Principal
Age 0 – 59R1 375p/m
Age 60+R1 915p/m
Monthly premiums
The rates below are for individuals, per member per month. If you are a member as part of a group or company, your rate may be different.
Adult Dependent
Age 0 – 59R1 090p/m
Age 60+R1 520p/m
Child Dependent
Age 0 – 59R485p/m
Age 60+N/A
Retail rates 2026 include the R50 intermediary fee per policy per month. Premiums are subject to annual review.
Benefits
| Description | Benefit Detail |
|---|---|
| In-Hospital Accident Benefit | R425 000 per member per event, limited to R1 500 000 per policy per annum.Pre-authorisation required |
| ICU Benefit | Included in Hospital Illness Benefits. |
| In-Hospital Illness Benefit | R120 000 per member per event inclusive of all authorised associated costs. Cataract surgery limited to R30 000 per member per annum. Limited to R1 000 000 per policy per annum.Pre-authorisation required |
| Post-Hospital Accident Rehabilitation | R10 000 per member per event for physiotherapy, occupational therapy and home care/wound care.Pre-authorisation required |
| Maternity Benefit | R35 000 for the birth per pregnancy. Limited to 1 event per policy every 12 months. Includes out-of-hospital scans. |
| Casualty Benefit for Accidents | R10 000 per policy per annum. Accumulates to overall in-hospital accident cover.Pre-authorisation required |
| Casualty Benefit for Illness | R7 000 per policy per annum for after-hours treatment only. Accumulates to overall illness cover.Pre-authorisation required |
| General Practitioner Visits (GP/Doctor) | Unlimited GP visits at contracted network GPs. from the 5th consultation onward.Pre-authorisation required |
| Out-of-Network GP Visits | 2 visits per policy per annum refunded at R500 per consultation. |
| In-Room Procedures | Defined list of procedures a network GP can perform in their rooms at no additional charge. |
| Pharmacy Clinic Nurse Care | Unlimited visits per member at networked pharmacies with contracted clinics. |
| Specialist Benefit | Referral by network GP. Limited to R2 600 per member per annum. Pay and claim. |
| Acute Medication | Unlimited. Subject to formulary and generic reference pricing. |
| Over-the-Counter Medication (OTC) | R250 per policy per month, limited to R850 per policy per annum. Subject to formulary. |
| Chronic Medication | Unlimited as per Chronic Disease List. Subject to ChroniLine approval and formulary. |
| Radiology | Unlimited black and white X-rays only. Referred by a network GP. Pay and claim. |
| Pathology | Unlimited. Referred by a network GP. Subject to protocols. Pay and claim. |
| Dentistry | Basic dentistry only at contracted network dentists. Subject to defined protocols. |
| Optometry | 1 consultation and 1 set of frames with single vision lenses every 24 months from Specsavers, limited to R1 550. |
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.
Hospital footprint
Access to all private hospitals accepting health insurance products. Pre-authorisation is required for all hospital admissions on 086 000 2402.
Value added benefits
24 Hour Emergency Medical Services
24-hour cover for private ambulances and emergency medical evacuation. Pre-authorisation required.
Client Assistance Programme
- Personal Health Advisor available 24/7
- Credit and debit assist
- Legal assist from qualified attorneys
- Trauma counselling by qualified nurses
Accidental Death Benefit
A lump sum payout of R15 000 for the principal member, R10 000 for an adult dependant and R8 000 per child dependant.
Pharmacy clinic nurse care
Care from qualified nurses at over 700 pharmacy wellness clinics. Visit in store or book an appointment. Nurses will give you a medical referral if necessary. Available at contracted Mediscor pharmacies including Dis-Chem, Clicks and MediRite. Pre-authorisation may be required after the 10th visit.
General member wellness
- Glucose and cholesterol screening
- Treatment of wounds
- Administration of injections, including flu
- Hb, malaria and urine screening
- Syringing of ears
- Advice on managing your health
Women’s health
Pregnancy testing, breast screening, pap smear testing and other female health assessments.
Chronic condition support
- Diabetes HbA1c and foot screening
- Blood pressure, lipogram and BMI monitoring
- Peak flow and nebulisation for asthma
- HIV screening, testing and counselling