Pre-paid preventative Health Care Service (Out-of-hospital cover) : Doctors, Dentists, prescribed medicines, maternity etc.

The member is supplied with a Visa electronic card for immediate payment of the bills to the service provider. This benefit is subject to a 15 day waiting period and applicants must be younger than 65 years.

The Out-of-Hospital benefits can only be obtained at designated CareCross service providers. Should a member select not to visit a CareCross clinic but another service provider, he will be allowed a maximum of 2 visits per year for each person on the scheme. The member will have to pay cash for any service rendered and will be refunded a maximum of R180.00, including medication.

Out-of Hospital cover provides the following benefits;

General Practitioners & prescriptions.

A. Unlimited doctor visitations.

B. Pre- and post natal care including 2 growth sonars as referred by the CareCross service provider.

C. Acute Medication.

As prescribed by the CareCross service provider or obtained on a script from a Medicredit Pharmacy linked to the CareCross medicine formulary.

D. Pathology

Unlimited tests as referred by the CareCross service provider linked to the CareCross pathology formulary.

E. Radiollogy.

Unlimited tests as referred by the Medi-/CareCross service provider linked to the Medi /CareCross Radiollogy formulary.

F. Dentistry

Unlimited conservative and preventative dentistry, such as cleaning and treatment of pain as well as permanent fillings and extractions. Root canals and specialist treatments are excluded.

G. Optical

One eye test per beneficiary every 24 months plus one set of mono/bifocal white standard lenses and frames. A 12 month exclusion period applies.

H. Accident cover.

A R5000 guaranteed hospital admission plus R10 000 for hospital bills due to an accident is also provided under this section. A further R10 000 per incident is allowed for hospital visits relating to the same incident within 1 year from the date of the accident.

I. HIV/AIDS.

Each member covered under the plan will receive assistance in the event of accidental exposure to HIV/AIDS. The incident giving rise to the exposure must be reported to the helpline within 72 hours.

This plan provides cover in respect of sickness and accident that necessitates the beneficiary being taken up in hospital for 24 hours or longer.
The member is supplied with a Visa electronic card with an emergency hospital admission guarantee of up to R5000. Applicants must be younger than 55 years.

Sickness: Cover is from Day 1 in hospital, with an illness benefit of R10 750 for the 1st three days , calculated as follows;

• R4500 for the 1st day
• R2500 for the 2nd day
• R3750 for the 3rd day
• R1250 per day thereafter for 18 days, per person per illness.

If a person is in hospital for example 10 days for a sickness and he is readmitted within 6 months for the same sickness, he still has 18 -10 days = 8 days left for treatment. If a person is readmitted after 6 months for the same or a different sickness the person  again has 18 days benefit.

The 1st and 2nd day benefits are subject to a 90 day waiting period.

Dread Diseases are covered from the day it is first diagnosed at R7,500 per day. Dread disease includes the following;

This benefit is subject to a 90 day waiting period.

Accident: Cover is limited to R 100,000 per person per event with a limit of R 200,000 per annum per family. The principle member also enjoys a R 250 000 benefit in the event of accidental permanent disablement. The member will be responsible for the first R500 of each accident claim.

Claims procedures:

• QA Care Plus are the appointed admin Managers for Day 1 Health.
• All hospital admissions must be authorized with QA Care 48 hours prior to admission for all non-emergency procedures.
• For accidents/emergencies authorization must be obtained within 48 hours of admission.
• All claims settlements are effected via the VISA electronic card.