You do life. We take care of the rest.
combination plans
hospital & accidental combo
IN-HOSPITAL BENEFITS BENEFITS
Overall Annual Limit (OAL)
Treatments while in hospital -
Doctor / Specialist fees
Anaethetist
Radiology & Specialist Radiology
Laboratory
Illness & Operations / Procedures -
Surgical procedures where admission to a hospital or day clinic is more than 24 consecutive hours
Surgical procedures where admission to a hospital or day clinic is less than 24 consecutive hours
Special limits / waiting periods apply to:
-
Appendicetomy
-
Kidney stones
-
Gall bladder
-
Hernia
-
Hysterectomy
-
Gall bladder
-
Tonsillitis
-
Grommets
Dreaded Disease
Pre-existing Conditions
PREGNANCY BENEFIT
Birth / Delivery of baby
Miscarriage
Ectopic Pregnancy
EMERGENCY BENEFITS
ER / Trauma room
EMS, Ambulance and Paramedic service
ACCIDENTAL BENEFITS
EMS, Ambulance and Paramedics
ER / Trauma Room Treatment
Accidental Hospitalisation after admission
WAITING PERIOD
3 months
3 months
3 months
3 months
3 months
3 months
3 months
6 months
12 months
12 months
12 months
12 months
12 months
12 months
6 months
12 month
9 months
9 months
9 months
3 months
3 months
none
none
none
BENEFIT LIMITS
Single Member Limit : R150 000
Family Limit : R300 000
R5 000 per event – subject to OAL
R2 500 per event – subject to OAL
R5 000 per event – subject to OAL
R2 000 per event – subject to OAL
R60 000 per event – subject to OAL
R25 000 per event
Limited to R100 000 per annum
– subject to OAL
R35 000 – subject to OAL
R60 000 – subject to OAL
R45 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
subject to OAL and any special limits
R30 000 per annum
R25 000 per annum
R40 000 per annum
R15 000 per annum
R35 000 per annum
R35 000 per annum
R15 000 per annum
R150 000 per annum
green combo
WAITING PERIOD
3 months
3 months
3 months
3 months
3 months
3 months
3 months
6 months
12 months
12 months
12 months
12 months
12 months
12 months
6 months
12 month
9 months
9 months
9 months
3 months
3 months
none
none
none
DAY-2-DAY BENEFITS
GP visits
Specialist visits
Acute / Chronic medication
Blood tests
Radiology
Optometry
Consulting room benefit
Investigative procedures
PRIME DENTAL BENEFITS
Consultation
Fillings
X-Rays
Extractions
Emergency Root Canal
Trauma- on ER/ police report
WAITING PERIOD
1 month
3 months
1 month
1 month
1 month
12 months
1 month
6 months
3 months
3 months
3 months
3 months
3 months
1 month
EVENTS PER YEAR
4
2
Limited to R250 per event
3
3
1 every 24 months
3
1
3
2
2
2
2
1- subject to pre-auth
IN-HOSPITAL BENEFITS BENEFITS
Overall Annual Limit (OAL)
Treatments while in hospital -
Doctor / Specialist fees
Anaethetist
Radiology & Specialist Radiology
Laboratory
Illness & Operations / Procedures -
Surgical procedures where admission to a hospital or day clinic is more than 24 consecutive hours
Surgical procedures where admission to a hospital or day clinic is less than 24 consecutive hours
Special limits / waiting periods apply to:
-
Appendicetomy
-
Kidney stones
-
Gall bladder
-
Hernia
-
Hysterectomy
-
Gall bladder
-
Tonsillitis
-
Grommets
Dreaded Disease
Pre-existing Conditions
PREGNANCY BENEFIT
Birth / Delivery of baby
Miscarriage
Ectopic Pregnancy
EMERGENCY BENEFITS
ER / Trauma room
EMS, Ambulance and Paramedic service
ACCIDENTAL BENEFITS
EMS, Ambulance and Paramedics
ER / Trauma Room Treatment
Accidental Hospitalisation after admission
BENEFIT LIMITS
Single Member Limit : R150 000
Family Limit : R300 000
R5 000 per event – subject to OAL
R2 500 per event – subject to OAL
R5 000 per event – subject to OAL
R2 000 per event – subject to OAL
R60 000 per event – subject to OAL
R25 000 per event
Limited to R100 000 per annum
– subject to OAL
R35 000 – subject to OAL
R60 000 – subject to OAL
R45 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
subject to OAL and any special limits
R30 000 per annum
R25 000 per annum
R40 000 per annum
R15 000 per annum
R35 000 per annum
R35 000 per annum
R15 000 per annum
R150 000 per annum
BENEFIT PER EVENT
R400
R560
R800 overall annual limit
R370
R370
R1 650
R50
R750
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
upto R16 000
blue combo
DAY-2-DAY BENEFITS
GP visits
Specialist visits
Acute / Chronic medication
Blood tests
Radiology
Optometry
Consulting room benefit
Investigative procedures
SILVER DENTAL BENEFITS
Consultation
Fillings
X-Rays
Extractions
Emergency Root Canal
Bite Plate
Mouth Guard
PAN Scan (panoramic)
Scale and Polish
Root Canal
Temporary Crown
Wisdom Teeth in Chair
Wisdom Teeth in Hospital
Dentures
Crowns / Bridge Work
Implants
Trauma- on ER/ police report
WAITING PERIOD
1 month
3 months
1 month
1 month
1 month
12 months
1 month
6 months
3 months
3 months
3 months
3 months
3 months
3 months
3 months
3 months
3 months
6 months
6 months
6 months
6 months
6 months
6 months
6 months
1 month
EVENTS PER YEAR
8
4
Limited to R300 per event
3
3
1 every 24 months
3
1
4
4
5
3
3
1
1
1 per lifetime
1
2 – subject to pre-auth
2 – subject to pre-auth
4 – subject to pre-auth
2 – subject to pre-auth
1 per 5 years – pre-auth
1 – subject to pre-auth
1 – subject to pre-auth
1 - subject to pre-auth
IN-HOSPITAL BENEFITS BENEFITS
Overall Annual Limit (OAL)
Treatments while in hospital -
Doctor / Specialist fees
Anaethetist
Radiology & Specialist Radiology
Laboratory
Illness & Operations / Procedures -
Surgical procedures where admission to a hospital or day clinic is more than 24 consecutive hours
Surgical procedures where admission to a hospital or day clinic is less than 24 consecutive hours
Special limits / waiting periods apply to:
-
Appendicetomy
-
Kidney stones
-
Gall bladder
-
Hernia
-
Hysterectomy
-
Gall bladder
-
Tonsillitis
-
Grommets
Dreaded Disease
Pre-existing Conditions
PREGNANCY BENEFIT
Birth / Delivery of baby
Miscarriage
Ectopic Pregnancy
EMERGENCY BENEFITS
ER / Trauma room
EMS, Ambulance and Paramedic service
ACCIDENTAL BENEFITS
EMS, Ambulance and Paramedics
ER / Trauma Room Treatment
Accidental Hospitalisation after admission
WAITING PERIOD
3 months
3 months
3 months
3 months
3 months
3 months
3 months
6 months
12 months
12 months
12 months
12 months
12 months
12 months
6 months
12 month
9 months
9 months
9 months
3 months
3 months
none
none
none
BENEFIT LIMITS
Single Member Limit : R150 000
Family Limit : R300 000
R5 000 per event – subject to OAL
R2 500 per event – subject to OAL
R5 000 per event – subject to OAL
R2 000 per event – subject to OAL
R60 000 per event – subject to OAL
R25 000 per event
Limited to R100 000 per annum
– subject to OAL
R35 000 – subject to OAL
R60 000 – subject to OAL
R45 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
subject to OAL and any special limits
R30 000 per annum
R25 000 per annum
R40 000 per annum
R15 000 per annum
R35 000 per annum
R35 000 per annum
R15 000 per annum
R150 000 per annum
BENEFIT PER EVENT
R400
R560
R1 550 overall annual limit
R430
R430
R1 650
R75
R1 000
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
upto R1 000 each
upto R3 500 each
upto R3 000
upto R3 500
upto R5 000
upto R25 000
RED combo
DAY-2-DAY BENEFITS
GP visits
Specialist visits
Acute / Chronic medication
Blood tests
Radiology
Optometry
Consulting room benefit
Investigative procedures
SILVER DENTAL BENEFITS
Consultation
Fillings
X-Rays
Extractions
Emergency Root Canal
Bite Plate
Mouth Guard
PAN Scan (panoramic)
Scale and Polish
Root Canal
Temporary Crown
Wisdom Teeth in Chair
Wisdom Teeth in Hospital
Dentures
Crowns / Bridge Work
Implants
Trauma- on ER/ police report
WAITING PERIOD
1 month
3 months
1 month
1 month
1 month
12 months
1 month
6 months
3 months
3 months
3 months
3 months
3 months
3 months
3 months
3 months
3 months
6 months
6 months
6 months
6 months
6 months
6 months
6 months
1 month
EVENTS PER YEAR
12
8
Limited to R350 per event
3
3
1 every 24 months
3
1
4
4
5
3
3
1
1
1 per lifetime
1
2 – subject to pre-auth
2 – subject to pre-auth
4 – subject to pre-auth
2 – subject to pre-auth
1 per 5 years – pre-auth
1 – subject to pre-auth
1 – subject to pre-auth
1 - subject to pre-auth
IN-HOSPITAL BENEFITS BENEFITS
Overall Annual Limit (OAL)
Treatments while in hospital -
Doctor / Specialist fees
Anaethetist
Radiology & Specialist Radiology
Laboratory
Illness & Operations / Procedures -
Surgical procedures where admission to a hospital or day clinic is more than 24 consecutive hours
Surgical procedures where admission to a hospital or day clinic is less than 24 consecutive hours
Special limits / waiting periods apply to:
-
Appendicetomy
-
Kidney stones
-
Gall bladder
-
Hernia
-
Hysterectomy
-
Gall bladder
-
Tonsillitis
-
Grommets
Dreaded Disease
Pre-existing Conditions
PREGNANCY BENEFIT
Birth / Delivery of baby
Miscarriage
Ectopic Pregnancy
EMERGENCY BENEFITS
ER / Trauma room
EMS, Ambulance and Paramedic service
ACCIDENTAL BENEFITS
EMS, Ambulance and Paramedics
ER / Trauma Room Treatment
Accidental Hospitalisation after admission
WAITING PERIOD
3 months
3 months
3 months
3 months
3 months
3 months
3 months
6 months
12 months
12 months
12 months
12 months
12 months
12 months
6 months
12 month
9 months
9 months
9 months
3 months
3 months
none
none
none
BENEFIT LIMITS
Single Member Limit : R150 000
Family Limit : R300 000
R5 000 per event – subject to OAL
R2 500 per event – subject to OAL
R5 000 per event – subject to OAL
R2 000 per event – subject to OAL
R60 000 per event – subject to OAL
R25 000 per event
Limited to R100 000 per annum
– subject to OAL
R35 000 – subject to OAL
R60 000 – subject to OAL
R45 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
R60 000 – subject to OAL
subject to OAL and any special limits
R30 000 per annum
R25 000 per annum
R40 000 per annum
R15 000 per annum
R35 000 per annum
R35 000 per annum
R15 000 per annum
R150 000 per annum
BENEFIT PER EVENT
R450
R675
R2 400 overall annual limit
R650
R650
R1 650
R100
R1 250
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
@ AGS Network Rate
upto R1 000 each
upto R3 500 each
upto R3 000
upto R3 500
upto R5 000
upto R25 000