| GP visits | Members can make use of any National HealthCare Group network GP, either in person or virtually (where available). Benefits include unlimited consultations, when required. WhatsApp functionality for medical advice from qualified nurses is available within the 30-day waiting period and thereafter. |
| Basic Pathology | Basic blood tests as requested by a National HealthCare provider, subject to National HealthCare protocols and the approved list of tests. A 30-day waiting period applies from the participation date or reinstatement date of the policy. |
| Basic Radiology | Basic black-and-white X-rays as requested by a National HealthCare provider, subject to National HealthCare protocols and the approved list of codes. A 30-day waiting period applies from the participation date or reinstatement date of the policy. |
| Acute Medication | Provided by a National HealthCare network GP or a prescription from a network pharmacy according to the National HealthCare medicine formulary. A 30-day waiting period applies from the participation date or reinstatement date of the policy. |
| HIV benefit | HIV ELISA blood test. Referral by a National HealthCare network GP to a state facility if required. A 30-day waiting period applies from the participation date or reinstatement date of the policy. |
| Chronic Medication | Unlimited for 26 chronic conditions. Subject to registration and according to the National HealthCare medicine formulary. A 6-month waiting period applies. |
| Basic Dentistry | Benefits include consultations, fillings, extractions, infection control, cleaning and polishing of teeth. Subject to a list of approved dental codes. A 6-month waiting period applies. |
| Basic Optometry | Benefits include one optical test, standard basic frame, one set of clear single vision lenses or bifocal lenses or contact lenses (to the value of R500) every 24 months. A 6-month waiting period applies. |
| Specialist Visits | Specialist visits are limited to a maximum of R2 600 per member per annum. A 3-month waiting period applies. Specialist visits will only be covered if a NETWORK GP has referred the insured to a specialist. |
| 24/7 Telephonic Employee Assistance Programme benefits | Personal Health Advisor: Health advice from qualified nurses.
Credit & Debt Assist: Unlimited free expert advice on how best to improve your financial standing.
Legal Assist: Advice line manned by qualified in-house attorneys who provide guidance on all legal matters.
Trauma Counselling: Trauma debriefing.
No waiting period applies. |
| Emergency transportation services provided by LifeMed | Ambulance services are available for accidents or life-threatening emergencies as assessed by the LifeMed ambulance emergency call centre. |
| Accidental Hospitalisation | Maximum of R200 000 per insured per event. Maximum of R400 000 per insured per annum. In the event of an accident, access to a private hospital for emergency stabilisation and treatment is provided. This includes general, high care or ICU wards of a private hospital.
The meaning of an accident is defined in the policy wording. |
| Emergency Casualty Cover | Emergency treatment in a casualty ward of a private hospital for injuries resulting from an accident up to a maximum of R18 000 per insured per annum. |
| Accidental Death | A benefit of R15 000 is payable on the accidental death of the policyholder. |
| Entry Age | Maximum age of 64. |
| Annual Amendments | Plan changes are allowed on the annual anniversary date of the policy. |
| Network | National HealthCare providers – national coverage. |
| Enquiries | 0860 002 403 or tmbcustomercare@nationalhealthcare.co.za |
