FAQ - DAY 1 HEALTH

FREQUENTLY ASKED QUESTIONS

Q: Does Day1 Health cover hysterectomy operations in hospital?

Day1 Health pays costs in hospital of up to a maximum of R20 000.00

Q: How long after discharge should I send my claim form through to Day1 Health?

In order for hospital costs incurred to be paid after date of discharge, you will need to complete a claim form and submit it to the Day1 Health offices within 120 days of the admission.

Q: What are the maternity benefits covered by Day1 Health?

Natural Birth & C-Sections – Day1 Health pays costs in-hospital of up to R10 000.00 in the first year of membership and R20 000.00 thereafter.

Q: Does Day1 Health cover appendectomy operations in hospital?

Day1 Health pays costs in-hospital of up to a maximum of R20 000.00

Q: Can I go to any private hospital?

Day1 Health has formal contracts with all Life Healthcare, Mediclinic, Africa Health Care and Clinix private hospitals nationwide. All hospital admissions must be pre-authorised via Africa Assist (A-A). The pre-authorisation number is on the back of your Day1 Health membership card (0861 144 144).

Q: Can I go to any Dentist on the Network list?

Yes. You may make use of any dentist on our Network. Please refer to your Day1 Health Product Guide for covered procedure codes.

Q: What is the procedure to follow should I get diagnosed with a Chronic Condition?

If you are diagnosed with a chronic condition, you must register on the Day1 Health Chronic Disease Management Programme via your Day1 Health Network GP in order to receive your chronic medication. Chronic Medication Application Form and have your network GP complete same. Chronic medication may be collected from any Clicks, Dischem or Medirite pharmacy nationwide and is subject to pre-authorisation.

Q: Can I buy my medication over the counter?

No. Your Day1 Network GP has to prescribe medication in accordance to our medicinal formulary. Both acute routine and chronic medication are covered and are unlimited according to the Day1 Health formulary. The Network GPs usually dispense the medication, however, if the GP is a scripting doctor i.e. ‘does not dispense’, you may obtain your medication from any Clicks, Dischem or Medirite pharmacy nationwide.

Q: What happens if there isn’t a Network doctor in my area? Can I nominate my own GP?

Yes. Kindly contact us on 0876 100 600 and we shall endeavour to contract directly with your own.

Q: What happens if I am ill and out of town?

If you are out of town and you are unable to see your Network GP, the Day to Day benefits will allow 3 “out-of-area” visits per policy per annum to an alternative Network GP or GP of your choice. Should you choose to consult a GP of your choice, simply complete a Day1 Health Reimbursement Form and send it to Day1 Health together with a copy of the receipt and you will thereafter be reimbursed the agreed tariff ie. R340.

Q: When I see a GP/ Dentist, do I have to pay cash for the consultation?

No. By paying your monthly contribution in advance, you have already paid for your consultation. The accredited providers claim directly from Day1 Health.

Q: Can I go to any Doctor?

The Day1 Health day to day benefits are made available through the Day1 Health provider network. You must therefore be allocated to a Day1 Health network doctor.

What are the waiting periods for day to day benefits?

The following waiting periods generally apply for:

New Day1 Health members; and
When existing Day1 Health members upgrade their policies to include benefits not previously covered

Day to Day Benefits & Waiting Periods

Day to Day Benefits & Waiting Periods	A 1 month waiting period applies
Specialist Benefit	A 3 month waiting period applies
Acute Medication	A 1 month waiting period applies
Chronic Medication (unknown conditions)	A 3 month waiting period applies
Chronic Medication (known/pre-existing conditions)	A 12 month waiting period applies
Radiology Benefits	A 1 month waiting period applies
Pathology Benefits	A 1 month waiting period applies
Dentistry Benefits	A 3 month waiting period applies
Optometry Benefits	A 12 month waiting period applies
Out-of-Area Visits	A 1 month waiting period applies
Family Funeral Benefit	A 3 month waiting period applies

Q: Does health insurance have any tax benefits?

No. Unlike medical aid, health insurance offers no tax benefits to policyholders. As per current legislation. Employer contributions are, however, tax-deductible.

Q: What is Health Insurance?

Health Insurance is governed by either the Long-Term Insurance Act or the Short-Term Insurance Act. Demarcation Exemption is now also required in terms of the Medical Schemes Act. Practical Medical Insurance – Providing cover since 2003 Day1 Health (Pty) Ltd is an authorised Financial Services Provider – FSP Number 11319. Day1 Health (Pty) Ltd is duly approved and accredited by the Council for Medical Schemes – CMS Ref: 1074. Underwritten by African Unity Life Ltd, a licensed life insurer and an authorised Financial Services Provider, FSP No.8447. Day1 Health offers Medical Insurance plans and is not a Medical Aid product.

Q: What is a Medical Aid Scheme?

Medical aids are regulated by the Medical Schemes Act (1998). They are essentially non-profit organisations and belong to their members.

Q: What is the waiting period for maternity benefits?

There is a 3 month waiting period applicable to the maternity benefit for unknown conditions from date of inception of policy and a 12 month waiting period for pre-existing conditions ie where the member is pregnant at inception date. Once the maternity benefit has been utilised by a member, a further 12 month waiting period will apply in respect of such member for maternity.

Q: Does the hospital plan cover casualty?

Casualty consultations are covered under the Accident/Trauma Benefit i.e. any bodily injury as a result of an accident. Casualty illness is only covered up to R2 000.00 if the casualty consultation results in hospital admission for at least 24 hours. Please refer to your hospital plan policy wording for detailed information.

Q: Does the hospital plan cover day procedures?

Day1 Health products are designed to provide cover for procedures that require hospitalisation for 24 hours or more under the Illness Benefit (E.g.: Scans/Scopes/Grommets/Tonsillectomy). Hospitalisation for 24 hours or less will therefore not be covered (unless for Accident/Trauma related incidents).

Q: Will I be covered for pre-existing conditions?

If you are suffering from a pre-existing condition prior to taking out health cover, a 12 calendar month waiting period will apply.

Q: What does Day1 Health classify as pre-existing conditions?

Pre-existing conditions are defined by a medical practitioner as ‘any illness or ailment that existed at any time during the 12 months prior to joining Day1 Health or on upgrading your cover, including any medical advice or treatment thereof within the specified waiting period. Day1 Health will not pay a claim on a pre-existing condition/ailment for the first 12 months of the plan / policy.

Q: What will happen to my waiting periods if I upgrade my cover?

If you decide to upgrade your Day1 Health cover, you may be required to serve waiting periods for any increase in your limits as well as any new benefits that you were not previously covered for.

Q: Why does Day1 Health impose waiting periods?

Waiting periods protect you and Day1 Health from consumers joining for financial gain as this would invariably lead to increased premiums and/or loss of benefits.