affintiy health presentation lydia 2016
TRANSCRIPT
Our health insurance plans cover your day to day medical expenses, as well as emergency or hospital treatment in the
event of an accident or illness.
TABLE OF CONTENTSDay-to-Day Cover
Hospital Plan
Comprehensive Cover
Senior and Junior Options
Optional Booster Benefits
DAY TO DAY COVER
UNLIMITED DOCTOR VISITSand medication for general day to day ailments, as per our formulary.
Basic and emergency dentistry as per our formulary.
Basic acute medication as per our formulary
Family funeral cover.
R2000 emergency casualty benefit.
Basic optometry as per formulary.
Post hospital, private home for up to R10 000 nursing.
1 Specialist visit per member per year up to R600 or R1 200 per family as referred by the Network GP only
3 month waiting period
30 day waiting period
3 month waiting period
12 month waiting period
Subject to pre-authorisation
SINGLE MEMBER CHILD - 5 maximum SPOUSER379p/m R179p/m each R339p/m
An Affinity Health Day-to-Day plan helps cover your everyday costs of staying healthy......such as doctor visits and medication, keeping your teeth healthy or even getting yourself a pair of glasses.
HOSPITAL COVERWith an Affinity Health hospital plan you get access to private hospitals.You never know when an accident will happen, or what the consequences of one will be,
but you can make sure you are prepared for it when it does happen.
24/7 emergency medical advice, ambulance services and inter-hospital transfers
Daily hospitalisation cashbenefit in the event of illness
Hospitalisation cover in the event of an accident
Hospitalisation coverduring child birth.
A permanent disability hospitalisation benefit – includes accidental death cover
12 months waiting period
SINGLE MEMBERR499p/m
CHILD - 5 maximumR89p/m each R449p/m
SPOUSE
Hospital costs are for charges like your bed, your meals and theatre.
Medical costs are charges from specialists like surgeons, radiologists and anaesthetists.
SINGLE MEMBERR769p/m
CHILD - 5 maximum
R239p/m eachSPOUSE
R699p/m
COMPREHENSIVE COVERENJOY THE BEST OF BOTH COVER OPTIONS
When you take both our Day-to-Day and Hospital Plan options, you receive even greater value on your monthly premium.
COMBINED COVER
Day-to-Day Policy Principal R10 000, Spouse & Children over age 14 : R10 000Children 6 to 14 : R5 000; Birth to 6 : R2 500; Still born : R1 250
Membership includes body repatriationfrom countries bordering RSA
Hospital PlanPrincipal R25 000, Spouse & Children over age 14 : R10 000Children 6 to 14 : R5 000; Birth to 6 : R2 500; Still born : R1 250 (90 day waiting period)
CombinedPrincipal R30 000, Spouse & Children over age 14 : R15 000Children 6 to 14 : R10 000; Birth to 6 : R5 000; Still born : R2 500 (90 day waiting period)
Day-to-Day BenefitsDentistryChronic MedicationOptometryFamily Funeral Benefit
30 Days3 Months6 Months12 Months3 Months
Hospital Daily Illness BenefitsStated BenefitsAccidentFamily Funeral Benefit
3 Months12 Months (Hysterectomy 24 months)None3 Months
GROUP SCHEMES (negotiated)
NO WAITING PERIOD NO MAXIMUM ENTRY AGE
Maximum Entry Age: 64
Maximum Entry Age: 54
DAY TO DAY COVER
WAITING PERIODS
24 Hour EmergencyMedical Assistance 24-hour health advisory and trauma counselling service
Emergency EvacuationServices
Emergency Trauma Centre dispatches ambulance, helicopter or fixed wing as appropriate
Emergency Casualty Benefit
Two incidences per member / family per year up to R10,000 per incident. Covers any medical and trauma emergency, including road accidents, school sports injuries, crime related such as hi-jacking, rape etc.
Hospital AdmissionGuarantee
Covers up to R50,000 Hospital Admission Guarantee Deposit to ensure that member is not rejected from a private hospital, is admitted, treated and stabilised within the Golden Hour
Body Repatriation BenefitBody of deceased member will be Repatriated to place of burial if death occurred at a different location. Benefit is applicable anywhere within the boarders of South Africa, Lesotho or Swaziland.
WAITING PERIOD None
Age Limit 64 years old
SINGLE MEMBERR99p/m
Product TypeOption 1
Day-To-DayOnly
2016 Rates
Option 2Hospital Benefits
Only
Option 3 (Option 1 & 2)
Complete PackageAffinity Rescue
Principal Member
Spouse
Child Dependent (only pay up to 4 children)
R379 R499 R769
R339 449 R699
R179 R89 R239
Senior Member R579
R 109 or R 169
per family
Spouse
Child Dependent (only pay up to 4 children)
R519
R179N/A
R 109 or R 169
per family
Senior Plan (ages 55-64)
Product TypeOption 1
Day-To-DayOnly
Option 2Hospital Benefits
Only
Option 3 (Option 1 & 2)
Complete PackageAffinity Rescue
Doctor VisitsGP Network
Out of Network
No claim necessary for Network GP as submitted electronically by GP of their choice.
Member may see any doctor by paying first and claim back from Affinity Health for up to R220 per visit
Medication
AcuteSupplied by the dispensing doctor or script dispensed by any Pharmacy including Dischem and Clicks as per formulary
Complete and submit chronic application form to Affinity Health Chronic Authorisation department for processing. 6 month waiting period.Chronic
Hospital
Accident Member calls 0861 11 00 33 who will ensure member is taken to nearest hospital equipped to treat specific condition.
Illness Member calls Affinity Help Line for pre-authorisation
24hr Emergency Services Member calls emergency help line 0861 11 00 33 for 24 hour medical advice line
AFFINTIY RESCUE EMSEmergency Casualty & Hospital Admission Guarantee
Member calls Affinity Rescue Help Line 086 111 7774 for 24 hour emergency assistance, emergency casualty assistance, or hospital admission guarantee
Affinity Health Claims Process
Emergency Services
