For employer groups, any employee may join if they are permanently employed.  If the member is an individual member that wants to join in a private capacity, they can do so. The member will need a valid ID or passport and proof of banking details.

The employer may deduct their share of the Unity Health premium payment and receive corporate tax relief of 28% (or at the applicable corporate tax rate).

1. Contact the Unity Health call centre on 0861 366 006 for a list of providers close to where you live or work.
2. Make an appointment with the provider and ensure you present your Unity Health membership card and ID when you arrive for the consultation.
3. You may also search for a provider using the Unity Health App or by logging into the member portal where you can search for a provider online.

The Unity Health call centre operates during the following hours:

Monday to Friday: 08:00 to 17:00 and Saturday: 08:00 to 13:00;

In the case of emergency after hours call, ER24 on 010 205 3044.

A dispensing provider will provide your medication during the consultation and you will not receive a script to go to the pharmacy.  A non-dispensing provider will give you a script during the consultation and you will need to go to a Mediscor pharmacy to collect your medication.  The script will be subjected to the Mediscor Formulary which your network provider will have.

Call the Unity Health call centre on 0861 366 006 and ask for a provider request form.  Fill out the form with your GP’s details and e-mail the form to Unity Health at networks@unityhealth.co.za. Unity Health will contact the GP and advise you whether the GP decided to join or not. You will also receive the provider request form in your welcome pack.

You have access to the Unity Health website portal. You have to register and log in to gain access, to be able to search for a provider close to you via the Unity Health unique GEO mapping tool. This function is also available on the Unity Health mobile application. You can download the app from your play store.

You can also contact Unity Health on 0861 366 006 or e-mail at networks@unityhealth.co.za. Unity Health will forward a list of providers closest to you.

A dispensing provider may issue a script of he/she recommends a medication which is not kept in their rooms.  These medications are usually a higher schedule medication and will not be covered by Unity Health.

As per legislation, a consultation is confidential and between a doctor and patient.  The doctor will use his/her discretion on which and how much medication to give and/or prescribe to the patient.

It is best to visit your doctor again if the same problem persists.

Pre-authorisation would need to be obtained from visit 10 onwards and all authorisations are subject to clinical review.

To ensure optimal patient management and care the Underwriting Manager may require pre-authorisation to access benefits in respect of any service provider at any time.

Please contact the Unity Health Call Centre on 0861 366 006 during office hours to request authorisation for your GP visit before the consultation.

You can consult with a nurse at approved pharmacy clinics. In many practices, nurses can provide scripts for minor ailments for up to schedule 2 medications.

No, but pre-authorisation would need to be obtained from visit 10 onwards for both the nurses’ as well as the GP consultations, and all authorisations are subject to clinical review. Please contact the Unity Health Call Centre on 0861 366 006 during office hours to request an authorisation.

Any Dischem, Pick n Pay or Clicks pharmacy are approved on the Unity Health Networks.

Unity Health has an open network of dentists which means you may consult with any dentist of your choice on this list. Once at the dentist, you must present your membership card and ID document. The provider is then required to contact the Unity Health call centre at 0861 366 006 for confirmation of benefits.

If you have visited your Unity Health Network GP and he/she believes that you require the treatment of a specialist, he/she must write a referral letter, you will then have to contact the Unity Health call centre at 0861 366 006 to obtain an authorisation.

Members are required to provide the Unity Health case manager with the following information when requesting an authorisation:

• Name and surname of the member requiring the authorisation
• Name and practice number of the Specialist your network GP has referred you to
• Membership number
• ICD10 code or diagnosis
• Name and practice number of the referring GP
• The specialist authorisation provided is valid for two (2) weeks allowing time for you to make an appointment and consult the specialist

You may only visit a specialist if the treatment failed that was provided by the GP and your GP is of the opinion that you require a specialist’s intervention.

Yes, please make sure that only the Unity Health pathology/radiology form for tests/referrals are completed and given to you before going for these tests.  All tests not listed on these forms are not covered by Unity Health and will be for the patient’s account. The correct forms are available on the web portal.

“Accident” means bodily injury caused by violent accidental and external physical means. Examples include motor vehicle accidents, severe burns, exposure to poisons.

1. Call Unity Health call centre on 0861 366 006 or ER24on 010 205 3044.
2. ER24 will verify the membership of the person in need of help, whether it be the main member or a dependant.
3. ER24 will assist the member with advice and emergency transportation to the nearest inpatient hospital facility.
4. ER24 will issue the hospital with a guarantee of payment and the member will be admitted for treatment.
5. Unity Health will then settle the account directly with the hospital, subject to the benefit limitations of your chosen plan.

1. Call the Unity Health call centre for a list of the nearest outpatient facilities that accept a guarantee of payment, as some outpatient facilities only accept cash.
2. The member must please ensure that they have their Unity Health membership card and ID for verification purposes.
3. ER24 will arrange the guarantee of payment with the outpatient facility.
4. Unity Health will then settle the account directly with the outpatient facility, subject to the benefit limitations of your chosen plan.

An emergency department, also known as an accident and emergency department, emergency room (ER) or casualty department, is a medical treatment facility specialising in emergency treatment of patients who arrive without a prior appointment; either by their own means or by that of an ambulance. The emergency department is usually found in a hospital or other primary care centres.  Due to the unplanned nature of patient attendance, the department must provide initial treatment for a wide range of illnesses and injuries, some of which may be life-threatening and require immediate medical attention.

A benefit equal to the cost of inpatient hospital treatment in a hospital emergency or casualty unit provided that such treatment is in the event of an emergency. Stabilisation for the medical condition, e.g. appendicitis in the emergency unit would be covered under the stabilisation benefit, but admission to hospital for surgery would not be covered. In terms of your policy, it is the immediate treatment administered to a person in an emergency, to stabilise the patient before they are transferred to a state facility for further management.

Yes, you can contact ER24, the designated provider on 010 205 3044 or Unity Health call centre on 0861 366 006 in the event of an emergency or serious accident. Once you have been transported to the closest appropriate facility, the hospital should contact Unity Health.

No, international cover is not provided.

You should contact the Unity Health call centre on 0861 366 006 and select the option for pre-authorisations. To access the benefit, you will require a pre-authorisation number from Unity Health.

Yes. Once the member has selected their network GP or gynaecologist the member or provider should contact Unity Health call centre and request to speak to the Unity Health Case Manager for pre-authorisation of their consultations and pregnancy ultrasounds.

This is a disease that lasts 3 months or more and generally cannot be prevented by vaccines or cured by medication, nor do they just disappear. A chronic disease can be treated by medication that will be required to be taken for a lifetime.

For example: Asthma; Chronic Obstructive Pulmonary Disorder; Diabetes Type 1&2; Epilepsy; HIV/AIDS; Hyperlipidaemia; Hypertension; Tuberculosis

Refers to the list of services, conditions or events as per below, which are always excluded from cover.

1. Nuclear weapons or nuclear material or by ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the purpose of this exception combustion shall include any self-sustaining process of nuclear fission;
2. Investigations, treatment or surgery for obesity or its sequel or cosmetic surgery or surgery directly or indirectly caused by or related to or in consequence of cosmetic surgery other than as a result of an Insured Incident;
3. Suicide, attempted suicide or self-inflicted injuries unless such injuries are sustained to preserve another human life;
4. Routine physical or any other procedure of a purely diagnostic nature or any other examination where there are no objective indications of impairment in normal health and laboratory diagnostic or x-ray examinations except in the course of a medical condition or disability established by prior call or attendance of a Medical Practitioner;
5. All costs which are in the opinion of the Underwriting Manager’s clinical review team:
   1. Not medically necessary or clinically appropriate or do not meet the healthcare needs of the Insured Person;
   2. Not consistent in type, frequency and duration of treatment;
6. Procedures performed in doctors’ rooms that are not listed in the list of tariff code descriptions;
7. Any accident where the initial accident event occurred prior to the Insured Person’s commencement date with this policy;
8. The taking of any drug or narcotic unless prescribed by and taken in accordance with the instructions of a registered Medical Practitioner (other than the Insured Person) or any illness caused using alcohol;
9. Any medical transportation service for non-emergency purposes;
10. Drug addiction;
11. The supply of medication that is not listed on the Underwriting Manager’s formulary list;
12. An event directly attributable to the Insured Person having an alcohol content exceeding zero point zero five (0.05) grams per one hundred (100) millilitres of blood or the Insured Person suffering from alcoholism;
13. Artificial insemination, infertility treatment or contraceptive;
14. Robotic surgery, specialised mechanical or computerised appliances equipment or all related Service Providers;
15. Contact lenses;
16. Participation in:
    1. Active military duty, police duty or police reservist duty;
    2. Aviation other than as a passenger;
    3. Any Competitive or Professional Sport or Activity;
    4. Any form of race or speed test (other than on foot or involving any non-mechanically propelled vehicle vessel craft or aircraft);
17. External prosthesis or appliances such as artificial limbs;
18. Any activity prohibited by law;
19. Any benefit requiring pre-authorisation where no authorisation was requested or approved.

31 days’ written notice must be provided to Unity Health via e-mail to membership@unityhealth.co.za or faxed to 011-706-5568.

Yes, you must complete the accidental death beneficiary form and send it to membership@unityhealth.co.za or fax it to 011 706 5568. This form is also now included with your application form.

Your beneficiary nomination form has been sent to you in the welcome pack.  You can also register and log into the Unity Health web portal where you will have access to all the forms.  Alternatively, call Unity Health’s call centre on 0861 366 006 and one of our friendly call centre agents will forward the form to you.

Please inform your broker of any contact or address changes. You can also contact Unity Health’s call centre on 0861 366 006, e-mail membership@unityhealth.co.za or update this information on your Unity Health App. It is very important to keep your details up to date so we can effectively communicate with you and to ensure in the case of an emergency that you are assisted as fast as possible.

It is medicine prescribed by a medical practitioner for an uninterrupted period longer than three (3) months. This medicine is used for a medical condition which forms part of an approved list of chronic conditions.

For example: Asthma; Chronic Obstructive Pulmonary Disorder; Diabetes Type 1&2; Epilepsy; HIV/AIDS; Hyperlipidaemia; Hypertension; Tuberculosis

A formulary is an approved list of medication that has been approved by Unity Health.  The member can normally find both generic and brand name drugs in formularies.  Formulary prescription medication is chosen for its cost, effectiveness and safety.  Non-formulary drugs will be for the member’s own cost.

No, you can only get medication from a pharmacy with a script from a non-dispensing Unity Health network GP. You may consult with a nurse at an approved pharmacy and he/she can supply a script for minor ailments.

Yes, some pharmacies do offer delivery services. You can arrange with your selected pharmacy.

1. You must consult with your Network GP who will prescribe your chronic medication accordingly (existing or new chronic conditions).
2. The Network GP will assist you by one of the following methods:
3. The Network GP can contact Chroniline on 0860 119 553 to obtain telephonic authorisation on behalf of the patient.
4. The Network GP can fax a copy of the prescription to 0866 151 509 with the member’s details reflecting on the script.
5. The Network GP can e-mail a copy of the prescription to preauth@mediscor.co.za

Once your chronic medication has been approved, you may collect it from any Mediscor pharmacy which includes Clicks, Dischem and Pick n Pay.

Once you are registered to get chronic medication you have an option for your medications to be delivered by our courier pharmacy (MediLogistics) Your medications can be delivered to

• To your network GP
• To your home physical address
• To your work physical address

Deliveries are usually free of charge.

Benefit coverage will be suspended, and any claims submitted during the time of suspension will only be paid once premium payments are up to date.  If premiums are not paid for 2 consecutive months and there are no attempts to pay arrear premiums, the policy will be cancelled.

Please contact your broker or contact Unity Health’s call centre on 0861 366 006 or e-mail membership@unityhealth.co.za

In most cases, you simply present your Unity Health membership card and ID to the provider and the provider will submit the claim directly to Unity Health for processing and payment.  In isolated cases, if you have paid the provider directly, they may fill out a reimbursement form and e-mail Unity Health at claims@unityhealth.co.za with all supporting documentation within 6 months from the date of treatment. Unity Health will assess and reimburse you in respect of all valid claims.

Unity Health encourages our members to access Unity Health’s dashboard online portal to access the following:

• Membership certificate;
• The member’s information loaded on Unity Health’s system;
• Claims received, processed and paid;
• Communication, policy document and brochures.

If the member is not registered on Unity Health’s dashboard online portal, please register here. If the member requires more information regarding the use of the dashboard, please contact Unity Health Call Centre on 0861 366 006.

A claim may be disputed by:

Making representation to Unity Health or the Insurer indicated in the Disclosure Notice attached to the policy wording within 90 days of receipt of the benefit /rejection letter. Unity Health or the insurer is obligated to provide the member with feedback within 45 days.

The member should first aim to resolve their dispute with Unity Health before contacting the Insurer. The member may also contact the Financial Service Ombudsman indicated in the Disclosure Notice attached to the policy wording should they not be satisfied with the response of the Insurer.

1. The FAIS Ombudsman may also be contacted for any complaints against the member’s broker.
2. The Ombudsman for Short-Term Insurance may also be contacted for any complaints against the insurer.

The member may also constitute legal action should the matter not be resolved by either the insurer or the relevant Ombudsman. The claim will prescribe 6 months after the expiry of the 90-days indicated above (no further claims will be payable for the specific claim).