Our In-patient health care benefits cover admission to any private hospital within our network of healthcare providers at cost. We pay for the hospital bill and any associated costs from these benefits.
Our health plans provide the following benefits subject to pre-authorisation:
Hospital treatment and services
We cover in-patient General Practitioner (GP) consultations and specialist consultations (including psychiatric consultations) and all the medical treatment and services you need when you are admitted to hospital.
In-country ambulance service
We cover in-country ambulance transport from the scene of the emergency to the nearest available medical facility.
In-hospital maternity cover
We cover confinement, childbirth, midwives and non-elective caesarean sections by a registered physician.
We cover the costs related to elective circumcision.
Costs related to the circumcision of a newborn will be covered from the major medical benefits as part of the maternity package authorised and performed immediately after the birth before the discharge of the mother.
We cover neonatal care required for a new-born baby.
Prosthesis and devices
We provide benefits for artificial limbs and internal (surgically implanted) devices and prostheses.
We provide benefits for specialised radiology required in or out of hospital, such as CT and MRI scans.
External medical appliances
We cover wheelchairs, glucometers, hearing aids, low-vision appliances and large orthopaedic orthotics (for example, a back brace).
We cover the costs of psychiatric treatment received as an inpatient in a psychiatric unit of a hospital. All treatment must be administered under the supervision of a registered psychiatrist.
Major Disease Benefits
We provide benefits for the treatment (in and out of hospital) for oncology (cancer), organ transplants and renal (kidney) dialysis up to the major disease benefit limit, and subject to clinical and treatment protocols.
Out-patient health care benefits
Our out-patient health benefits cover day-to-day medical treatment that does not require hospitalisation. We provide benefits for the following treatment and services:
GP and specialist consultations benefit
We cover General Practitioner (GP) consultations and specialist consultations.
We cover pathology or blood tests requested by a doctor, radiology or basic x-rays, and non-surgical procedures such as stitches or applying plaster of Paris to broken bones.
Acute medicines benefit
We provide benefits for medicines needed to treat acute conditions such as colds and flu that are prescribed by a registered doctor.
Acute conditions usually appear suddenly, progress rapidly and do not last long.
Additional maternity benefit
We provide additional day-to-day benefits for the cost of out-of-hospital maternity care including consultations, radiology and blood tests.
We pay for chronic medicines from the Chronic medicine benefit once you register with our Chronic Disease Programme.
Chronic medicines are used to treat a chronic condition such as diabetes or high blood pressure for more than three (3) continuous months. We cover medicines for the treatment of chronic conditions on our Chronic Disease List according to our evidence-based clinical funding protocols.
We include one eye examination per member per year, and frames and lenses (including contact lenses) every two years.
International Emergency Evacuations
We provide benefits for transportation in the case of an emergency medical condition.
We pay for the transportation costs from the country where the emergency medical condition occurs to the nearest, appropriate medical facility within the member’s area of cover (based on their chosen health plan).
The nearest medical facility may be within the country where the emergency medical condition occurs.
International emergency medical evacuation (ambulance and air travel)**
We pay your transport costs for evacuation from the country where the emergency medical condition occurs to the nearest available medical facility on the African continent.
This benefit is available on the Essence, Core Care, Traditional, Classic and Plus plans.
Compassionate travel and accommodation costs
We will fund 3 nights’ accommodation for an accompanying adult if required.
Transfer to country of residence
We provide benefits to transport you to your country of residence on the African continent, following an international emergency medical evacuation, provided that we pre-authorise these costs before you travel.
Return of remains of the deceased
We cover the preparation and transport of your remains from the place of death to your home country, should you or your beneficiaries die during an international emergency medical evacuation.
This applies provided that your home country is in your area of cover.
Requires pre-authorisation and approval by our Medical Adviser.
The medical condition must be a serious or life-threatening emergency medical condition that requires immediate evacuation.
The purpose of evacuation will be to avoid death or serious impairment of the insured person’s immediate or long-term health.