Description
Summary of Benefits of Hospital Plan (Illness and Operations)
| Name of Product/benefit | Specific limits | Benefits payable in the following events |
| Illness and operations upon hospitalization
(Up to R100 000 per single person & R200 000 per family per annum and R50 000 per single per event and R100 000 per family per event.) |
· Treatment by doctors limited to R5 000 per event.
· Anesthetist limited to R2500 per event. · Radiology limited to R5000 per event. · In- Hospital Laboratory limited to R2000 per event. · Gall blader Removal R45 000 per member per annum after 6 months waiting period. · Kidney stones R60 000 per member per annum after 6 months waiting period. · Any other surgical procedures where admission to a hospital or day clinic is less than 24 consecutive hours and which procedures are not specified elsewhere and which is not related to an accident will be limited to R50 000 per event. Limited to R100 000 per annum per member.
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This benefit is payable in cash. The illness benefit is payable in the event of hospitalization related to the illness or operation of the insured member, subject to pre-authorisation. The illness benefits will not be paid in addition to any of the other benefits for the same event except for the dread disease benefit. General 3 months waiting period, subject to pre-authorisation. Specific illness 6 months. |
| Maternity Benefit
(Up to R30 000 per policy per annum.) |
· Miscarriage: R25 000 per spouse per annum after 9 months waiting period.
· Ectopic pregnancy: R40 000 per spouse per annum after 9 months waiting period. |
This benefit is payable in cash. The maternity benefit is the maximum stated amount cover for the actual childbirth, which includes any admission into hospital for pregnancy related complications.
The benefit only be available to the principal insure or spouse and not to any of the children who are added as dependents on the policy. This benefit will not paid with illness benefit. 9 months waiting period, subject to pre-authorisation. |
| Emergency/ Trauma room benefit
(Up to R35 000 per single insured member per life threatening event, illness or accidental event |
This benefit is payable in cash. Payable per life threatening event, illness event or an accident event. In the event of accident, the R15 000 will be available for doctor’s consultation, x-rays and treatment in the Emergency room. Should the cause for this benefit be illness, pre-authorisation and assessment by a medical team is required. (Africa-Assist). Once authorization is granted, R15 000 will be available for life-threatening events such as a heart attack or stroke. Where the medical team advises the member to consult a doctor after hours in the Emergency room, R2000 will be available. No waiting periods. Provided that the first premium has been received. | |
| EMS, Ambulance Services and Para-Medics
(Up to R35 000 per single insured member per emergency event to and between medical facilities). |
This benefit is payable in cash. This emergency medical services benefit is for transportation to and between medical institutes. No waiting periods. Provided that the first premium has been received 12 months if the life-threatening event relates to pre-existing condition. | |
| Dread Disease Benefit
(R5000 per day for a maximum of 10 days per event. Limited to R50 000 per annum. |
The dread disease is payable in the event of admission, treatment or hospitalization of the insured member, which relates to a dread disease as defined in this agreement, subject to pre-authorisation. Compensation under Dread Disease shall be in addition to the illness and Operations Benefit covered under this policy. Dread Disease as defined in part 3.1 of the Policy wording. This benefit is payable per day for the hospitalization due to a dread disease. Upon payment of the 100% of the compensation for any one claim under this benefit i.r.o any insured person, all cover provided shall be terminated and cannot be reinstated unless a period of 12 months has passed after the first claim. |
Hospital Recuperation Benefit.
| Name of Product/benefit | Specific limits | Benefits payable in the following events |
| Hospital Recuperation Benefit (non-medical expenses) | R5 000 | In the event the insured stays in hospital for a duration longer than 72 hours where after a lump sum will be paid out to the insured person. This benefit is to be used for non-medical expenses.
72 hours waiting period applies. Principal Insured. |
| Hospital Recuperation Benefit (non-medical expenses) | R10 000 | In the event the insured stays in hospital for a duration longer than 72 hours where after a lump sum will be paid out to the insured person. This benefit is to be used for non-medical expenses.
72 hours waiting period applies. Principal Insured. |
