| Benefit | Golden Hour Plan | Hospital Plan | Primary Standard Plan | Primary Standard and Hospital Plan | Comprehensive Plus Plan | Comprehensive Advanced Plan |
|---|---|---|---|---|---|---|
| Main member 0–59 | R255p/m | R310p/m | R560p/m | R800p/m | R1 205p/m | R1 375p/m |
| Adult dependant 0–59 | R160p/m | R220p/m | R490p/m | R680p/m | R930p/m | R1 090p/m |
| Child dependant 0–59 | R140p/m | R160p/m | R215p/m | R275p/m | R395p/m | R485p/m |
| Hospital footprint | Access to all private hospitals accepting health insurance products. Pre-authorisation required. | Access to all private hospitals accepting health insurance products. Pre-authorisation required. | No benefit | Access to all private hospitals accepting health insurance products. Pre-authorisation required. | Access to all private hospitals accepting health insurance products. Pre-authorisation required. | Access to all private hospitals accepting health insurance products. Pre-authorisation required. |
| In-hospital maternity | No benefit | No benefit | No benefit | No benefit | R30 000 per pregnancy for the birth. Limited to 1 event per policy every 12 months. Includes out-of-hospital scans. | R35 000 per pregnancy for the birth. Limited to 1 event per policy every 12 months. Includes out-of-hospital scans. |
| In-hospital accident | R400 000 per member per event. Max R1 500 000 per policy per annum. | R475 000 per member per event. Max R1 500 000 per policy per annum. | No benefit | R475 000 per member per event. Max R1 500 000 per policy per annum. | R350 000 per member per event. Max R1 500 000 per policy per annum. | R425 000 per member per event. Max R1 500 000 per policy per annum. |
| In-hospital illness | No benefit | R70 000 per member per event. Gradual progression excluded. Limited to R500 000 per policy per annum. | No benefit | R70 000 per member per event. Gradual progression excluded. Limited to R500 000 per policy per annum. | R95 000 per member per event. Overall R1 000 000. Cataract surgery R30 000. | R120 000 per member per event. Overall R1 000 000. Cataract surgery R30 000. |
| ICU / shortfall / specialised radiology | Included in hospital benefits | Included in hospital benefits | No benefit | Included in hospital benefits | Included in hospital benefits | Included in hospital benefits |
| Post-hospital accident rehabilitation | R10 000 per member per event | R10 000 per member per event | No benefit | R10 000 per member per event | R10 000 per member per event | R10 000 per member per event |
| Casualty (accident) | R30 000 per policy per annum | R30 000 per policy per annum | R5 000 per policy per annum | R30 000 per policy per annum | R10 000 per policy per annum | R10 000 per policy per annum |
| Casualty (illness) | R15 000 for emergency stabilisation | No benefit | R5 000 after-hours only | R5 000 after-hours only | R5 000 after-hours only | R7 000 after-hours only |
| GP consultations | 2 GP consultations at a contracted network doctor | No benefit | Managed unlimited network GP visits. Pre-auth from 5th visit | Managed unlimited network GP visits. Pre-auth from 5th visit | Managed unlimited network GP visits. Pre-auth from 5th visit | Managed unlimited network GP visits. Pre-auth from 5th visit |
| Out-of-network GP | No benefit | No benefit | 2 consultations per policy per annum at R500 per visit | 2 consultations per policy per annum at R500 per visit | 2 consultations per policy per annum at R500 per visit | 2 consultations per policy per annum at R500 per visit |
| Pharmacy clinic nurse care | 3 visits per member per annum | No benefit | Unlimited visits at contracted pharmacy clinics | Unlimited visits at contracted pharmacy clinics | Unlimited visits at contracted pharmacy clinics | Unlimited visits at contracted pharmacy clinics |
| Specialist benefit | No benefit | No benefit | R2 600 per member per annum. Pay and claim | R2 600 per member per annum. Pay and claim | R2 600 per member per annum. Pay and claim | R2 600 per member per annum. Pay and claim |
| Acute medication | R1 500 per member per annum. Max R190 per script (combined with OTC) | No benefit | Unlimited, subject to formulary | Unlimited, subject to formulary | Unlimited, subject to formulary | Unlimited, subject to formulary |
| OTC medication | Combined with acute medicine limit | No benefit | R250 per month, max R850 per annum | R250 per month, max R850 per annum | R250 per month, max R850 per annum | R250 per month, max R850 per annum |
| Chronic medication | No benefit | No benefit | Unlimited on CDL, ChroniLine approval | Unlimited on CDL, ChroniLine approval | Unlimited on CDL, ChroniLine approval | Unlimited on CDL, ChroniLine approval |
| Radiology / pathology / dentistry / optometry | No benefit | No benefit | Unlimited protocol radiology & pathology. Basic dentistry. Specsavers R1 550 / 24 months | Unlimited protocol radiology & pathology. Basic dentistry. Specsavers R1 550 / 24 months | Unlimited protocol radiology & pathology. Basic dentistry. Specsavers R1 550 / 24 months | Unlimited protocol radiology & pathology. Basic dentistry. Specsavers R1 550 / 24 months |
| 24-hour emergency medical services | Unlimited 24/7. Pre-authorisation required | Unlimited 24/7. Pre-authorisation required | No benefit | Unlimited 24/7. Pre-authorisation required | Unlimited 24/7. Pre-authorisation required | Unlimited 24/7. Pre-authorisation required |
| Accidental death benefit | R15 000 principal / R10 000 adult / R8 000 child | R15 000 principal / R10 000 adult / R8 000 child | R15 000 principal / R10 000 adult / R8 000 child | R15 000 principal / R10 000 adult / R8 000 child | R15 000 principal / R10 000 adult / R8 000 child | R15 000 principal / R10 000 adult / R8 000 child |
This is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership. Premiums include a R50.00 Intermediary fee levied by R&P Wealth Management Services. Our premiums may be reviewed on an annual basis.