PROFESSIONAL PLAN

From* R 735

PLEASE NOTE : Plan prices and benefits are effective from the 1st of March 2017

Professional Health Insurance Plan

Our plans and pricing comparison – click here for all the information

Health Cover Waiting Periods Cover Limits Single Dep(2-3) Dep(4+)
General Practitioner (Doctor) 30 Days Up to R 310 per visit R3 165 R3 710 R4 595
Scripted Medication 30 Days Up to R200 per script. Paid through Mediscor
electronic claim system. No over
counter medication.
R1 225 R1 835 R2 145
Pathology 30 Days Up to R425 per event. R1 715 R3 370 R4 290
Radiology 30 Days Up to R425 per event. R1 715 R3 370 R4 290
Dentistry 90 Days Up to R610 per visit. Max of 3 visits a year. R1 780 R3 245 R4 600
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 R490 per visit. 3 Visits per Pregnancy.
Annual limit of R 1470.
Optometry 12 Months Up to R1 220 - Limited to claim this every
24 months per dependant.
Maximum overall limits for Health Cover of: Single: R10 050 2 or 3: R15 630 4 plus: R19 350
Hospital Risk Cover Waiting Periods Cover Limits Excess
Emergency Illness 90 Days Up to R4800 for life threatening emergency illness
in casualty units.
Excess:4 months plus - R200
Emergency Accident Immediate Up to R4800 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 R165 000 per insured event. Up to R330 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 R48 600 per insured event p/p. Up to R98 000 per insured per year.
Excess:4-6 Months - 15% | 7 months onwards - 5%
Dread Disease 6 Months Up to R227 000 per defined disease per year.
Natural Birth and
Emergency Caesareans
12 Months Up to R48 600 per insured event p/p. Cover forms part
of illness and operations annual limits.
Excess: 10% of claim amount.
Accident Disability Immediate Up to R159 000 for the duration fo the policy.
only principal insured is covered.
Family Death Cover Accidental Death:
(Immediate)
Natural Death:
90 Days
Principal Insured: R12 250 | Spouse/Partner:R12 250 | Children 14-21 yrs:R12 250
Children 6-13 yrs R6 120 | Children 1-5 yrs R3 060
Children unborn(28 weeks) ro Oyrs: R1 530
Trauma,Assault and
Accidental HIV
Immediate Trauma and assault counselling, Accidental HIV protection services.
Accidental HIV infection treatment.
Repatriation Immediate Up to R12 200 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.