Benefits
Premier 2025 | Premier 2026 | ||
Monthly premium: R673 per family for under 65yrs Monthly premium: R968 per family for 65yrs+Monthly premium: R496 per individual for under 65yrs Monthly premium: R677 per individual for 65yrs+ |
Monthly premium: R737 per family for under 65yrs Monthly premium: R1 060 per family for 65yrs+Monthly premium: R538 per individual for under 65yrs Monthly premium: R741 per individual for 65yrs+ Monthly premium: R315 for Premier Youth |
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In-hospital benefits | Medical Expense Shortfall Cover | Increases the Medical Aid rate up to 600%. Subject to OAL | Increases the Medical Aid rate up to 600%. Subject to OAL |
Co-payment Cover | Subject to OAL | Subject to OAL | |
Non-DSP Hospital Penalty Cover | R16500 per admission. Limited to 2 claims per family per annum and subject to OAL | R18000 per admission. Limited to 2 claims per family per annum and subject to OAL | |
Sub-limit Cover | R43000 per admission. Subject to OAL | R46500 per admission. Subject to OAL | |
Trauma Recovery Cover | Provides cover for when the Medical Scheme has imposed a sub-limit on a step-down facility for physical rehabilitation as a result of an accident which occurred while on the Policy. Limited to R6000 per admission per insured and R10000 per family per annum. Subject to OAL | Provides cover for when the Medical Scheme has imposed a sub-limit on a step-down facility for physical rehabilitation as a result of an accident which occurred while on the Policy. Limited to R6500 per admission per insured and R11000 per family per annum. Subject to OAL | |
In-hospital and out-of hospital Benefits | Traditional Cancer Cover | Pays for treatment in a private facility, including sub-limits, deductibles or co-payments related to cancer treatment. Subject to the OAL | Pays for treatment in a private facility, including sub-limits, deductibles or co-payments related to cancer treatment. Subject to the OAL |
Biological Cancer Drug Cover | Provides cover for Biological Cancer Drugs when the Medical Scheme imposes a sub-limit. Subject to formulary and OAL | Provides cover for Biological Cancer Drugs when the Medical Scheme imposes a sub-limit. Subject to formulary and OAL | |
Innovative Cancer Drug Cover | Provides cover for Innovative Cancer Drugs. Limited to R12000 per claim. Subject to OAL | Provides cover for Innovative Cancer Drugs. Limited to R13000 per claim. Subject to OAL | |
Breast Cancer Prevention Cover | Increases the Medical Aid rate up to 600% for a Prophylactic Mastectomy. Subject to OAL (Clinical Entry Criteria applies) | Increases the Medical Aid rate up to 600% for a Prophylactic Mastectomy. Subject to OAL (Clinical Entry Criteria applies) | |
Breast Cancer Reconstruction Cover | Increases the medical aid rate up to 600% for a breast reconstruction post mastectomy due to Cancer for the affected breast. Reconstruction of the unaffected breast for the purposes of symmetry, where there is no benefit on the Insured person’s Medical Scheme is limited to R29000 per insured person, per lifetime Subject to OAL | Increases the medical aid rate up to 600% for a breast reconstruction post mastectomy due to Cancer for the affected breast. Reconstruction of the unaffected breast for the purposes of symmetry, where there is no benefit on the Insured person’s Medical Scheme is limited to R31500 per insured person, per lifetime Subject to OAL | |
MRI and CT scan Cover | Provides cover for MRI and CT scans when there is no benefit available on your Medical Scheme. Limited to R8000 per event and 2 claims per family per annum. Subject to OAL | Provides cover for MRI and CT scans when there is no benefit available on your Medical Scheme. Limited to R8500 per event and 2 claims per family per annum. Subject to OAL | |
Trauma Care Cover | Covers the cost of trauma counselling consultations with a registered healthcare provider after a member has been diagnosed with a critical illness, a victim of a violent crime or experienced the death of an immediate family member. Limited to R3000 per consultation and R8000 per family per annum. Subject to OAL | Covers the cost of trauma counselling consultations with a registered healthcare provider after a member has been diagnosed with a critical illness, a victim of a violent crime or experienced the death of an immediate family member. Limited to R3300 per consultation and R8500 per family per annum. Subject to OAL | |
Out-of-hospital benefits | Co-payments for MRI, CT and PET scans | Subject to OAL | Subject to OAL |
Co-payments for Scopes | R6000 per admission. Limited to 2 claims per insured per annum. Subject to OAL. | R6500 per admission. Limited to 2 claims per insured per annum. Subject to OAL. | |
Sub-limit Cover for MRI, CT and PET scans | R35000 per event per insured. Subject to the OAL. | R46500 per event per insured. Subject to the OAL | |
Casualty Benefit for Accidents | R18000 per event per insured. Subject to OAL | R19500 per event per insured. Subject to OAL | |
Casualty Benefit for Illness | R5000 per event. Limited to 3 claims per family per annum. Subject to OAL. Treatment is restricted to between the hours of 7pm – 6am Mondays to Fridays, Saturdays, Sundays and Public Holidays | R5500 per event. Limited to 3 claims per family per annum. Subject to OAL. Treatment is restricted to between the hours of 6pm – 6am Mondays to Fridays, Saturdays, Sundays and Public Holidays | |
Added benefits | Cancer Diagnosis Benefit | Once off payment of for first diagnosis of Cancer based on stage at time of diagnosis Stage 1: R7500 Stage 2: R18000 Stage 3: R25000 Stage 4: R30000 |
Once off payment of for first diagnosis of Cancer based on stage at time of diagnosis Stage 1: R8000 Stage 2: R19500 Stage 3: R27500 Stage 4: R33000 |
Medical Scheme Contribution Waiver | Up to R7500 per month for 6 months; in the event of death or permanent and total disability as a result of an accident, of the Medical Scheme Contribution Payer | Up to R8200 per month for 6 months; in the event of death or permanent and total disability as a result of an accident, of the Medical Scheme Contribution Payer | |
Gap Premium Waiver | Pays the premium for your Premier Policy for 12 months in the event of death or permanent and total disability as a result of an accident, of the Contribution Payer | Pays the premium for your Premier Policy for 12 months in the event of death or permanent and total disability as a result of an accident, of the Contribution Payer | |
Personal Accident Benefit | R34000 per insured on the policy in the event of accidental death and permanent and total disability | R37000 per insured on the policy in the event of accidental death and permanent and total disability | |
Critical Illness Benefit | R13500 per insured on the policy in the event of death due to a critical illness (excludes cancer) | R14700 per insured on the policy in the event of death due to a critical illness (excludes cancer) | |
International Travel Cover | R5 million per insured (notification of travel required 48 hrs prior to departure) | R5 million per insured (notification of travel required 48 hrs prior to departure) | |
In-Hospital Dental Cover | Medical Expense Shortfall Cover | Increases the medical aid rate up to 600% for impacted wisdom teeth, reconstructive maxillofacial surgery due to an accident (which occurred while on the Policy) and oral cancer (which was diagnosed while on the Policy). Subject to the OAL | Increases the medical aid rate up to 600% for impacted wisdom teeth, reconstructive maxillofacial surgery due to an accident (which occurred while on the Policy) and oral cancer (which was diagnosed while on the Policy). Subject to the OAL |
Basic Dental Medical Expense Shortfall Cover For Children | Increases the Medical Aid rate up to 600% for basic dentistry for children up to and including 12 years. Limited to R5000 per family per annum. Subject to OAL | Increases the Medical Aid rate up to 600% for basic dentistry for children up to and including 12 years. Limited to R5500 per family per annum. Subject to OAL | |
Co-payment Cover | Subject to OAL | Subject to OAL | |
Sub-limit and Co-payment Cover for dental implants | Covers the cost of dental implants for reconstructive maxillofacial surgery due to an accident (which occurred while on the Policy) and oral cancer (which was diagnosed while on the Policy). Limited to R55 000 per family per annum. Subject to the OAL | Covers the cost of dental implants for reconstructive maxillofacial surgery due to an accident (which occurred while on the Policy) and oral cancer (which was diagnosed while on the Policy). Limited to R60 000 per family per annum. Subject to the OAL | |
Sub-limit Cover | R34000 per admission per insured for impacted wisdom teeth, orthognathic surgery, reconstructive maxillofacial surgery due to an accident (which occurred while on the Policy) and oral cancer (which was diagnosed while on the Policy). Subject to the OAL | R37000 per admission per insured for impacted wisdom teeth, orthognathic surgery, reconstructive maxillofacial surgery due to an accident (which occurred while on the Policy) and oral cancer (which was diagnosed while on the Policy). Subject to the OAL |
Youth Option Eligibility
The Youth Option applies when the main policyholder is under the age of 26 and no dependants over the age of 26 are included on the policy.
Additional Information
Biological Cancer Drugs
Click the button below to view the lists of the Biological Cancer Drugs covered under Premier.
Waiting Periods
Click the button to review the Waiting Periods and Exceptions
