Senior Comprehensive Plan
Affordable medical cover from R775 per month. When you’re looking for health insurance, it’s a good idea to take a look at all the angles. You want health cover that complements your lifestyle and helps you get the best care possible compatible with your financial needs. That’s where Kingdom Blue & Day1 Health comes in.
DAY TO DAY BENEFITS
UNLIMITED MANAGED DOCTOR VISITS
Via a registered Day1 Health Network Provider. A co-payment of R75.00 will apply for all additional visits after the 5th visit per member per annum. A 1 month waiting period applies.
ACUTE MEDICATION
Acute medication covered according to the Day1 Health formulary. A 1 month waiting period applies.
CHRONIC MEDICATION
Chronic medication is covered according to the Day1 Health formulary. A 3 month waiting period applies on chronic medication for unknown conditions and a 12 month waiting period on pre-existing conditions. (All chronic medication is subject to preauthorisation. An additional administration fee may be levied on all approved chronic medication).
RADIOLOGY
Basic radiology according to the Day1 Health formulary via a Day1 Health network GP. Black and white diagnostic x-rays only. A 1 month waiting period applies.
PATHOLOGY
Basic diagnostic blood tests on referral by a Day1 Health Network GP and subject to a list of basic pathology tests approved by Day1 Health. A 1 month waiting period applies.
BASIC DENTISTRY
Basic treatment includes preventative cleaning, fillings, extractions and emergency pain and sepsis control via a Day1 Health Network Dentist. 2 visits per annum per member A 3 month waiting period applies.
OPTOMETRY (ISO LESO OPTICS)
One eye test and one set of glasses every 24 months per the specific Iso Leso Optics agreed protocol range. A 12 month waiting period applies.
OUT-OF-AREA VISITS
In the event that you cannot see your Network GP, the Plan will allow 3 “out of area” visits per family per annum to an alternative Network GP or GP of your choice, subject to pre-authorisation. A 1 month waiting period applies.
IN-HOSPITAL ILLNESS BENEFIT
Covers up to R 10,000 after the first 24 Hours in hospital, up to R 10,000 for the second day in hospital, up to R 10,000 for the third day in hospital. Thereafter R 1,500 per day up to a maximum of 21 days. A 3 month waiting period applies and a 12 month pre-existing conditions exclusion applies.
INHOSPITAL ILLNESS BENEFITS
Ist Day in Hospital – Not less than 24 hours from time of admission to time of discharge, Up to R 10 000.00.
2nd Day in Hospital – Payable in units of R2 500.00 for every quarter day (6 hours), Up to R 10 000.00 payable in units of R 2 500.00.
3rd Day in Hospital – Payable in units of R2 500.00 for every quarter day (6 hours), Up to R 10 000.00 payable in units of R 2 500.00, Every subsequent day thereafter R 1 500.00
Maximum Benefit payable for 21 day period – Up To R 57 000.00
ACCIDENT/TRAUMA BENEFIT
Up to R 75,000 per single member and up to R 150,000 per family incident. Immediate cover. (limited to two events per annum)
24 HOUR EMERGENCY SERVICES AMBULANCE &
PRE-AUTHORISATION (0861 144 144)
24 Hour Emergency Services, Medical Assistance and
Pre-Authorisation provided by Africa Assist. Immediate cover.
Guaranteed private hospital admission with preference to all Life Healthcare, Mediclinic, Africa Health Care and Clinix hospitals.