GP Consultations
You can visit any network doctor for an unlimited number of times.
When you visit your network doctor or nurse for 10 or more times per year pre-authorisation will be required.
GP Procedures
Basic medical and surgical procedures can be performed in your network doctor’s rooms, such as a circumcision, stitching of a wound or applying a cast to a broken arm.
Nurse Consultations
Unlimited nurse consultations available at approved pharmacies (Clicks, Dischem & Pick n Pay) for minor ailments. In many practices nurses can provide scripts for minor ailments for up to schedule 2 medications. Pre-authorisation required for 10 or more GP or Nurse visits per person per year.
Specialist Consultations
Limited to R1,200 per visit with an overal limit of R2,500 per family per year. Referral by network doctor and pre-authorisation required.
Acute Medication
DISPENSING GP – This means your GP dispenses medication and will provide you with the necessary medication.
NON-DISPENSING GP – Unlimited for medication prescribed during your Network GP visits. This means your GP does not provide you with medication but will provide you with a prescription to collect your medication at your nearest pharmacy. Medication is covered according to a set formulary. Approved pharmacies include Clicks, Dischem & Pick n Pay.
Chronic Medication
Chronic Medication Programme: 8 Listed “high impact” Conditions* HIV/AIDS included.
*Asthma, Chronic Obstructive Pulmonary Disorder; Diabetes Type 1&2; Epilepsy; HIV/AIDS; Hyperlipidaemia; Hypertension; Tuberculosis.
Chronic condition: A condition / disease that lasts for an extended period of time.
Chronic Medication Programme: Your Network GP will assist you to register on the Chronic Medication Programme with Mediscor. Your prescribed chronic medicines will be covered according to a set formulary. Find the chronic medica- tion formulary (list) on Mediscor’s website: www.mediscor.net. Approved pharmacies include Clicks, Dischem, Pick n Pay & Medipost.
Basic & Emergency Dentistry Treatment
Limited to R1 200 per person per incident. Treatment includes: full mouth assessment, intra oral radiographs, scale & polish, extractions, emergency root canal treatment, fillings, pain and sepsis treatment. Only available at network dentists. Specialised dentistry/treatment, such as bridgework or crowns; orthodontic treatment; and dentures are not covered.
Optometry
One eye test per person per year.
A standard frame to the value of R254 and one pair of clear standard spectacle lenses per person per 24 months. Available at PPN Network Optometrists.
Pathology
Basic list of blood tests at a Designated Service Provider.
Your Network GP must ask for these tests to be done. E.g. blood sugar or cholesterol tests.
Radiology
Black & white X-rays only at a Designated Service Provider. Your Network GP has to refer you to have X-rays done. Specialised radiology such as MRI / CT Scans is not covered.
Maternity
2 gynaecologists visits, 2 ultrasound scans per pregnancy. Pre-authorisation is required. Limited to R3 000 per family per year.
HEALTH SCREENINGS & ASSISTANCE PROGRAMME
Health Screenings
Limited to one screening per person per year. Available at Approved pharmacies (Clicks, Dischem & Pick n Pay).
Health screenings include health checks for:
- Blood pressure;
- Cholesterol;
- Glucose levels;
- Body Mass Index (BMI);
- Waist Circumference; and – HIV/AIDS, which includes counselling before and after testing.
Pap Smears
Available once every 3 years after the age of 21. Available at Approved pharmacies (Clicks, Dischem & Pick n Pay).
Your GP may or may not offer pap smears.
PSA Screening
Available once every 2 years after the age of 50. Available at Approved pharmacies (Clicks, Dischem & Pick n Pay).
Vaccination Programme
Influenza: Available annually – needs to be administered by 31 May each year.
Tetanus: Available once every 10 years.
Hepatitis A & B: Available once-off.
Pneumococcal: Available once every 5 years for those aged 60 or older and for those individuals with medically proven compromised immune system. Available at Approved pharmacies (Clicks, Dischem & Pick n Pay).
Our ASSISTANCE PROGRAMME (AP) is automatically included regardless of whether you belong to our PRIMARY (Day-to- Day) Benefit Option, EMERGENCY AND ACCIDENT Benefit Option or COMBINATION (Primary, Emergency and Accident) Benefit Option.
Assistance Programme (AP)
Unlimited telephonic counselling services are provided by registered counsellors who follow specific procedures and clinical protocols.
The service is available 24 / 7 and includes counselling for:
- Critical incidence / trauma counselling.
- HIV counselling.
- Legal Advice.
- Financial Advice.
- Face to face counselling can be arranged for your own account.
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Policy waiting periods
Waiting periods apply from each insured person’s cover start date before specific policy benefits can be claimed from.
During the first 2 months of cover a general waiting period applies to our DAY-TO- DAY and HEALTH SCREENINGS & ASSISTANCE benefits.
During the first 9 months of cover a waiting period for pre-birth maternity benefit.
During the first 12 months of cover a waiting period applies to Chronic Medication benefit.
During the first 12 months of cover a waiting period applies to optometry benefit.
Waiting periods do not apply to our Emergency and Accident Benefits and Assistance Programme (AP).
Unity Health is a division of Ambledown Financial Services (PTY) Ltd, an authorised FSP 10287. In partnership with Optivest Health Services, an authorised FSP 13475. Unity Health Insurance is not a medical aid scheme but a short-term insurance product underwritten by Bryte Insurance Company Limited, a licensed insurer and an authorised FSP 17703.
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