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:

  1. Appendicetomy

  2. Kidney stones

  3. Gall bladder

  4. Hernia

  5. Hysterectomy

  6. Gall bladder

  7. Tonsillitis

  8. 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:

  1. Appendicetomy

  2. Kidney stones

  3. Gall bladder

  4. Hernia

  5. Hysterectomy

  6. Gall bladder

  7. Tonsillitis

  8. 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:

  1. Appendicetomy

  2. Kidney stones

  3. Gall bladder

  4. Hernia

  5. Hysterectomy

  6. Gall bladder

  7. Tonsillitis

  8. 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:

  1. Appendicetomy

  2. Kidney stones

  3. Gall bladder

  4. Hernia

  5. Hysterectomy

  6. Gall bladder

  7. Tonsillitis

  8. 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