Underwritten by GENRIC FSP 43638
Email Address
info@membersplan.co.za
Phone Number
010 035 0410
Our Location
Unit 12, 1st floor, 1 Melrose Boulevard, Melrose Arch, Johannesburg, 2191
Frequently Asked Questions
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FAQ
General Question
Members Benefit Plan is an exempt medical insurance, fully compliant with the Demarcation Regulations. Governed by the short-term and long-term insurance as well as reporting to the council of medical schemes.
Please find the link to our formulary here: https://secure.mediscor.co.za/adocs/schemeformularies/wesmart_formulary_lookup.html
Follow this link to find out which medication is covered.
1 month general waiting period will be applied on all out-of-hospital benefits unless otherwise stated.
3 months general waiting period will be applied on any in-hospital illness related benefits unless otherwise stated.
6 months general waiting period will be applied on dental benefits.
10 months waiting period will be applied on all pregnancy and confinement treatment.
12 months waiting period will be applied on all pre-existing conditions, diseases, or illnesses. These include any conditions which existed prior to inception, or for which an insured person has sought or received medical advice or received treatment by a Registered Medical Professional or exhibited symptoms before inception of the policy. Failure to disclose any pre-existing condition could render the policy being cancelled.
The prescribing doctor must contact our Chronic Medication department 0860 119 553 to register you.
You must fully complete and sign the claim form.
• Provide clear copies of all account statements.
• Hospital account, etc.
• All documents must be submitted within 90 days
If you do not find a service provider in your area, please send an email to networks@pamc.co.za nominating your current service provider by providing us with:
1. Your name and contact details.
2. Recommended Service provider Name and Contact details
If you have visited your Wesmart Network GP and they believe that you require the treatment of a specialist, he/she must write a referral letter, you will then have to contact the Wesmart call centre at 010 599 1170 to obtain an authorization.
Yes, you can contact ER24, the designated provider on 010 599 1172 or Wesmart call centre on 010 599 1170 in the event of an emergency or serious accident. Once you have been transported to the closest appropriate facility, the hospital should contact Wesmart.
Yes, you can use your Wesmart card to purchase over the counter medication stated by the Wesmart formulary and protocol’s and prescribed by your GP in the network provider.
All South African citizens can apply for Members Benefit Plan health insurance.
Application forms are available and ready to be competed online. You can also contact the call Centre on 0105991170 , should you require assistance with competing the form.
