Value Plus Plan

Plan overview

The Value Plus Plan is a comprehensive Day1 Health option that combines day-to-day and hospital-related benefit categories in one plan type.

Who this plan may suit

Consider this plan type when you are comparing a combination of everyday healthcare support and hospital-related benefits.

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
• In-hospital illness, accident and trauma benefits
• 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.

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.

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.

• Executive Plan
• Platinum Plan

Value Plus Plan frequently asked questions