Premier is the umbrella sheltering your entire family. It offers a vast range of benefits to cater for unforeseen medical expense shortfalls and provides comprehensive cancer benefits.

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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

R13 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 500 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

Innovative Cancer Drug Cover

Provides cover for Innovative Cancer Drugs. Limited to R10 000 per claim. Subject to 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, where there is no benefit on the Insured person’s Medical Scheme is limited to R20 000 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 R6 000 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 R1 500 per consultation and R8 000 per family per annum. Subject to OAL

Co-payments for MRI, CT and PET Scans

Subject to the OAL

Co-payments for Scopes

R3 500 per admission. Limited to 2 claims per insured per annum. Subject to 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 500 per event per insured. Subject to OAL

Casualty Benefit for Illness

R3 000 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

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

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 R3 000 per family per annum. Subject to 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.

List of Drugs

Waiting Periods

Click the button to review the Waiting Periods and Exceptions

Waiting Periods
Exceptions
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