Major Medical Event Benefits

Major Medical Event Benefits

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    Benefits

    Major medical event benefits can only be taken in conjunction with Health4Me day-to-day benefits.

    Benefits

    Accident and Emergency Cover*
    Casualty benefit
    Accident cover in-hospital benefit
    Emergency cover (heart attack and stroke only) in-hospital benefit
    Hospital Cash and Maternity Lump Sum Benefit
    Payment per day in hospital (waiting periods apply) **
    Maternity lump sum benefit (waiting periods apply)
    Funeral Benefits (natural death waiting periods apply)
    Principal member, spouse and children > 14 years
    Children 6 - 13 years
    Children 1 - 5 years
    Children < 1 year
    Stillborn babies (past 28 weeks gestation)

    Base

    Accident and Emergency Cover*
    Casualty benefit
    Up to R30 000 per event
    Accident cover in-hospital benefit
    Up to R200 000 per event at a private hospital
    Emergency cover (heart attack and stroke only) in-hospital benefit.
    Up to R250 000 per event at a private hospital
    Hospital Cash and Maternity Lump Sum Benefit
    Payment per day in hospital (waiting periods apply) **
    R500 per day for stays > 48 hours
    Maternity lump sum benefit (waiting periods apply)
    R10 000 lump sum benefit if hospitalisation is due to childbirth, irrespective of number of days member has been hospitalised
    Funeral Benefits (natural death waiting periods apply)
    Natural Death
    Accidental Death
    Principal Member, Spouse and Children > 14 years​
    R10 000
    R20 000
    Children 6 - 13 years
    R5 000
    R10 000
    Children 1 - 5 years​
    R2 500
    R5 000
    Children < 1 year
    R1 250
    R2 500
    Stillborn babies (past 28 weeks gestation)
    R750
    R1 500
    Premiums
    Main Member

    R147.50

    Spouse

    R147.50

    Child

    R78.80

    Standard

    Accident and Emergency Cover*
    Casualty benefit
    Up to R30 000 per event
    Accident cover in-hospital benefit
    Up to R1 000 000 per event at a private hospital
    Emergency cover (heart attack and stroke only) in-hospital benefit.
    Up to R500 000 per event at a private hospital
    Hospital Cash and Maternity Lump Sum Benefit
    Payment per day in hospital (waiting periods apply) **
    R1 000 per day for stays > 48 hours
    Maternity lump sum benefit (waiting periods apply)
    R20 000 lump sum benefit if hospitalisation is due to childbirth, irrespective of number of days member has been hospitalised
    Funeral Benefits (natural death waiting periods apply)
    Natural Death
    Accidental Death
    Principal Member, Spouse and Children > 14 years​
    R15 000
    R30 000
    Children 6 - 13 years
    R7 500
    R15 000
    Children 1 - 5 years​
    R3 750
    R7 500
    Children < 1 year
    R1 875
    R3 750
    Stillborn babies (past 28 weeks gestation)
    R1 125
    R2 250
    Premiums
    Main Member

    R211.10

    Spouse

    R211.10

    Child

    R116.50

    * Accident and emergency cover

    Emergency transportation, stabilisation and treatment cost paid in case of an accident that requires immediate medical treatment. If the benefit limit is exceeded, and further treatment is required, the member will be transported to a state facility for further care. An accident shall mean a medical emergency that is an external, unexpected event that is not traceable, directly or indirectly, to a member’s state of mental or physical health prior to the event. In the case of medical emergencies that do not fit the qualifying criteria, transportation, stabilisation and treatment at a state facility will be covered.

    ** Payment per day in hospital

    Base

    Maximum of R20 000 payable per member per year.
    Maximum of 40 days payable per member per year.

    Standard

    Maximum of R20 000 payable per member per year.
    Maximum of 20 days payable per member per year.

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