Value Plus Plan

R485.00R1,570.00

Intro

COVER: Unlimited Doctor Visits etc. | Private Hospital Benefits | Illness / Accident / Ambulance

COVER AGE: Member under the age of 65: Max entry age: 64

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Terms & Conditions

Pre-paid Preventative Healthcare supplied by Day1 Health (Pty) Ltd | Waiting periods per benefit | Maximum age limit entry on standard terms and conditions is 64 

 

Unlimited Managed Doctor Visits

Via a registered 1Doctor Health Network Provider. A co-payment of R 75.00 will apply for all additional visits after the 5th visit. 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.

Specialist Benefit

Specialist Benefit of up to R 500 per family per annum. Subject to pre-authorisation and referral from a 1Doctor Health Network GP. A 3 month waiting period applies.

Basic Dentistry

Basic treatment includes preventative cleaning, fillings, extractions and emergency pain and sepsis control via a 1Doctor Health Network Dentist. A 3 month waiting period applies.

Acute Medication

Acute medication covered according to the 1Doctor Health formulary. Linked to the 1Doctor consultation dispensed by the 1Doctor Health Network GP or obtained on script from a Network Pharmacy. A 1 month waiting period applies.

Optometry (Iso Leso Optics)

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

 

Chronic Medication

Chronic medication covered according to the 1Doctor Health formulary. A 3 month waiting period applies on chronic medication for unknown conditions and 12 months waiting period on pre-existing conditions.

 

Out-of-Area Visits

In the event that you cannot see your Network GP, the Plan will allow 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.

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.

In-hospital Illness Benefit

Covers up to R10,000 after the first 24 Hours in hospital, up to R10,000 for the second day in hospital, up to R 10,000 for the third day in hospital. Thereafter R1,500 per day up to a maximum of 21 days. A 3 month waiting period applies and a 12 month pre-existing conditions exclusion applies.

 

 

 

IN-HOSPITAL ILLNESS BENEFITS AMOUNT PAYABLE
1st Day in HospitalNot less than 24 hours from time of admission to time of discharge Up to R10 000.00
2nd Day in HospitalPayable in units of R2 500.00 for every quarter day (6 hours) Up to R10 000.00 payable in units of

R2 500.00

3rd Day in HospitalPayable in units of R2 500.00 for every quarter day (6 hours) Up to R10 000.00 payable in units of

R2 500.00

Every subsequent day thereafter R1 500.00
Maximum Benefit payable for 21 day period Up To R57 000.00

 

Accident/Trauma Benefit

Up to R 150,000 per single member and up to R 300,000 per family incident. Immediate cover.

Death Benefit

R10,000 for the Principal Member. A 3 month waiting period applies

Family Funeral Benefit

Principal, Spouse & Child > 14 years R10,000. Child > 6 years R5,000.

Child > 0 years > R2,500. Child > 28 weeks R1,250. A 3 month waiting period applies.

24 Hour Emergency Services ambulance & Pre-Authorisation (0861 144 144)

24 Hour Emergency Services, Medical Assistance and Pre-Authorisation provided by Africa Assist. Immediate Cover. Guaranteed private hospital admission with preference to all Life Healthcare and Mediclinic hospitals

 

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.

Day1 Health complies with the principles of open enrolment, community rating and cross-subsidisation and does not discriminate or refuse membership on the basis of race, age, gender, marital status, ethnic or social origin, sexual orientation, pregnancy, disability, state of health, geographical location or any other means of discrimination.