WORKERS PLANS
In our workers plan options, we have created a simple but effective employee benefit offered for employer groups to provide cover for those employees who simply cannot afford a medical aid. The workers plan options combines Emergency medical transport with a hospital cashback plan and a funeral benefit to ensure your employees get the medical assistance they need in an emergency situation while being financially supported should there be a need for hospitalisation, or worse. Relieving the financial burden that lengthy hospital stays and funerals can put on employees, leads to better staff morale and increased productivity. We offer a selection of readymade options, as well as standalone funeral cover. Company specific products can be tailored for large employer groups, unions and bargaining counsels.
IN HOSPITAL PLAN – This is not a medical aid
| 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
Day 2 and onwards R1000 per day Limited to a total of 10 days per annum per member |
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. |
| ICU Admission | R3 000 per day.
Limited to 17 days per annum per member |
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. |
| Accidental Death Benefit | R100 000 per single member per annum
R200 000 per family per annum |
Accidental Death | Benefit will be payable in cash. | Principal Insured or his / her Nominated Beneficiary on the date of death. |
| 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. |
DAY TO DAY BENEFITS – OPTION PLAN 1
Unlimited Managed Doctor Visits
Via a registered 1Doctor Health Network Provider. A co-payment of R75.00 will apply for all additional visits after the 5th visit.
Specialist Benefit
Specialist Benefit of up to R500 per family per annum. Subject to pre-authorisation and referral from a 1Doctor Health Network GP.
Acute Medication
Acute medication covered according to the 1Doctor Health formulary. Linked to the doctor consultation dispensed by the 1Doctor Health Network GP or obtained on script from a Network Pharmacy.
Chronic Medication
Chronic medication covered according to the 1Doctor Health formulary.
Radiology
Basic radiology according to the 1Doctor Health formulary via a 1Doctor Health Network GP. Black and white diagnostic x-rays only.
Pathology
Basic diagnostic blood tests on referral by a 1Doctor Health Network GP and subject to a list of basic pathology tests approved by Day1 Health.
Basic Dentistry
Basic treatment includes preventative cleaning, pain control, fillings, one emergency root canal treatment and extractions via a 1Doctor Health Network Dentist.
Optometry (Spec-Savers)
One eye test and one set of glasses every 24 months per the specific Spec-Savers agreed protocol range. 6 month waiting period applies.
Out-of-Area Visits
In the event that you cannot see your Network GP, the Plan will allow 3 “out of area” visits per family per annum to an alternative Network GP or GP of your choice, subject to pre-authorisation.
DAY TO DAY BENEFITS – OPTION PLAN 2
Unlimited Managed Doctor Visits
Via a registered 1Doctor Health Network Provider including. 1st & 2nd trimester pregnancy ultrasounds. No waiting period applies.
Acute Medication
Acute medication is covered according to the 1Doctor Health formulary. No waiting period applies.
Chronic Medication
7 “High Impact” Chronic conditions are covered according to the 1Doctor Health formulary. These conditions are; Diabetes, Type 1 & 2, Epilepsy, HIV/AIDS, Hypertension, Tuberculosis, Hyperlipidaemia and Chronic Obstructive Pulmonary Disorder. No waiting period applies
Radiology
Basic radiology according to the 1Doctor Health formulary via a 1Doctor Health Network GP. Black and white diagnostic x-rays only. No waiting periods apply.
Pathology
Basic diagnostic blood tests on referral by a 1Doctor Health Network GP and subject to a list of basic pathology tests approved by Day1 Health. No waiting periods apply.
Basic Dentistry
Basic treatment includes preventative cleaning, pain control, fillings, one emergency root canal treatment and extractions via a 1Doctor Health Network Dentist. No waiting periods apply.
- Out-of-Area Visits
In the event that you cannot see your Network GP, the Plan will allow 3 “out of area” visits per family per annum to an alternative Network GP or GP of your choice, subject to pre-authorisation. No waiting periods apply.
DAY TO DAY BENEFITS – OPTION PLAN 3
Unlimited Managed Doctor Visits
Via a registered 1Doctor Health Network Provider, incl. 1st & 2nd trimester pregnancy ultrasounds. No waiting period applies.
Acute Medication
Acute medication is covered according to the 1Doctor Health formulary. No waiting period applies.
Chronic Medication
7 “High Impact” Chronic conditions are covered according to the 1Doctor Health formulary. These conditions are; Diabetes, Type 1 & 2, Epilepsy, HIV/AIDS, Hypertension, Tuberculosis, Hyperlipidaemia and Chronic Obstructive Pulmonary Disorder. No waiting period applies.
Basic Dentistry
Basic treatment includes preventative cleaning, pain control, fillings, one emergency root canal treatment and extractions via a 1Doctor Health Network Dentist. No waiting period applies.
Out-of-Area Visits
In the event that you cannot see your Network GP, the Plan will allow 3 “out of area” visits per family per annum to an alternative Network GP or GP of your choice. No waiting period applies.
FUNERAL PLANS / LIVESTOCK
In case of death, the bereaved will receive a cash pay-out equal to the selected cover package. On request Live Wire will gladly refer the bereaved to one of the farmers on our panel to choose a cow, an ox or a bull of their choice to the value of his/her package. The livestock will then be delivered at the address where the funeral takes place.
Option 1
Livestock is available to families of the group from our national panel of suppliers.
The following cover is available:
- Main member: beef
- Spouse: beef
- Children 14 – 21: beef
- Children 7 – 13: meat hamper
- Children 1 – 6: meat hamper
All members must be under 65. Six months waiting period applicable if not a compulsory group only livestock of high quality will be delivered. Unnatural death will pay out. No commission included.
Option 2
Livestock is available to the main member and spouse of the group from our national panel of suppliers.
The following cover is available:
- Main member: beef
- Spouse: beef
Available to all members and individuals under 65 years. Six months waiting period applicable if not a compulsory group only livestock of high quality will be delivered. Unnatural death will pay out. No commission included.
Option 3
Livestock is available to the main member and spouse (for people over 65) of the group from our national panel of suppliers.
The following cover is available:
- Main member: beef
- Spouse: beef
Policy is for joining age between 65 and 84. Only livestock of high quality will be delivered. Six months waiting period applicable if not a compulsory group Unnatural death will pay out. No commission included.
BASIC FUNERAL PLANS |
|
| PRODUCT | BENEFIT VALUE |
| Family | R 5 000 |
| Family | R 10 000 |
| Family | R 20 000 |
Benefit Limits |
|
| PRODUCT | BENEFIT VALUE |
| Principle member and spouse | 100% |
| Child 14 – 20 years | 100% |
| Child 6 – 13 years | 50% |
| Stillborn to 5 years | 20% |