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
​