Medical Insurance
Like most medical cover in South Africa, Medical Insurance has day-to-day cover limits. Get Medical Insurance discusses the day-to-day cover limits of Medical Insurance.
The day-to-day benefits of Medical Insurance give you access to private healthcare. Our Medical Insurance policies give you access to private healthcare at an affordable price.
We pay for network doctor (GP) visits at 100% of the agreed rate during office hours. This includes minor medical procedures performed as part of the consult in the doctor’s rooms, subject to a list of approved procedures.
Our standard plan gives you 4 consultations per year. Our premium plan gives you unlimited consultations. Pre-authorisation is required from the 4th GP visit.
Network telephone or video call consultations are paid at 100% of the agreed rate. This includes the scripting of Acute and Chronic Medicine (when needed).
Our standard plan gives you 4 consultations per year. Our premium plan gives you unlimited consultations.
Our premium plan gives you one after hours visit to an out-of-network doctor, emergency medical facility doctor, or network doctor (GP) per insured party per year.
This benefit has an overall limit of two visits per family per year. Visits are paid at cost and limited to R1,100 per visit.
We cover nurse visits to a nurse in a network pharmacy clinic for the treatment
of minor Illnesses such as coughs and colds. You may use your Over-the-Counter (OTC) Medicine benefit for medicine prescribed by the nurse on the OTC Medicine Formulary. You’re covered for the following on our standard and premium plan:
Our standard and premium plan covers two health screening assessments at a Network Pharmacy Clinic, including:
We cover COVID-19 pathology tests up to a limit of R850 per insured party, per year, if the test result is positive. You will need to pay upfront for tests.
Our premium plan gives you cover for specialist visits. Specialist visits are covered at cost and limited to R2,000 per visit. Cover is limited to R2,000 per insured party, per year or R4,000 per family, per year. This includes the consultation and any related accounts such as X-rays, blood tests and medicine.
This benefit provides access to Acute Medication covered at 100% of the agreed rate. This applies provided:
Our standard plan gives you cover for 8 scripts per year, while our premium plan gives you unlimited scripts.
You can get your Over-the-Counter (OTC) Medication from a network pharmacy covered at 100% of the agreed rate. Ask your pharmacist for advice on OTC Medication.
Our standard plan has a limit of R105 per quarter with a maximum of R420 per insured
party, per year. Our premium plan has a limit of R110 per quarter with a maximum of R440 per insured party, per year.
One flu vaccination for qualifying insured parties per annum.
Chronic Medication is covered if:
After approval of the Chronic Medication, you can obtain your Chronic Medication at a network provider, contracted pharmacy or contracted courier pharmacy who will deliver your Chronic Medication to the address you selected at no additional cost.
Our standard plan covers 7 conditions, while our premium plan covers 27 conditions.
Cover for your HIV programme, including cover for:
Both of our plans give you cover for one consultation with a network dentist for a full mouth examination. One preventative treatment that includes cleaning, scaling and polishing. Fluoride Treatment is also covered for children under the age of 12 years.
We also cover:
Our premium plan gives you additional cover for:
Cover for plastic or acrylic dentures for insured parties over the age of 21 years. You will need to pay an upfront payment (Co-Payment) of 20% of the total account to the dentist and the laboratory.
After hours treatment is limited to one visit per family, per year, for pain and sepsis only. You may visit any dentist. You may have to pay the cost upfront to the provider and submit your claim to us for a refund.
One eye test per insured party per annum at a network optometrist. No pre-authorisation is required.
We cover one pair of glasses (one standard frame and one pair of single or bifocal lenses) every 24-months. Pre-authorisation is needed.
Glasses will only be granted if the following qualifying norms are met:
Cover for black and white X-rays and soft tissue ultrasounds. This cover only applies when referred to a network radiologist by a network doctor.
Our standard plan gives you cover for 8 visits. Pre-authorisation is needed from the 3rd visit. Our premium plan gives you cover for unlimited visits. Pre-authorisation is needed from the 4th visit.
Blood tests are covered at any network pathology lab when requested by a network doctor. According to a list of approved pathology codes. The tests must be requested by a network GP by completing a pathology referral form and the tests must be done by a network pathology laboratory - Ampath, Lancet, Pathcare or Lab24.
Our standard plan gives you cover for 8 visits. Pre-authorisation is needed from the 3rd visit. Our premium plan gives you cover for unlimited visits. Pre-authorisation is needed from the 4th visit.
You’re covered for two 2D sonar scans per pregnancy. The scans must be done at:
The day-to-day benefits of our Medical Insurance give you access to private healthcare. Contact Get Medical Insurance for a free Medical Insurance quote.