Medical Insurance South Africa

Medical Insurance Benefits

Day to Day Expenses:

Primary Care provided through a network of approved doctors.

• GP visits which can be unlimited or set number of consults with a network doctor dependent on the plan chosen. Medication includes acute medication and basic medication for a list of defined chronic conditions.
• Basic Dentistry and Optometry which covers fillings, extractions, basic eye tests and glasses. Authorisation is often required and benefits are plan dependent.
• Radiology and Pathology subject to referral by GP and authorisation by the provider. A list of defined benefits applies.

Accidents and Emergencies:

This benefit must form part of the plan choice. Covers accidents and life-threatening emergencies.

• Medical Insurance covers life-threatening emergencies and accidents. It does NOT cover planned surgeries in-hospitals or a day clinic.
• Hospitalisation is for a sudden and external event (car crash or serious fall). The insurance covers the private hospital admission. Rand limits apply dependent on the plan chosen.
• Hospitalisation for a sudden life-threatening illness (heart attack or stroke). The insurance covers the private hospital admission. Rand limits apply dependent on the plan chosen. It is important to check what constitutes an accident or emergency on the plan type chosen, and to know the financial limits of the plan chosen for hospitalisation for an accident and emergency.
• Ambulance Services: 24/7 emergency transport (like through providers such as ER24 or Netcare) is almost always included.
• Casualty Benefit: Covers “out-patient” emergency room visits for minor accidents (like a dog bite or deep cut) that do not require full hospital admission. This benefit is plan type dependent and condition specific.