Affinity Health Product Guide
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Affinity Health
Product Guide | 2019
V6.5
9.4 Affinity Health, medical cover you can trust. Medical Provider Industry Affinity Health Average Average Hellopeter Rating Hellopeter Rating Through our knowledge, passion and expertise we have revolutionised the Medical Insurance Industry. Access to private, primary healthcare services remains out of reach for many South Africans. Our goal is to change this by providing all South Africans with access to affordable, private health cover.
Who are we?
Affinity Health is South Africa’s leading health insurance provider
offering you an extensive range of health cover at affordable rates.
What do we offer?
Affinity Health provides you with a Day-to-Day plan, a Hospital plan or a
combination of the two for total peace of mind. We also offer benefit booster
options to increase your level of cover.
Doctors Dentists
Specialists Hospitals
Medication Day Clinics
We understand the importance of having medical insurance that meets
your needs, budget and lifestyle.
Through extensive research, we have created a varied and affordable
range of healthcare products that are designed to protect you and your
family when it matters most.
Quick access to over 4000 medical
professionals on our provider network.
Day-to-Day Overview Hospital Overview
The Affinity Health Day-to-Day plan has been designed to In the unfortunate event that you fall severely ill or
help you cover the everyday costs of staying healthy such require hospitalisation due to an accident or injury,
as going to the doctor or dentist, obtaining prescribed your treatment can be performed at one of our
acute medication or receiving a pair of reading glasses. preferred listed private hospitals.
GP and Specialist Consultations Dailly Illness Hospitalisation, including Day Clinics
Acute and Chronic Medication 24hr Emergency Services
Radiology and Pathology Maternity
Basic Dentistry Accidental Permanent Disability
Optometry Dread Disease
Casualty Room Treatment Family Funeral Cover
Day-to-Day Plan ‘Out-of-hospital’ medical benefits Our Day-to-Day Health Plan assists with the management and treatment of common illnesses, injuries, preventative measures and other essential medical requirements.
General Doctor Consultations Specialist Consultations
DAY-TO-DAY PLAN
Your health is our primary concern and as such, our In more serious cases your GP may refer you to a
Day-to-Day plan provides you with UNLIMITED, specialist for further treatment. We will cover a Rand
managed visits to a network GP. We’ll do our best to help value for the consultation based on your plan
you get back on track and feeling better as soon as composition (individual or family).
possible.
Single Member Family
Out-of-network consultations Covers 1 visit per Covers 1 visit per
policy per year policy per year
You may also visit a doctor of your choice, outside of our
provider network, in which case we will reimburse you up R800 R1,600 per visit
to a maximum Rand value for the consultation fee.
3 Month waiting period
1 Month waiting period
Acute Medication
Depending on your diagnosis, your doctor may dispense or
prescribe acute medication to help alleviate your symptoms.
We will cover the medication costs according to our formulary.
1 Month waiting period
Casualty Room Treatment
DAY-TO-DAY PLAN
Casualty Room treatment is for a sudden emergency
like a car accident or severe illness where you would
Immediate Casualty
need to be treated and stabilised as a matter of
Room Treatment
urgency. This benefit is available 24/7 and requires
pre-authorisation. Casualty room treatment as a result of an
accident between the application date and the
Up to R3,000 per Up to R4,000 (R4,250 Senior) per commencement date, up to R1,000 per policy.
policy per year policy per year if a combined plan
is taken.
1 Month waiting period
Dentistry Radiology and Pathology
Good oral hygiene is important for overall health. With our Sometimes medical ailments go beyond the doctor’s
basic dentistry benefit, you get proactive and reactive room and require futher tests and analysis for a more
dental care for prevention and repair, provided by one of accurate diagnosis.
our network dentists.
Affinity Health will cover unlimited basic blood tests and
We will cover 1 full mouth assessment or 1 scale and polish, x-rays as recommended by a medical practitioner.
infection control, 2 intraoral radiographs, 3 extractions and
3 amalgam fillings per member per year.
1 Month waiting period
3 Month waiting period
06
Medical Society
Optometry Centre Consultations
DAY-TO-DAY PLAN
Struggling to see those road signs or the fine print in your Operating in partnership with strategically located
favourite book? Why not go for a quick eye test at your private medical centres, The Medical Society is able to
nearest Spec-Savers? We will pay for for your consultation service thousands of people in need of primary health
and a pair of standard frames and lenses. care, everyday.
This benefit is applicable per member, every 24 months. Easy walk-in service with no need for an appointment
and you get unlimited, managed consultations.
12 Month waiting period
1 Month waiting period
Family Funeral Cover
Nobody wants to think about losing a loved one, but it’s
something we all need to plan ahead for. Funerals are
often unexpected and the costs are high. This benefit
offers funeral assistance to you and to your family as a
result of the death of a member. Waiting periods commence on the Commencement
Date, unless otherwise stated.
Policyholder R12,500
Spouse and Children over the age of 14 R12,500 The Day-to-Day Plan Family Funeral benefit is
excluded on Affinity Junior.
Children over the age of 6 R6,000
Children birth to 6 years of age R3,000
Stillborn from 28 weeks R1,500
3 Month waiting period
Hospital
Plan
Private hospitalisation
cover
Our hospital plan provides
you with a wide range of
benefits in the event of
hospitalisation as a result
of an accident or illness.
When it comes to medical expenses there
are two types of costs associated with
HOSPITAL PLAN
hospitalisation; hospital stay costs and
medical costs.
Hospital Stay Costs
These costs are associated with
general daily expenses like your
bed, your meals and theatre. These
costs accrue with each passing day
during your stay in hospital.
Medical Costs
Medical costs are charges
from specialists like surgeons,
radiologists and anaesthetists.
Having Hospital Cover with Affinity Health
means that you have a benefit amount
available to help cover these kinds of costs.Dailly Illness Hospitalisation If you have an active ICU Booster, the maximum daily
cover amount increases to up to R24,000 per day if
you are admitted to ICU within the first 3 days.
When you are admitted to hospital due to an illness,
HOSPITAL PLAN
we will cover the associated expenses up to a
maximum Rand amount per day.
1st Day Up to R20,000 Senior: Up to R17,000 Day Clinics
2nd Day Up to R20,000 Senior: Up to R17,000
3rd Day Up to R20,000 Senior: Up to R17,000 As a cost saving measure and to minimise any
potential shortfalls, we now cover certain minor
4th Day Up to R8,500
procedures at an affiliated Day Hospital under
5th Day Up to R8,500 the Daily Illness Hospitalisation benefit.
Thereafter up to R3,000 per day up to a maximum 3 Month waiting period
of 21 days per member, per illness event.
Accident Cover
Cover for accidental injuries that require admission to
Immediate Accident Benefit
hospital where you will be stabilised and treated. Each
event is covered up to a maximum Rand value. Up to R100,000 per single member per event.
Up to R150,000 per family per event.
Up to R175,000 per single member per event.
Senior Only
Up to R275,000 per family per event.
Up to R70,000 per single member per event.
Senior Only Up to R85,000 per family per event.
Up to R110,000 per single member per event.
Up to R150,000 per family per event. Available between the application
date and the commencement date.
No waiting periodCasualty Room Treatment Accidental Permanent Disability
Casualty Room treatment is for a sudden onset of severe No one wants to imagine being involved in an accident
HOSPITAL PLAN
illness where you would need to be treated and stabilised as a that may result in them losing their arms, legs or even
matter of urgency. This benefit is available 24/7 and requires eyesight.
pre-authorisation.
This benefit will cover the costs of all your medical bills
such as hospital stay, treatment and procedures.
Up to R3,000 per Up to R4,000 (R4,250 Senior)
policy per year. per policy per year if a
combined plan is taken. Up to R250,000 cover for the
Policyholder or spouse only.
1 Month waiting period
No waiting period
Maternity 24-Hour Emergency Services
Hospital cover isn’t much without the ability to get
Having a baby can be an exciting, yet stressful time.
you there safely. Our extensive list of medical
With our maternity benefit, you will have peace of
providers inlcudes ambulance services standing by
mind knowing that you have financial assistance up to to come to your aid, 24/7.
a maximum Rand value, depending on the procedure.
This benefit also provides 24-hour medical advice,
Maternity Natural Maternity C-Section inter-hospital transfers and the arrangement of
Up to R25,000 Up to R35,000 guarantees of payment to the treating facility.
3 Month waiting period No waiting periodFamily Funeral Cover Dread Disease
Nobody wants to think about losing a loved one, but it’s Being diagnosed with a dread disease is not something
HOSPITAL PLAN
something we all need to plan ahead for. Funerals are most people plan for. Affinity Health’s Dread Disease
often unexpected and the costs are high. This benefit benefit will cover your treatment costs up to R200,000
offers funeral assistance to you and to your family as a according to severity.
result of the death of a member.
• Heart Attack • Cancer
Policyholder R25,500
Spouse and Children over the age of 14 R10,000 • Coronary Heart Disease • Kidney Failure
Children over the age of 6 R5,000 • Stroke • Major Organ Transplant
Children birth to 6 years of age R2,500
Stillborn from 28 weeks R1,250 3 Month waiting period
3 Month waiting period
Pre-Existing Conditions are subject to a 12 month The Hospital Plan Family Funeral benefit is excluded on
waiting period from Commencement Date. Affinity Junior and Affinity Senior.
Waiting periods commence on the Commencement The Dread Disease and Accidental Permanent Disability
Date, unless otherwise stated. benefits are excluded on Affinity Senior.Combined Plan
The Affinity Health Combined Plan provides you with a combination
of all the benefits available on the Day-to-Day and Hospital Plans.
Your benefit amounts for the Family Funeral and Casualty Room
Treatment benefits increase automatically. Your overall premium is
also discounted.
Casualty Room Treatment
Up to R4,000 per policy per year.
Funeral Cover
Policyholder R30,000
Included in both Day-to-Day and Hospital
Spouse and Children over the age of 14 R15,000
Children over the age of 6 R10,000 Plans, Post-Hospital Private Home Nursing for
Children birth to 6 years of age R5,000 up to R10 000 per policy as recommended by
Stillborn from 28 weeks R2,500 an Affinity Health Specialist.Policy Rates / Monthly premiums are based on the plan type chosen Monthly Premiums and the number of dependents on your policy. Standard Day-to-Day Hospital Combined Policyholder From R509pm From R819pm From R1,179pm Add spouse From R459pm From R699pm From R1,029pm Add adult dependant From R509pm each From R769pm From R1,129pm Add child dependant From R239pm each From R194pm each From R394pm each Senior Policyholder From R789pm From R879pm From R1,349pm Add spouse From R709pm From R769pm From R1,169pm Add adult dependant From R789pm From R829pm From R1,299pm Add child dependant From R239pm each From R194pm each From R394pm each Junior First Child From R479pm From R734pm From R1,104pm Add child From R239pm each From R234pm each From R394pm each • You may add up to a maximum of 7 dependants. • Premiums may be subject to an additional risk premium which will be confirmed upon application.
Optional
Benefit Boosters
Get the most out of your Health Plan
Within each plan type there are benefits which are eligible
to be upgraded for better overall cover. You can add or
remove boosters on your policy at any time.
You have access to the following Boosters:
Chronic Increased Accident
Medication Cover
ICU iERConditions Covered
Medication
Chronic Essential Addison’s Disease
Asthma
Bronchiectasis
Cardiac Failure
This benefit offers cover for chronic medication Cardiomyopathy
Chronic Renal Failure
over and above the Acute Medication benefit on
COPD
the Day-to-Day Plan. We have a defined list of 23 Coronary Artery Disease
chronic conditions covered under this benefit. Crohn’s Disease
Diabetes Insipidus
We will pay for the medication as defined on our Diabetes Mellitus 1
medicine formulary. Diabetes Mellitus 2
Dysrhythmia
Epilepsy
Glaucoma
“How do I qualify?” Hyperlipidaemia
Hypertension
You will need to see your doctor who will
Hypothyroidism
diagnose, approve and prescribe the required Multiple Sclerosis
BOOSTERS
medication accordingly. Parkinson’s Disease
Rheumatoid Arthritis
Systematic Lupus Erythematous
Ulcerative Colitis
“How do I get my medicine?”
Your doctor can dispense the medication directly
(if he/she is a dispensing doctor) or you can
collect your prescription from any pharmacy
linked to the Affinity Health formulary.
R69pm per member
per chronic condition.
3 Month waiting periodAccident Benefit
Booster
You don’t want to find yourself in a situation where
your medical expenses exceed your cover limit.
Get complete peace of mind with increased Accident
Cover up to a maximum of R1,050,000 depending
on the level of cover chosen.
Single Cover Family Cover
BOOSTERS
Up to R250,000 R89pm Up to R400,000 R159pm
Up to R350,000 R178pm Up to R550,000 R318pm
Up to R450,000 R267pm Up to R700,000 R477pm
Up to R550,000 R356pm Up to R850,000 R636pm
Up to R650,000 R445pm Up to R1,000,000 R795pm
Up to R750,000 R534pm
Up to R850,000 R623pm The Accident Booster has no
Up to R950,000 R712pm waiting period and is applicable
Up to R1,050,000 R801pm from the Commencement Date.Intensive Care Unit
(ICU)
An Intensive care unit provides specialised treatment to
patients that require critical medical care. Patients in ICU
are under constant care by specialised medical staff.
Up to
R12,500
cover per day in ICU for up to 5 days.
BOOSTERS
Single Cover Family Cover
R79pm R158pm
Remember, when you take out the ICU booster, your
Daily Illness Hospitalisation Benefit amount is increased
to R24,000 per day if you are admitted to ICU within the
first 3 days of hospitalisation.iER
Booster
iER is South Africa’s leading, dedicated 24-hour emergency
response and disaster management network. This service is
linked directly to our own ‘free to use’ and graphically appealing
mobile application with built in GPS location functionality.
• Access to over 2000 network providers.
• Private Emergency Evacuation Services.
• Hospital stabilisation deposit up to R40,000.
• Emergency Casualty Room Stabilisation up to R6,000.
• 24-Hour telephonic medical advice.
• All benefits, except the telephonic medical advice, are
applicable to life-threatening events only.
BOOSTERS
Single Cover Family Cover
R39pm R59pm
Download the FREE
TO USE iER App today.
SAVING LIVESContact Information
Call Centre Email Address Fax Number
0861 11 00 33
@ info@affinityhealth.co.za 086 607 9419
Physical Address Postal Address
1 Dingler Street, Posnet Suite 124,
Rynfield, Private Bag x101,
Benoni 1501 Farramere,
Benoni 1518
affinityhealthcoza
Disclaimer
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.
Subject to Demarcation Regulations, the Insurer does not refuse
membership on the basis of any means of discrimination.
Affinity Health, a product of National Risk Managers (Pty) Ltd (FSP 47132), the
Underwriting Managing Agency; Lion of Africa Life Assurance Company Ltd (FSP 15283),
the Insurer. This policy shall be voidable in the event of misrepresentation, misdescription
or non-disclosure of any particular material fact to this insurance by or on behalf of an
insured person. Terms and conditions as contained in the policy document apply.You can also read
