Platinum Plan

Plan overview

The Platinum Plan is a comprehensive Day1 Health option in the Platinum tier. It combines day-to-day and hospital-related benefit categories, subject to the applicable plan terms.

Who this plan may suit

Consider this plan type when you want to compare the Platinum tier with other comprehensive Day1 Health options.

Key benefit categories

The following categories may be available under this plan. Read the relevant plan document for full details, limits, exclusions and eligibility requirements.

• Network doctor consultations and selected day-to-day services
• Acute and chronic medication support, subject to plan rules
• Hospital-related, critical illness and disability benefit categories
• Maternity and funeral benefits

Detailed benefit card information

These benefit-card details are provided for plan comparison. Read the relevant plan document before applying, as benefits, limits, exclusions, waiting periods and terms apply.

Private Managed Doctor Visits

Consultations available via a registered Day1 Health Network Partner. Limited to 5 doctor visits per member per annum. A pay-as-you-go virtual doctor consultation platform is available thereafter. Pre-authorisation is required. A 1 month waiting period applies.

Specialist Benefit

Specialist benefit of up to R1 000 per family per annum. Subject to pre-authorisation and referral from a 1Doctor Health Network GP. A 3 month waiting period applies.

Acute & Chronic Medication

Both acute and chronic medication are covered according to the Day1 Health formulary. Acute medication has a 1 month waiting period. Chronic medication is limited to R500 per member per month and R6 000 per member per annum. A 3 month waiting period applies for unknown conditions and a 12 month waiting period for pre-existing conditions. Pre-authorisation applies.

Radiology

Basic radiology according to the 1Doctor Health formulary via a 1Doctor Health network GP. Black-and-white diagnostic X-rays only. A 1 month waiting period applies.

Pathology

Basic diagnostic blood tests on referral by a 1Doctor Health Network GP and subject to a list of basic pathology tests approved by Day1 Health. A 1 month waiting period applies.

Basic Dentistry

Preventative cleaning, fillings, extractions and emergency pain and sepsis control via a Day1 Health Network Dentist. Two visits per member per annum. Pre-authorisation is required for each visit. A 3 month waiting period applies.

Optometry (Iso Leso Optics)

One eye test and one set of glasses every 24 months in the specific Iso Leso Optics agreed protocol range. A 12 month waiting period applies.

Out-of-Area Visits

If you cannot see your network GP, the plan allows 3 out-of-area visits per family per annum to an alternative network GP or GP of your choice, subject to pre-authorisation. A 1 month waiting period applies.

In-hospital Illness Benefit

Covers up to R 10 000 after the first 24 hours in hospital, up to R 10 000 for the second day in hospital and up to R 10 000 for the third day in hospital. Thereafter R 1 500 per day up to a maximum of 21 days. A 3 month waiting period applies and a 12 month pre-existing conditions exclusion applies.

1st Day in Hospital

Up to R 10 000.00 — not less than 24 hours from time of admission to time of discharge.

2nd Day in Hospital

Up to R 10 000.00.

3rd Day in Hospital

Up to R 10 000.00.

Every subsequent day thereafter

R 1 500

Maximum Benefit payable for 21 day period

Up To R 57 000.00

Accident/Trauma Benefit (Exclusion: Sports injuries)

Up to R150 000 per single member per incident and up to R300 000 per family incident. Immediate cover.

Critical Illness Benefit

One incident per family per annum. Critical illness up to R250 000; the benefit is limited to R50 000 unless the insured person accedes to a short medical examination, at their own cost, arranged by Day1 Health. The underwriter decision is final. A 3 month waiting period applies.

Accidental Permanent Disability Benefit

R250 000 for the principal member only. Single event only. Immediate cover.

24 Hour Emergency Services ambulance & Pre-Authorisation

24 hour emergency services and pre-authorisation provided by Africa Assist, including 24 hour medical advice and access to unlimited pay-as-you-go virtual doctor consultations. Immediate cover.

Maternity Benefit

Covers up to R20 000 for the birth of a child in hospital. A 12 month waiting period applies. Benefit is available to plan members aged 16 years and older.

Funeral Benefit

Principal member R20 000; spouse and child over 14 years R10 000; child over 6 years R5 000; child over 0 years R2 500; stillborn over 28 weeks R1 250. A 3 month waiting period applies. Benefit is available to plan members.

Important plan conditions

• Benefits, limits, exclusions, waiting periods and terms may apply.
• Some benefits may require use of a network provider, referral or pre-authorisation.
• Benefit availability is subject to the applicable plan rules and supporting documents.
• Request a quote and review the relevant documentation before applying.

Compare related options

Compare plan categories and tiers before choosing the option that best matches your healthcare needs.

• Value Plus Plan
• Executive Plan

Platinum Plan frequently asked questions