plan

Health Cover Waiting Periods Cover Limits Single Dep(2-3) Dep(4+)
General Practitioner (Doctor) 30 Days Up to R 295 per visit R2 585 R4 300 R5 160
Scripted Medication 30 Days Up to R220 per script. Paid through Mediscor
electronic claim system. No over
counter medication.
R1 420 R1 870 R2 270
Pathology 30 Days Up to R510 per event. R2 720 R3 630 R4 650
Radiology 30 Days Up to R510 per event. R2 040 R3 630 R5 105
Dentistry 90 Days Up to R680 per visit. Max of 4 visits a year. R2 670 R3 400 R4 535
Specialist Cover 90 Days Up to R1 700 per visit. 3 visits per family per year.
Referral from GP required and subject to authorisation.
Maternity Pre Birth 7 Months applicable to new policies.

Thereafter waiting period of 4 months from date of conception.

Up to R455 per visit. 4 Visits per Pregnancy.
Annual limit of R 1815.
Optometry 12 Months Up to R1 130 - Limited to claim this every
24 months per dependant.
Maximum overall limits for Health Cover of: Single: R16 470 2 or 3: R22 910 4 plus: R27 490
Hospital Risk Cover Waiting Periods Cover Limits Excess
Emergency Illness 90 Days Up to R4500 for life threatening emergency illness
in casualty units.
Excess:4 months plus - R200
Emergency Accident Immediate Up to R4500 for accident events in casualty units
that does not result in admission.
Excess:0-3 Months - 15 % | 4 months plus -R200
Accident Cover Immediate Up to R250 000 per insured event. Up to R500 000 per family
per event.
Excess: R500 | Contact sport -15% of claim amount
(12 months waiting period)
Illness In Hospital 90 days
Certain conditions are excluded for 12 months.
Up to R57 000 per insured event p/p. Up to R114 000 per insured per year.
Excess:4-6 Months - 15% | 7 months onwards - 5%
Dread Disease 6 Months Up to R283 000 per defined disease per year.
Natural Birth and
Emergency Caesareans
12 Months Up to R57 000 per insured event p/p. Cover forms part
of illness and operations annual limits.
Excess: 10% of claim amount.
Accident Disability Immediate Up to R147 000 for the duration fo the policy.
only principal insured is covered.
Family Death Cover Accidental Death:
Natural Death:
90 Days
Principal Insured: R11 340 | Spouse/Partner:R11 340 | Children 14-21 yrs:R11 340
Children 6-13 yrs R5 670 | Children 1-5 yrs R2 835
Children unborn(28 weeks) ro Oyrs: R1 420
Trauma,Assault and
Accidental HIV
Immediate Trauma and assault counselling, Accidental HIV protection services.
Accidental HIV infection treatment.
Repatriation Immediate Up to R11 300 per insured person. Repatriation of mortal remains to funeral home.
Ambulance and
Emergency Services
Immediate 24 hr Medical assistance with an emergency dedicated line.
In the event of a justifiable,life-threatening medical emergency,
the insured will be transported by ambulance to the nearest
appropriate medical facility.