Benefits
Medical Expense Shortfall Cover
Increases the Medical Aid rate up to 600%. Subject to the OAL
Co-payment Cover
Subject to the OAL
Non-DSP Hospital Penalty Cover
R12 000 per admission. Limited to 2 claims per family per annum. Subject to the OAL
Sub-limit Cover
R35 000 per admission. Subject to the 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 R2 000 per admission per insured and R10 000 per family per annum. Subject to the OAL
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
Biological Cancer Drug Cover
Provides cover for Biological Cancer Drugs when the Medical Scheme imposes a sub-limit. Subject to a formulary and the OAL
Breast Cancer Prevention Cover
Increases the Medical Aid rate up to 600% for a Prophylactic Mastectomy. Subject to the 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, when there is no benefit on the Insured person’s Medical Scheme, is limited to R20 000 per insured, per lifetime. Subject to the 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 R5 500 per event and 2 claims per family per annum. Subject to the 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, has been a victim of a violent crime or experienced the death of an immediate family member. Limited to R1 000 per consultation and R8 000 per family per annum. Subject to the OAL
Co-payments for MRI, CT and PET Scans
Subject to the OAL
Co-payments for Scopes
R3 000 per event. Limited to 2 claims per insured per annum. Subject to the OAL
Sub-limit Cover for MRI, CT and PET Scans
R35 000 per event per insured. Subject to the OAL
Casualty Benefit for Accidents
R14 000 per event per insured. Subject to the OAL
Casualty Benefit for Illness
R2 500 per event. Limited to 3 claims per family per annum. Subject to the OAL. Treatment is restricted to between the hours of 7pm – 6am Mondays to Fridays, Saturdays, Sundays and Public Holidays
Cancer Diagnosis Benefit
Once off payment for first diagnosis of Cancer based on the stage at time of diagnosis:
Stage 1: R5 000
Stage 2: R15 000
Stage 3: R20 000
Stage 4: R25 000
Medical Scheme Contribution Waiver
Up to R6 000 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 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
R30 000 per insured on the Policy in the event of accidental death or permanent and total disability due to an accident
Critical Illness Benefit
R10 000 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)
Medical Expense Shortfall Cover
Increase 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
Co-payment Cover
Subject to the 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 R50 000 per family per annum. Subject to the OAL
Sub-limit Cover
R30 000 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
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
