Primary Standard Plan

Monthly Premiums

Rates below are for Individuals, per member per month. If you are a member as part of a Group/ Company, your rate may be different.

Individual

R399 PM

Adult Dependent

R380 PM

Child Dependent

R140 PM

Primary Care Benefits

CASUALTY BENEFIT (accidents)

R2,000 per policy per annum combined with any casualty admissions for illness. Subject to pre-authorization.

NURSE BASED CARE

Care from qualified nurses at over 700 pharmacies. Nurses will give you a medical referral if necessary.
Unlimited visits. subject to pre-authorization after 10th visit.

CASUALTY BENEFIT (illness)

R2,000 per policy per annum combined with any casualty admissions for Accidents.

GP CONSULTATIONS

Managed unlimited GP visits at a contracted Network providers only. Members do not have to pay cash or co-payments.

OUT-OF-NETWORK CONSULTATIONS

2 Consultations per person per annum refunded at R400.

SPECIALIST CONSULTATIONS

R2 000 per member per annum. Specialist benefits are available on a pay and claim basis. The member must be referred by a network GP.

ACUTE MEDICATION

Unlimited medicine prescribed for a temporary illness. Medicine must be obtained at a pharmacy and is subject to the Wesmart Formulary.

OVER-THE-COUNTER MEDICATION

R200 per policy per month as per Wesmart formulary. Limited to R800 per policy per annum.

CHRONIC MEDICATION

Unlimited medication prescribed by a network GP for a condition on our Chronic Disease List (CDL). Pre-authorization by ChroniLine. Subject to the Wesmart Formulary.

RADIOLOGY

Limited to 1 and 2 sided black and white x-rays. Member must be referred by a network GP provider. No cover for specialized radiology, such as MRI Scans, CT Scans or ultra-sounds (except in case of pregnancy). Services are directly linked and limited to the Wesmart formulary.

PATHOLOGY

Unlimited blood tests at any pathologist. Member must be referred by a network GP. Subject to the Wesmart Formulary.

DENTISTRY

Unlimited cover for basic dentistry per Wesmart protocols, No upfront payment or co-payments at a Network Dentist.

OPTOMETRY

1 consultation, 1 set of frames with single vision lenses per member every 24 month.
Available at Specsavers outlets only(if there in no Specsaver branch within 30km's, call us for authorization to go to another optician).

IN-ROOM PROCEDURES

Certain in-room procedures are covered. Examples include nebulisation, wound stitching including normal aftercare, drainage of abscesses, limb cast.

Value Added Benefits

PERSONAL HEALTH ADVISOR

Telephonic consultations with clinically trained Personal Health Advisors available 24/7. You can call them for trauma counselling, general medical advise, COVID advice or any ailments or concerns you may have about your health.

24 HOUR EMERGENCY MEDICAL SERVICES

24-Hour cover for private ambuances and emergency medical evacuation in the event of emergencies. Pre-authorization required (not available on the Primary Standard Option).

ACCIDENTAL DEATH BENEFIT

A lump sum payout in the event an unintentional death a member.

NURSE BASED PHARMACY CLINIC

PHARMACY CLINIC NURSE CARE

Care from qualified nurses at 700 pharmacy Wellness Clinics. Visit them in store at your convenience or book an appointment for a consultation. Nurses will give you a medical referral if necessary. Available at all contracted Mediscor Pharmacies, including Dischem, Clicks, Medrite etc. Pre-authorization is required is required after the 10th visit.

WOMENS HEALTH

Caring advice women can rely on, offering all types of female health assessments such as pregnancy testing, breast screening, pap smear testing and other female screenings.

GENERAL MEMBER WELLNESS

Glucose and Cholesterol screening/testing/ monitoring.
Treatment of wounds.
Administration of injections, including annual flu injection.
Hb, Malaria and Urine Screening.
Syringing of ears.
Advise on how to best manage your status and health.

ASSISTANCE MANAGING CHRONIC CONDITION

Nurses will help you manage your chronic condition and assist you with monitoring and advise, including but not limited to:
Diabetes Hba1C and foot screening.
Blood pressure and lipogram testing, BMI monitoring.
Peak flow and nebulization. Control asthma by getting rescue medication directly into the lungs.
HIV screening, testing and counselling: Learn you HIV status and get psychological help after testing positive. A counselling session is offered pre-testing as well.

WAITING PERIODS

WAITING PERIOD

Waiting periods are applicable on all newly incepted policies and/or additional dependents added to the current policy, except in the event of an accident. Additional dependents added after the policy inception will be subject to individual underwriting and waiting periods, unless it is a new-born whose details are provided to the insurer within 90(ninety) days of birth. If the Policyholder has held a policy for 12 (twelve) months without a break in cover and wants to upgrade to a higher option, all additional benefits will be subject to a 3 (three) month waiting period. If the Policyholder has held a policy for less than 12 (twelve) months and intends to upgrade to a higher option, the balance of the relevant waiting periods on the higher option per benefit category are applicable in addition to the 3 (three) month waiting period on the upgraded benefits.

GENERAL WAITING PERIODS

1 (one) Month General Waiting Period will be applied on all out-of-hospital benefits unless otherwise stated.
6 (six) Months General Waiting Period will be applied on dental and optical benefits.
3 (three) Months General Waiting Period will be applied on any in-hospital illness related benefits unless otherwise stated.
6 (six) Months General Waiting Period will be applied on Chronic Medication.

PRE-EXISTING CONDITIONS WAITING PERIODS

12 (twelve) Months waiting period will be applied on all in-and out-of-hospital related pre-existing conditions, diseases, or illnesses. These include any conditions, including cancer, 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 conditions could render the policy being cancelled.

POLICY SPECIFIC WAITING PERIODS

The following conditions are excluded within the first 6 (six) months of the policy covers inception:
Myringotomy and grommets;
Adenoidectomy;
Tonsillectomy;
Hysterectomy (except where malignancy can be proven);
Spinal, back, neck and joint related procedures or treatment except in the case of an accident.

SPECIFIC WAITING PERIODS APPLICABLE TO CERTAIN BENEFITS CATEGORIES

12 (twelve) Months waiting period for pregnancy and confinement.
12 (twelve) Months waiting period on all pre-existing cancer-related treatments.
6 (six) Months waiting period is applicable on the Accidental Death Benefit.

DISCLOSURE

This Plan is administered by WESMART Financial and Administration Solutions (Pty) Ltd (WESMART), an authorised Financial Services Provider (FSP 45769). Underwritten by GENRIC Insurance Company Limited (FSP 43638). GENRIC is an authorised Financial Services Provider and licensed non-life Insurer.

DISCLAIMER

The above is subject to the terms, conditions, benefits and exclusions included in the policy wording.

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