BENEFITS

Overall Annual Limit (OAL) – R150 000 per insured per annum
Benefits for in-hospital treatment
Medical Expense Shortfall Cover Increases the medical aid rate up to 500%. (e.g. Specialists, GPs, Anaesthetists, Radiology, Pathology, etc.). Subject to the Overall Annual Limit
Co-payment Cover R20 000 per admission per insured. Subject to the Overall Annual Limit
Sub-limit Cover for Internal Prosthesis R10 000 per admission per insured. Limited to R50 000 per family per annum, subject to the Overall Annual Limit
Benefits for in-hospital and out-of-hospital treatment
Traditional Cancer Cover Co-payment cover for traditional cancer treatment limited to 20% per admission and subject to the Overall Annual Limit (R200 000 excess)
Biological Cancer Drug Cover Provides cover for Biological Cancer Drugs when the medical aid imposes a sub-limit. Subject to the Overall Annual Limit (R200 000 excess) and Formulary
Benefits for out-of-hospital treatment
Co-payments for MRI, CT and PET scans R20 000 per admission per insured. Subject to the Overall Annual Limit
Casualty Benefit (Accidents only) R6 000 per event per insured. Subject to the Overall Annual Limit
ADDED BENEFITS
International Travel Cover R5 000 000 per insured

Waiting Periods

  • A 3-month general waiting period applies to all benefits, with exception of benefits providing cover up to 500% should the commencement of the policy be in line with the commencement date of the medical scheme
  • A 9-month waiting period on pregnancy/childbirth
  • A 12-month waiting period on: hysterectomy (except where malignancy can be proven), hysteroscopies and endometrial ablations; joint replacements and spinal investigations, treatment or surgery (except in the event of an accident); tonsillectomy, myringotomy, grommets, adenoids, wisdom teeth and treatment or surgery for a hernia (except as a result of emergency surgery), treatment and/or surgery for cataracts, gastroscopies, colonoscopies and pre-diagnosed cancer
Please note that this is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership.
Disclaimer: This document is a summary for information purposes only and does not supersede the policy terms and conditions. In the event of any discrepancy, the policy, terms and conditions will prevail. Underwritten by Lombard Insurance Company Limited.