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 R50 000 per admission per insured. Subject to the Overall Annual Limit
Non-DSP Hospital Penalty Cover R8 500 per admission. Limited to 1 claim per family per annum and subject to the Overall Annual Limit
Sub-limit Cover R20 000 per admission per insured. Subject to the Overall Annual Limit
Benefits for in-hospital treatment
Traditional Cancer Cover Pays for treatment in a private facility, including sub-limits, deductibles or co-payments related to cancer treatment. (R200 000 excess). Subject to the Overall Annual Limit
Biological Cancer Drug Cover Provides cover for Biological Cancer Drugs when the medical aid imposes a sub-limit. Subject to the Overall Annual Limit (See Formulary)
Benefits for in-hospital treatment
Co-payments for MRI, CT and PET scans R50 000 per admission per insured. Subject to the Overall Annual Limit
Sub-limit Cover for MRI, CT and PET scans R20 000 per admission per insured. Subject to the Overall Annual Limit
Casualty Benefit (Accidents only) R7 500 per event per insured. Subject to the Overall Annual Limit
ADDED BENEFITS
Cancer Diagnosis Benefit Once off payment of R20 000 for first diagnosis of cancer, provided that the insured is on an approved oncology treatment plan
Medical Scheme Contribution Waiver R5 000 per month for 6 months; covers death or permanent and total disability as a result of an accident, of the medical scheme contribution payer
Personal Accident Benefit R20 000 per insured on the policy, covers death and permanent and total disability
´╗┐International Travel Cover R5 000 000 per insured

Biological Cancer Drugs

The lists below provide the cancer types that may require treatment through the use of a biological cancer drug covered under Premier.
Specific Cancer Categories List Of Drugs
HER 2 + Breast Cancer Acute myeloid leukaemia Herceptin Mylotarg
Advanced hepatocellular carcinoma Acute myeloid leukaemia Nexavar Gleevec
Chronic myeloid leukaemia Acute lymphoblastic leukaemia Sprycel Faslodex
Hairy cell leukaemia Chronic lymphocytic leukaemia Velcade Tarceva
HER -ve breast cancer Myelodysplasia Alimta Zevalin
Multiple myeloma Gastrointestinal stromal tumour Avastin Erbitux
Non-hodgkins lymphoma Metastatic colorectal cancer Sutent Fludara
Advanced renal cell carcinoma Head and neck cancer Mabthera

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.