PROFESSIONAL PLAN

From* R 670

Professional Health Insurance Plan

Health Cover Waiting Periods Cover Limits Single Dep(2-3) Dep(4+)
General Practitioner (Doctor) 30 Days Up to R 285 per visit R2 005 R3 435 R4 225
Scripted Medication 30 Days Up to R185 per script. Paid through Mediscor
electronic claim system. No over
counter medication.
R1 135 R1 700 R1 985
Pathology 30 Days Up to R395 per event. R1 590 R3 120 R3 970
Radiology 30 Days Up to R395 per event. R1 590 R3 120 R3 970
Dentistry 90 Days Up to R565 per visit. Max of 3 visits a year. R1 645 R3 005 R4 255
Specialist Cover 90 Days Not covered on this plan.
Maternity Pre Birth 7 Months applicable to new policies.

Thereafter waiting period of 4 months from date of conception.

Up to R455 per visit. 3 Visits per Pregnancy.
Annual limit of R 1360.
Optometry 12 Months Up to R1 130 - Limited to claim this every
24 months per dependant.
Maximum overall limits for Health Cover of: Single: R9 310 2 or 3: R14 470 4 plus: R17 920
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 R153 000 per insured event. Up to R306 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 R45 000 per insured event p/p. Up to R91 000 per insured per year.
Excess:4-6 Months - 15% | 7 months onwards - 5%
Dread Disease 6 Months Up to R210 000 per defined disease per year.
Natural Birth and
Emergency Caesareans
12 Months Up to R45 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:
(Immediate)
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.