Comprehensive Advanced Plan

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Monthly Premiums

Rates above are for Individuals, per member per month. If you are a member as part of a Group/ Company, your rate may be different.

Principal

R1007 PM

Adult Dependent

R811 PM

Child Dependent

R366 PM

BENEFITS

In-Hospital Accident Benefit

R250 000 per member per event. Maximum of R1 000 000.

Hospital Footprint

Access to all private hospitals accepting health insurance products.

ICU Benefit

Included in Hospital Illness Benefits.

Shortfall Benefit

Included in Hospital Illness Benefits.

Post-Accident Rehabilitation

R10 000 per member per event for physiotherapy and occupational therapy only.

In-Hospital Illness Benefit

R100 000 per member per event. Overall limit of R1 000 000. Cataract Surgery is limited to R30 000 per member.

Maternity Benefit

R35 000 for birth. Limited to 1 event every 12 months. Includes 2 out-of-hospital ultra-sounds.

Casualty Benefit (Accident)

R10 000 per policy.

Casualty (Illness)

R6 000 for after-hours treatment only.

GP Consultations

Managed unlimited GP consultations at a network doctor.

Out-of-Network General Practitioner visits (GP)

2 consultations refunded at R450 per visit.

In-Room Procedures

Defined list of procedures a network GP can perform in their rooms at no additional charge.

Pharmacy Clinic Nurse Care

Unlimited care for a defined list of procedures available from nurses at Mediscor pharmacies with contracted clinics.

Specialist Benefit

R2 500 per member. Referral by network GP required. Members must pay cash and claim from Wesmart.

Acute Medication

Unlimited Acute Medication available only from a Mediscor pharmacies. Subject to Formulary.

Over-the-Counter Medication (OTC)

R200 per month. R800 per year. Subject to Formulary.

Chronic Medication

Unlimited. Approval must be obtained from Chroniline. Chronic Medication may be obtained from a Mediscor pharmacy or from a Network Dispensing Doctor. Subject to Formulary.

Radiology

Unlimited Black and white x-rays only. Members must be referred by a network GP.

Pathology

Unlimited blood tests according to our list of tests. Members must be referred by a network GP.

Dentistry

Basic dentistry only. Treatment available based on Wesmart‘s Protocols and limits.

Optometry

Only available at Specsavers branches. 1 consultation, 1 set of frames with single vision lenses per member, every 24 months. Maximum of R1 375.

ADDITIONAL BENEFITS

Hospital Footprint

At Wesmart, we have strong relationships with all the private hospitals. Our largest shareholder owns Africa Health Care.
Follow this link to find an Africa Health Care hospital near you:
https://www. africahealthcare.co.za/find-a-hospital/.
Pre-Authorisation is required for all hospital admissions on 010 599 1172.

Value Added Benefits
24-hour Emergency Medical Services

Unlimited

Personal Health Advisor

Clinically trained Personal Health Advisor available for telephonic consultations and advice, including Trauma Councelling, Health Information, Chronic condition management, general Health advice.

Accidental Death Benefit

Principal: R15 000

Adult Dependant: R10 000

Child Dependant: R8 000

Pharmacy Clinic Nurse-Based Care
Nurse-Based Care

Care from qualified nurses at over 700 pharmacy Wellness Clinics. Visit them in store at your convenience or book an appointment for a consultation. Nurses will give you a medical referral if necessary. Available at all Mediscor Pharmacies with contracted Clinics.

• General Member Wellness

• Women’s Health

• Assistance Managing Chronic Conditions

General Member Wellness

• Glucose and Cholesterol screening / testing / monitoring.
• Treatment of wounds.
• Administration of injections, including annual flu injection.
• Hb, Malaria and Urine Screening.
• Syringing of ears.
• Advice on how to best manage your status and health.

Women's Health

Caring advice women can rely on, offering all types of female health assessments such as
pregnancy testing, breast screening, pap smear testing and other female screenings.

Assistance Managing Chronic Conditions

Nurses will help you manage your chronic condition and assist you with monitoring and
advice, including but not limited to:
• Diabetes Hba1C and foot screening.
• Blood pressure and lipogram testing, BMI monitoring.
• Peak flow and nebulization. Control asthma by getting rescue medication
directly into the lungs.
• HIV screening, testing and counselling: Learn your HIV status and get psycho
logical help after testing positive. A counselling session is offered pre-testing
as well.