HEALTH BENEFIT
| Name of Product / Benefit | Amount of the Benefit | Benefits payable in the following events | Description of Benefit | Benefits Payable to: | ||||
| Hospital Illness Benefit | Day 1 R500 per day | Hospitalisation due to illness | The benefit amount will be payable in cash for any non-medical expenses incurred due to hospitalisation due to illness. The benefit will be payable the member. Pre-authorization is required from Africa Assist. | Principal Insured or his / her Nominated Beneficiary on the date of death. | ||||
| Day 2 and onwards R1000 per day | ||||||||
| Limited to a total of 10 days per annum per member | ||||||||
| ICU Admission | R3 000 per day. | Admission to ICU | Should a member be admitted to ICU, the benefit will be payable in cash to the member. Pre-authorization is required from Africa Assist. | Principal Insured or his / her Nominated Beneficiary on the date of death. | ||||
| Limited to 17 days per annum per member | ||||||||
| Accidental Death Benefit | R100 000 per single member per annum | Accidental Death | Benefit will be payable in cash. | Principal Insured or his / her Nominated Beneficiary on the date of death. | ||||
| R200 000 per family per annum | ||||||||
| Funeral Benefit: Family | R10 000 | Natural & Unnatural (including Accidental) Death as well as Suicide | The benefit amount will be payable in cash. | Principal Insured or his / her Nominated Beneficiary on the date of death. | ||||
| Debit Order Protection | Value Add | Wrongful Debit Order | This is an assistance contract to assist you with debit order transactions from your personal bank account which you are unaware of. | Non-Cash benefit |
| PRICING SCHEDULE | |
| Main Member | R220.00 |
| Main Member + Spouse | R365.00 |
| Main Member + Spouse + 4 Children | R470.00 |
| BENEFIT LIMITS FOR FUNERAL AND ACCIDENTAL DEATH BENEFIT | |
| Principle Member & Spouse | 100% |
| Child 14 – 20 years | 100% |
| Child 6 – 13 years | R30 000.00 |
| Stillborn – 5 years | R10 000.00 |
DAY TO DAY COVER
Unlimited Doctor Visits
With Over 2700 Network Doctors Nationwide.
Acute Medication
This is limited to medication prescribed during GP Visit, all medication is subject to a FORMULARY .
Chronic Medication
Chronic Medication is covered according to Health Formulary
Basic Dentistry
Basic treatment includes; full mouth assessment, intra oral radiographs, scale and polish, extractions, emergency root canal, fillings, pain and sepsis treatment.
Optometry
One eye test and one set of Spectacles every 24 months.
Pathology
Basic diagnostic blood tests on referral by GP.
Radiology
Basic radiology – Black and white X-rays only.
Vaccination Programme
Influenza, Tetanus, hepatitis A & B, Pneumococcal
Specialist Benefit
Specialist Benefit on referral of GP and Pre-Authorisation required
HOSPITAL CARE
In-patient Hospital Treatment – Accident Only
What is an accident? An accident means bodily injury caused by violent accidental and external physical means.
E.g. Motor Vehicle accident / Burns / Injury from a Crime / Injury from a fall
Out-patient Casualty Treatment – Accidents Only
What is an accident? An accident means bodily injury caused by violent accidental and external physical means.
E.g. Motor Vehicle accident / Burns / Injury from a Crime / Injury from a fall
In-patient Hospital Stabilisation – Emergency Only
What is a Emergency? An event or unexpected health condition, which if not treated immediately, would result in death or serious bodily impairment. E.g. Heart attack / Stroke
FUNERAL PLANS
| Basic Funeral Plans | |||
| PRODUCT | BENEFIT VALUE | PREMIUM | |
| Family | R 10 000 | R 19 | |
| Family | R 20 000 | R 27 | |
| Benefit Limits | |||
| Principle member and spouse | 100% | ||
| Child 14 – 20 years | 100% | ||
| Child 6 – 13 years | 50% | ||
| Stillborn to 5 years | 25% |
FAMILY CRISIS PLAN
| WHO IS COVERED? | EMPLOYEE’S WHOLE FAMILY: HUSBAND + WIFE + FINANCIALLY
DEPENDENT CHILDREN. (E.g. Biological, legally adopted) • Children covered from birth up to age of 21. • If full time student to the age of 25. • Disabled children remain on cover for as long as they are financially dependent on the main member. |
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| DAILY HOSPITAL BENEFIT
The benefit amount will be payable in cash for any non-medical expenses incurred due to hospitalisation due to illness. The benefit will be payable the member. Where more than one member of the family is hospitalised for the same incident, a benefit equal to R400 per day for each member shall apply. |
GENERAL WARD:
• R200 per day • R1,400 per week • R6,200 per month |
ICU WARD:
• R300 per day • R2,100 per week • R9,300 per month |
| TB COVER LIMITATION | Daily hospital benefit is limited to R5,000 per member and R25,000
per family per annum for hospitalisation due to TB. |
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| MEDICAL EMERGENCY TRANSPORTATION | You will have access to the most appropriate transport in the event of a medical emergency. (ambulance, helicopter or aeroplane). | |
| LEGAL ADVICE | • General Legal Advisory Helpline
• Labour Law Advice Line • Motor Accident Advice • Road Accident Fund Advice • Attorney referral service • Access to Standard Legal Documentation • Access to Extensive legal information databases |
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| EMERGENCY HOME ASSISTANCE | Home Assist covers the repair cost of 3 incidents per annum, limited to R500 per incident (R1,500 per annum). The repair cost is not limited to parts and labour but includes a call out fee and kilometer cost. Home Assist is a helpline that puts the client in touch with the appropriate service provider – all complying with specific requirements and maintaining a high level of professional service. | |
| HIV COVER | In case of accidental or traumatic exposure to HIV/AIDS you have:
• Unlimited telephonic counseling intervention, advice and information. |
|
| • “Morning after” pill to prevent pregnancy.
• 30 Day starter pack of anti-retroviral medication. • 7 Day course of medication for the prevention of the development of sexually transmitted deceases. • Registration for an HIV/Aids management programme. Counselor recommended. Contact Centre must be notified within 24 hours of exposure to access the C5 HIV prevention plan. |
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| TRAUMA & ASSAULT | • Cover for Assault is R5 000 per insured person with a maximum of R10 000 per family per occurrence in respect of medical indicated treatment for bodily injury.
• Cover for Trauma is R5 000 per insured person with a maximum of R10 000 per family per occurrence in respect of Psychiatric Consultations. |
| FUNERAL BENEFITS
Natural & Unnatural (including Accidental) Death as well as Suicide |
• Principle – R7,000
• Spouse – R5,000 • Children – R3,000 to R5,000 (aged depended) • Stillborn – R2,500 |
| ACCIDENTAL DEATH BENEFITS
Benefit will be payable in cash. |
R70 000 – Main member
R35 000 – Spouse R25 000 – Child dependent |
| REPATRIATION OF MORTAL REMAINS
Within the borders of RSA |
This benefit will be provided by FMS and is available to the whole family. |
MONTHLY CONTRIBUTION: R108.00 PER MONTH FOR THE WHOLE FAMILY.
This is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership. The details provided are only for marketing purposes. The Master Policy issued is the source of all benefits, rights, and obligations and exclusions. To determine your individual needs, we suggest that you contact your broker and request advice from him / her.
NOTES: FAMILY COVER
A maximum of two {2} spouses can be covered under the policy provided they are both declared at inception. A member who is not legally married can still enjoy family cover provided that all relevant information is supplied to Live Wire Call Centre Solutions. Claims for common-law spouses not declared at inception will not be considered for payment in the event of a death {traditional marriages – included}.
LEGAL LITIGATION
COVER AND BENEFITS
- Free telephonic Legal Advice 365/24/7
- Free Legal Mediation to resolve disputes amicably
- From R80,000 – R160,000 legal expense cover per annum depending on your choice product
- Cover for Individual and your family
- 3 month waiting period on all products
- Discounts on registration of Family & Business Trust & Company to protect your assets from creditors
LEGAL ADVICE
- Telephonic consultations
- Email advice & information
- Helpful advice in Small Claims Court matters
- When calling, the legal advisor will try and resolve the issue OR
- May advise that due to the complexity of the matter, he will have to study case law and revert back to you OR
- Provide you with standard documentation & contracts as required
LEGAL MEDIATION
- Settlement negotiations to resolve the dispute as quickly as possible
- Necessary Telephone calls on your behalf
- Necessary Letters/Faxes/Emails
- Review of legal documentation
LEGAL REPRESENTATION
- In the event that the legal advisor can’t resolve the matter because you must appear in Court, he will refer you to a panel practitioner whereby we will pay your legal bill after finalisation of the matter
- Any matter excluded or those that the inception date (referred to as “historical/old” cases) of the policy, can be attended too, on the condition that you pay the legal bill based on our reduced panel practitioner tariff
FAMILY MATTERS
- Uncontested Divorces
- Advice only on Maintenance/Custody, defamation & Interdicts
CIVIL MATTERS
- Action by or against you
- Prepare and serve Letter of Demand
- Issue Summons and Obtain Warrant of Execution
- Remove Black listing – terms & conditions apply
- Black listing of default/bad payer
- Debt collection
- Problems paying off accounts/defective goods
CRIMINAL MATTERS
- Assault, reckless/negligent/drunken driving charges
- R3,000 Bail Bond on behalf of arrested – t’s & c’s apply (applicable only to *Gold* product choice)
- Murder, Rape, Fraud, Theft & Robbery charges
NOT COVERED
- Traffic fines or any other fine
- Claims arising from political sources
- Patents & Copyrights, Conveyancing and Sheriff’s costs
- Claims against your insurer, 3rd Party Claims (Motor Vehicle Accident)
- Interdicts and Defamation of character
- Contested Divorces and maintenance matters