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2020
Product name
Authorised Financial Services Provider,
FSP 45750
Underwritten by Constantia InsuranceCompany Limited, an authorised
FSP 31111
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CLASSIC & PRIME CLASSIC SENIOR
PRIME CLASSIC
You get a Classic Senior and a Prime Senior Package, benefits are the same as the classic and prime packages.
The classic option is an affordable healthcare plan with exceptional value for employees (additional dependents) in high risk sector. This plan offers unlimited comprehensive accidental & emergency hospital cover, with access to any private hospital in South Africa.
The prime option is a new generation healthcare option that offers complete day-to-day benefits (3000 network providers) with unlimited GP visits, unlimited nurse consultation, specialists consultations, acute prescribed medication and listed chronic medication, maternity, pathology, radiology, basic dentistry, basic optometry.Additional accidental & emergency hospital cover included.
The prime classic option is a new generation healthcare option that offers complete day-to-day benefits (3000 network providers) with unlimited GP visits, unlimited nurse consultation, specialists consultations, acute prescribed medication and listed chronic medication, maternity, pathology, radiology, basic dentistry, basic optometry.Additional accidental & emergency hospital cover included.
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, with provision of proof of registration at a tertiary institution, the age can be extended up to 25 years
MRI + CT ScansPhysio-TherapyOccupationalTherapy
Ÿ GP minor procedures -Ÿ Nurse consultations -
Ÿ Chronic medication -Ÿ Pre-brith maternity -
Ÿ Acute medication -
Ÿ GP consultations -
Ÿ Specialist consultations
Ÿ Pathology -
Ÿ Vaccines -
Ÿ Radiology -
Ÿ Pap smears -
Ÿ Dentistry -Ÿ Optometry -
2 months
2 months
2months2months
9 months12 months2 months
Additional Premiums: Additional premiums are payable for each insured person aged 56 and older at the commencement date of their policy with the company. If the insured person had either a medical scheme or primary healthcare insurance coverage for 15 years or more since the age of 35, then the additional premiums may be waived if the applicant can demonstrate otherwise. Open enrolment, community rating and cross-subsidisation: This policy is subject to open enrolment, community rating and cross-subsidisation. This means that for a particular plan anyone may join and premium rates are only differentiated by principal member, adult and child dependents. Termination of cover: Either party may cancel the policy by giving the other party thirty-one (31) day's notice in writing.
12months2 months
2 months2 months2 months
2 months
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GP consulta�ons
Nurse consulta�ons
Specialist consulta�on
AND PRIME CLASSIC
UnlimitedAt any Unity Health Network GP
Pre-authorisa�on required for 10 or more GP or Nurse visits per person per year.
Minor procedures in doctor's rooms are included in GP visits e.g. wound s�tching, applying a cast to a broken arm, circumcision, ect.
UnlimitedNurse consulta�ons available at approved pharmacies (Clicks, Dischem) for minor
ailments. Nurses can provide scripts for minor ailments for up to schedule 2 medica�ons at many prac�ces. Pre-authorisa�on required for 10 or more nurse
visits per person per year.
Limited to R1200.00 per visit with an overall limit of R 2500.00 per family per year. Referral by a Unity Health Network GP
Dispensing GP: UnlimitedThis means your GP dispenses medica�on and will provide you with the
necessary medica�on.Non - Dispensing GP: Unlimited
Limited to medica�on prescribed during your Unity Health Network GP visits. This means your GP does not provide you with medica�on, but will provide you
with a prescrip�on to collect your medica�on at your nearest pharmacy. Medica�on is only coverd according to a set formulary list.
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Chronic medica�on
Maternity
Pathology
Radiology
Den�stry
Optometry
(1.) Asthma; (2.) Chronic Obstruc�ve Pulmonary Disorder; (3.) Diabetes Type 1&2; (4.) Epilepsy; (5.) HIV/AIDS; (6.) Hyperlipidaemia; (7.) Hyperten�on; (8.)
Tuberculosis
Chronic Condi�on:
Your Unity Health Network GP will assist you to register on the Chronic Medica�on Programme with Mediscor. Your prescribed chronic medicines will be covered
according to a set formulary list. Find the formulary list on the Mediscor website: www.mediscor.net
A condi�on / disease that lasts for an extended period of �me.
Chronic Medica�on Programme: 8 Listed Condi�ons
Chronic Medica�on Programme:
Subject to a limit of R3000.00 per family per year 2 gynaecologist visits and 2 ultra-sound scans per pregnancy. Clients exceeding age
55 are excluded from this product benefit.
Basic list of blood tests according to specified "tarrif codes". Your Unity Health Network GP must ask for these tests to be done. E.g. blood sugar, cholestrol tests,
ect . Only a Designated Service Provider may be used.
Basic black and white X-rays according to specified "tarrif codes". Your Unity Health Network GP has to refer you to have X-rays done. Specialised radiology
such as MRI / CT scans is not covered. Only a Designated Service Provider may be used.
Subject to a limit of R1200.00 per person per incident Treatment includes: full mouth assesment, intra oral radiographs, scale & polish, extrac�ons, emergency
root canal treatment, fillings, pain and sepsis treatment. At any Unity Health Network Den�st.
One eye test per person per yearA standard frame to the value of R254.00 and one pair of clear standard spectacle
lenses per person every 24 months. At any PPN Network Optometrists.
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AND PRIME CLASSIC
Health Screenings
Pap Smeers
PSA Screening
Vaccina�on Programme
Limited to one screening per person per yearHealth screenings include health checks for: *Blood Pressure, *Cholesterol,
*Glucose Levels, *Body Mass Index, *Waist Circumference, *HIV and pre-&post Test Counselling. Available at approved pharmacies (Clicks, Dischem)
Available once every 2 years a�er the age of 21. Services may be rendered by both a private gynaecologist and/or a Unity Health Network GP.
Available once every 2 years a�er the age 50. Available at approved pharmacies (Clicks, Dischem)
Vaccina�ons include the following: *Influenza - before 31 May on a yearly basis, *Tetanus - available once every 10 years, *Hepa�tus A & B - available once-off,
*Pneumococcal - available once every 5 years for those aged 60 and older and for those with medically proven compromised immune system. Available at approved
pharmacies (Clicks,Dischem)
WELLNESS PROGRAMME
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AND PRIME CLASSIC
Overall Yearly Limit
In-Pa�ent Hospital Treatment (Accident Only)
Out-Pa�ent Casualty Treatment (Accident Only)
In-Pa�ent Hospital Stabilisa�on (Emergency Only)
AND PRIME CLASSIC
Unlimited
The actual cost of hospitalisa�on as an in-pa�ent, including all associated services during the hospital admission at any private facility in the event of injuries sustained due to an accident. Pre-authorisa�on is required.
An accident means bodily injury caused by violent accidental and external physical means. E.g severe injuries resul�ng from a vehicle accident or working with factory machinery.
Limited to R1 100 000.00 per person per incident
What is an accident?
What is an accident?
Limited to R6000.00 per person per incident The benefit payable for injuries sustained as a result of an accident shall be limited to treatment received in a hospital
emergency unit. Pre-authorisa�on is required.
An accident means bodily injury caused by violent accidental and external physical means. E.g severe injuries resul�ng from a vehicle accident or working with factory machinery.
The actual cost of hospitalisa�on as an in-pa�ent, in the event of an emergency that necessitates the stabilisa�on of the pa�ent before the pa�ent is transferred to a public hospital. Surgical procedures are injury sustained due to an
accident. Pre-authorisa�on is required.What is an emergency?
An event or unexpected health condi�on, which if not treated immediately would result in death or serious bodily impairment. E.g. heart a�ack, stroke.
Limited to R22000.00 per person per incident
MRI & CT Scans (Accident Only) The actual cost of a MRI & CT scan necessitated as a result of an injury sustained due to an accident. Pre-authorisa�on
is required.
Limited to R16000.00 per person per incident
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Physiotherapy & Occupa�onal Therapy (Accident Only)
Emergency Services (Er24)
Accidental Death Benefit
AND PRIME CLASSIC
Physiotherapy & Occupa�onal therapy following an in-pa�ent hospitalisa�on due to an accident. Limited to a period of 3 months following the discharge from an in-pa�ent hospitalisa�on incident. Pre-authorisa�on is required.
Limited to R3000.00 per person per incident
*Ambulance Services (road, air) *Inter-hospital Transfer *Repatria�on of mortal remains *Telephonic Medical Advice *Push-to-call Emergency Dialing Applica�on. Provide Hospital pre-authorisa�on & Guarentee-of-Payment (GOP) in the
event of an accident / emergency
Emergency Evacua�on, including:
A lump-sum will be payable for the life(s) assured in the case of accidental death. Only available with the Classic and/or Prime Classic op�on.
Limited to R10 000.00 for both main member and the spouse
Shopter Reward Limited to one reward benefit per family per year. A medical product will be issued to the main member on a subscribed term period. Available with all plan op�ons.
VALUE ADDED BENEFITS08
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PREMIUM RATES 2020
PLAN OPTION MEMBER RATE
Classic
(Hospital Benefits)(Age 18-55)
ShopterPrincipal
R103.00R159.00
Total R262.00
SpousePer child
R86.00R35.00
Prime (Age 18-55)(Day-to-Day Benefits)
PrincipalShopter R65.00
R370.00
Total R435.00
Per childSpouse R245.00
R110.00
Prime Classic (Age 18-55)(Day-to-Day Benefits & Hospital Benefits)
PrincipalShopter
R470.00R80.00
Total R550.00
SpousePer child
R335.00R130.00
(Age 56-100)Classic Senior
(Hospital Benefits)PrincipalShopter
R200.00R95.00
Total R295.00
Spouse R127.00
(Day-to-Day Benefits)(Age 56-100)Prime Senior
PrincipalShopter
R543.00R27.00
Total R570.00
Spouse R418.00
(Age 56-100)(Day-to-Day Benefits & Hospital Benefits)
Prime Classic SeniorPrincipalShopter R29.00
R671.00
Total R700.00
Spouse R536.00
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Head Office: +27 (0) 81 273 736215 Barnes Street, Westdene,
Bloemfontein, 9301 E-mail: info@ihealthinterna�onal.com
The iHealth interna�onal medical cover brand was created under Umbrella crea�on (Pty) Ltd who is an authorised financial services provider with FSP 45750.
Underwri�en by Constan�a Insurance
Company Limited, an authorised
FSP 31111
Product name
Physical Addess: Ambledown HouseEton Office Park East c/o Sloane & Harrison StBryanston 2191FSP 10287
