COMBINED
From R495
/month
Primary Healthcare & Hospital Plans
An affordable combination of our primary care and hospital plans.
Not only do we cover you for the cost of an annual health assessment, you also have access to our telephonic advice and counselling services
PRIMARY (Day-to-Day) BENEFITS
GP Consultations
You can visit any network doctor for an unlimited number of times.
When you visit your network doctor or nurse for 10 or more times per year pre-authorisation will be required.
GP Procedures
Basic medical and surgical procedures can be performed in your network doctor’s rooms, such as a circumcision, stitching of a wound or applying a cast to a broken arm.
Nurse Consultations
Unlimited nurse consultations available at approved pharmacies (Clicks, Dischem & Pick n Pay) for minor ailments. In many practices nurses can provide scripts for minor ailments for up to schedule 2 medications. Pre-authorisation required for 10 or more GP or Nurse visits per person per year.
Specialist Consultations
Limited to R1,275 per visit with an overal limit of R2,650 per family per annum. Referral by network doctor and pre-authorisation required.
Acute Medication
DISPENSING GP – This means your GP dispenses medication and will provide you with the necessary medication.
NON-DISPENSING GP – Unlimited for medication prescribed during your Network GP visits. This means your GP does not provide you with medication but will provide you with a prescription to collect your medication at your nearest pharmacy. Medication is covered according to a set formulary. Approved pharmacies include Clicks, Dischem & Pick n Pay.
Chronic Medication
Chronic Medication Programme: 8 Listed “high impact” Conditions* HIV/AIDS included.
*Asthma, Chronic Obstructive Pulmonary Disorder; Diabetes Type 1&2; Epilepsy; HIV/AIDS; Hyperlipidaemia; Hypertension; Tuberculosis.
Chronic condition: A condition/disease that lasts for an extended period of time.
Chronic Medication Programme: Your Network GP will assist you to register on the Chronic Medication Programme with Mediscor. Your prescribed chronic medicines will be covered according to a set formulary. Find the chronic medica- tion formulary (list) on Mediscor’s website: www.mediscor.net. Approved pharmacies include Clicks, Dischem, Pick n Pay & Medipost.
Basic & Emergency Dentistry Treatment
Limited to R1,275 per person per incident. Treatment includes: full mouth assessment, intra oral radiographs, scale & polish, extractions, emergency root canal treatment, fillings, pain and sepsis treatment. Only available at network dentists. Specialised dentistry/treatment, such as bridgework or crowns; orthodontic treatment; and dentures are not covered.
Optometry
One eye test per person per year.
A standard frame to the value of R254 and one pair of clear standard spectacle lenses per person per 24 months. Available at PPN Network Optometrists.
Pathology
Basic list of blood tests at a Designated Service Provider.
Your Network GP must ask for these tests to be done. E.g. blood sugar or cholesterol tests.
Radiology
Black & white X-rays only at a Designated Service Provider. Your Network GP has to refer you to have X-rays done. Specialised radiology such as MRI/CT Scans is not covered.
Maternity
2 gynaecologists visits, 2 ultrasound scans per pregnancy. Pre-authorisation is required. Limited to R3,250 per family per year.
EMERGENCY AND ACCIDENT BENEFITS
In-Patient Hospital
No Overall Annual Limit.
In-Patient Hospital
In-Patient Hospital Stabilisation – Emergency Only The actual cost of hospitalisation as an in-patient, in the event of an emergency that necessitates the stabilisation of the patient before the patient is transferred to a public hospital. Surgical procedures are excluded.
What is an emergency?
An event or unexpected health condition, which if not treated immediately would result in death or serious bodily impairment. E.g. Heart attack/stroke.
Limited to R25,000 per person per incident.
Pre-authorisation required.
In-Patient Hospital Treatment – Accident Only
The actual cost of hospitalisation as an in-patient, including all associated services during the hospital admission at any private facility in the event of injuries sustained due to an accident.
What is an accident?
An accident means bodily injury caused by violent accidental and external physical means. E.g. Severe injuries resulting from a vehicle accident or working with factory machinery.
Limited to R1,200,000 per person per incident Pre-authorisation required.
Out-Patient Casualty Treatment
Accident Only
The benefit payable for injuries sustained as a result of an accident shall be limited to treatment received in a hospital emergency unit. Limited to R6,500 per incident. Pre-authorisation required.
MRI and CT Scan
Accident Only
The actual cost of a MRI or CT scan necessitated as a result of an injury sustained due to an accident. Limited to R17,000 per person per annum. Pre-authorisation required.
Physiotherapy & Occupational Therapists
Physiotherapy & Occupational therapy following an in-patient hospitalisation due to an accident. Limited to a period of 3 months following the discharge from an in-patient hospitalisation incident and Limited to R3,250 per person per annum. Pre-authorisation required.
Accidental
Death
Limited to R15,000 per principal insured and first spouse dependant.
24-Hour Medical Emergency Services Benefit (ER24)
Emergency Evacuation, including:
- Ambulance services (air or road).
- Inter-hospital transfers.
- Repatriation of mortal remains.
- Telephonic Medical advice (Ask a Doctor or ask a Nurse).
- Push to call emergency dialing and find a provider application.
Hospital pre-authorisation & guarantee of payment to the treating facility in the event of an emergency/accident.
HEALTH SCREENINGS & ASSISTANCE PROGRAMME
Health Screenings
Limited to one screening per person per year. Available at Approved pharmacies (Clicks, Dischem & Pick n Pay).
Health screenings include health checks for:
- Blood pressure;
- Cholesterol;
- Glucose levels;
- Body Mass Index (BMI);
- Waist Circumference; and – HIV/AIDS, which includes counselling before and after testing.
Pap Smears
Available once every 3 years after the age of 21. Available at Approved pharmacies (Clicks, Dischem & Pick n Pay).
Your GP may or may not offer pap smears.
PSA Screening
Available once every 2 years after the age of 50. Available at Approved pharmacies (Clicks, Dischem & Pick n Pay).
Vaccination Programme
Influenza: Available annually – needs to be administered by 31 May each year.
Tetanus: Available once every 10 years.
Hepatitis A & B: Available once-off.
Pneumococcal: Available once every 5 years for those aged 60 or older and for those individuals with medically proven compromised immune system. Available at Approved pharmacies (Clicks, Dischem & Pick n Pay).
Our ASSISTANCE PROGRAMME (AP) is automatically included regardless of whether you belong to our PRIMARY (Day-to- Day) Benefit Option, EMERGENCY AND ACCIDENT Benefit Option or COMBINATION (Primary, Emergency and Accident) Benefit Option.
Assistance Programme (AP)
Unlimited telephonic or Skype counselling services are provided by registered counsellors who follow specific procedures and clinical protocols.
The service is available 24/7 and includes counselling for:
- Critical incidence/trauma counselling.
- HIV counselling.
- Legal Advice.
- Financial Advice.
- Face to face counselling can be arranged for your own account.
GET A QUOTE
Unity Health is a division of Ambledown Financial Services (PTY) Ltd, an authorised FSP 10287. In partnership with Optivest Health Services, an authorised FSP 13475. Unity Health Insurance is not a medical aid scheme but a short-term insurance product underwritten by Bryte Insurance Company Limited, a licensed insurer and an authorised FSP 17703.
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