Individual and Corporate Health Insurance Benefit Options ...

2021 HEALTH INSURANCE BENEFIT OPTIONS

Administered by Unity Health, a division of Ambledown Financial Services (Pty) Ltd, an authorised FSP 10287.

I n partnership with Stratum Benefits (Pty) Ltd, an authorised FSP 2111, underwritten by Constantia Insurance

Company Limited, an authorised FSP 31111. Terms and conditions apply.

CONTENTS

HEALTH INSURANCE BENEFIT OPTION OVERVIEWS

ESSENTIAL PRIMARY PLUS & CORPORATE ESSENTIAL

INDIVIDUAL .............................................................................................. 02

INTRODUCTION ...................................................................................... 06

CORPORATE ............................................................................................. 04

PREMIUMS ..............................................................................................

DAY-TO-DAY

BENEFIT OPTION

08

EMERGENCY & ACCIDENT

BENEFIT OPTION

10

DAY-TO-DAY, EMERGENCY &

ACCIDENT BENEFIT OPTION

07

11

THE LEGAL STUFF

WAITING PERIODS ................................................................................. 12

GENERAL EXCLUSIONS ........................................................................ 12

APPLY FOR COVER

E-mail your Client Application Form to:

e health@stratumbenefits.co.za

Apply online:

w stratumbenefits.co.za

QUERIES AND POLICY CHANGES

For policy amendments, benefit enquiries,

option changes, adding or removing

dependants or debit order changes, email:

e yoursupport@stratumbenefits.co.za

CLAIMS

e claims@unityhealth.co.za

f 011 706 5568

STRATUM BENEFITS (PTY) LTD

REG NO.: 2003/018155/07

HEAD OFFICE

367 Surrey Avenue,

Block C & D,

Ferndale,

Randburg,

2194

Suite 386,

Private Bag X09,

Weltevredenpark,

1715

t 011 781 4488

f 086 633 3761

e info@stratumbenefits.co.za

w stratumbenefits.co.za

Contact the 24-Hour Emergency Client Care Centre on (011) 781-4488

in case of an emergency or accident or ER24 directly on (010) 205-3044

REGIONAL OFFICES

CAPE TOWN

Corner Lubbe & Langeberg Roads,

Unit 4, Frazzitta Business Park,

Durbanville, 7550

t 021 914 6985 f 086 459 6033

DURBAN

2 Hopedene Grove, Main House,

Morningside, Durban, 4001

t 031 940 1918 f 086 541 7036

SATELLITE OFFICE

PORT ELIZABETH

10 Mendelssohn Avenue, Pari Park,

Port Elizabeth, 6070

t 041 366 1140 f 086 582 8361

STRATUM BENEFITS BUSINESS HOURS

Mon - Thurs

8:00 - 16:30

Fri

8:00 - 16:00

Sat

8:00 - 13:00

Health Insurance Call Centre

OVERVIEW

INDIVIDUAL HEALTH INSURANCE BENEFIT OPTIONS & PREMIUM OVERVIEW

DAY-TO-DAY

BENEFIT OPTION

DAY-TO-DAY,

EMERGENCY & ACCIDENT

BENEFIT OPTION

EMERGENCY & ACCIDENT

BENEFIT OPTION

DAY-TO-DAY COVER

CONSULTATION COVER

GP CONSULTATIONS AND MEDICAL PROCEDURES

Unlimited consultations at any network GP | Minor medical and surgical procedures in rooms

Subject to approved tariff codes and pre-authorisation from 10th visit per person per year

NURSE CONSULTATIONS

Unlimited consultations for minor illnesses at Clicks, Dis-Chem, Pick n Pay, Local Choice or Medicare pharmacies

Prescribed medication up to schedule 2. Subject to pre-authorisation from 10th visit per person per year

VIRTUAL GP CONSULTATIONS

Unlimited consultations through video conference link | Approved pharmacies like Dis-Chem and Medicare

Subject to pre-authorisation from 10th visit per person per year

SPECIALIST CONSULTATIONS

R 1 275 per consultation | R 2 650 per family per year

Subject to network GP referral and pre-authorisation

PRE-BIRTH CONSULTATIONS

2 Gynaecologist consultations and 2 ultrasound scans at any gynaecologist | R 3 250 per family per year

Subject to pre-authorisation

MEDICINE COVER

ACUTE MEDICATION

Unlimited formulary medication for every-day illnesses

DISPENSING NETWORK GP

Formulary medication given in the rooms

NON-DISPENSING NETWORK GP

Prescribed formulary medication | Collect at any Mediscor pharmacy, like Clicks, Dis-Chem, Pick n Pay, Local Choice or Medicare

CHRONIC MEDICATION

Unlimited formulary medication | Covers 8 chronic conditions or diseases

BLOODS, X-RAYS, DENTAL AND EYE CARE COVER

BLOOD TESTS AND X-RAYS

Unlimited basic blood tests through Ampath, Lancet and PathCare | Unlimited black-and-white x-rays

Subject to network GP referral and approved tariff codes

DENTAL CARE

Basic, emergency, and urgent dental treatment at any dentist | R 1 275 per person per event

Subject to pre-authorisation and approved tariff codes

EYE CARE

1 Eye test, 1 standard frame to the value of R 254 and 1 pair of spectacle lenses per person every 2 years | Available through PPN optometrists

EMERGENCY AND ACCIDENT COVER

HOSPITAL CARE

EMERGENCY COVER

Stabilisation due to a medical emergency at nearest private hospital | R 25 000 per person per event. Subject to pre-authorisation

ACCIDENT COVER

Medical treatment due to an accident at nearest private hospital | R 1 200 000 per person per event. Subject to pre-authorisation

CASUALTY VISITS

Immediate medical treatment due to a minor accident | R 6 500 per person per event. Subject to pre-authorisation

MRI AND CT SCANS

Required during hospitalisation due to an accident | R 17 000 per person per year. Subject to pre-authorisation

PHYSICAL REHABILITATION CARE

Physical therapy following hospitalisation due to an accident | Treatment within 3 months from discharge | R 3 250 per person per year.

Subject to pre-authorisation

24-HOUR MEDICAL EMERGENCY SERVICES

24-Hour national emergency contact centre | Includes services like emergency transport, repatriation, and telephonic medical advice

PAYOUT BENEFIT

ACCIDENTAL DEATH

R 15 000 Principal Insured | R 15 000 Spouse

WELLNESS BENEFITS

WELLNESS ASSESSMENT

1 Assessment per person per year | Health checks like blood pressure, cholesterol, and glucose levels

Available at Clicks, Dis-Chem, Pick n Pay, Local Choice or Medicare pharmacies

PREVENTATIVE CARE

Vaccinations and tests, like 1 flu vaccination per person per year; 1 hepatitis A and B vaccination once-off per person; 1 pap smear once every

3 years for females aged 21 years or older; and 1 prostate specific antigen screening once every 2 years for males aged 50 years or older

Available at Clicks, Dis-Chem, Pick n Pay, Local Choice or Medicare pharmacies

ESSENTIAL ASSISTANCE PROGRAMME (EAP)

Unlimited 24/7 telephonic advice and counselling services through Reality Wellness Group

LIFESTYLE BENEFIT

FUEL REWARDS

22 Cents per litre diesel and 15 cents per litre petrol. Subject to change without prior notice

DAY-TO-DAY BENEFIT OPTION

MONTHLY PREMIUM

02

EMERGENCY & ACCIDENT BENEFIT OPTION

ENTRY AGE

PRINCIPAL

INSURED

SPOUSE

ADULT

CHILD

DEPENDANT DEPENDANT

55 or younger

R 390

R 260

R 260

R 115

56 or older

R 573

R 443

--

--

DAY-TO-DAY, EMERGENCY & ACCIDENT BENEFIT OPTION

ENTRY AGE

PRINCIPAL

INSURED

SPOUSE

ADULT

CHILD

DEPENDANT DEPENDANT

60 or younger

R 167

R 90

R 90

R 37

61 or older

R 210

R 133

--

--

ENTRY AGE

PRINCIPAL

INSURED

SPOUSE

ADULT

CHILD

DEPENDANT DEPENDANT

55 or younger

R 495

R 355

R 355

R 138

56 or older

R 708

R 568

--

--

03

OVERVIEW

CORPORATE HEALTH INSURANCE BENEFIT OPTIONS OVERVIEW

DAY-TO-DAY

BENEFIT OPTION

EMERGENCY & ACCIDENT

BENEFIT OPTION

DAY-TO-DAY,

EMERGENCY & ACCIDENT

BENEFIT OPTION

DAY-TO-DAY COVER

CONSULTATION COVER

GP CONSULTATIONS AND MEDICAL PROCEDURES

Unlimited consultations at any network GP | Minor medical and surgical procedures in rooms

Subject to approved tariff codes and pre-authorisation from 10th visit per person per year

NURSE CONSULTATIONS

Unlimited consultations for minor illnesses at Clicks, Dis-Chem, Pick n Pay, Local Choice or Medicare pharmacies

Prescribed medication up to schedule 2. Subject to pre-authorisation from 10th visit per person per year

VIRTUAL GP CONSULTATIONS

Unlimited consultations through video conference link | Approved pharmacies like Dis-Chem and Medicare

Subject to pre-authorisation from 10th visit per person per year

SPECIALIST CONSULTATIONS

R 1 275 per consultation | R 2 650 per family per year

Subject to network GP referral and pre-authorisation

PRE-BIRTH CONSULTATIONS

2 Gynaecologist consultations and 2 ultrasound scans at any gynaecologist | R 3 250 per family per year

Subject to pre-authorisation

MEDICINE COVER

ACUTE MEDICATION

Unlimited formulary medication for every-day illnesses

DISPENSING NETWORK GP

Formulary medication given in the rooms

NON-DISPENSING NETWORK GP

Prescribed formulary medication | Collect at any Mediscor pharmacy, like Clicks, Dis-Chem, Pick n Pay, Local Choice or Medicare

CHRONIC MEDICATION

Unlimited formulary medication | Covers 27 chronic conditions or diseases

BLOODS, X-RAYS, DENTAL AND EYE CARE COVER

BLOOD TESTS AND X-RAYS

Unlimited basic blood tests through Ampath, Lancet and PathCare | Unlimited black-and-white x-rays

Subject to network GP referral and approved tariff codes

DENTAL CARE

Basic, emergency, and urgent dental treatment at any dentist | R 1 275 per person per event

Subject to pre-authorisation and approved tariff codes

EYE CARE

1 Eye test, 1 standard frame to the value of R 254 and 1 pair of spectacle lenses per person every 2 years | Available through PPN optometrists

EMERGENCY AND ACCIDENT COVER

HOSPITAL CARE

EMERGENCY COVER

Stabilisation due to a medical emergency at nearest private hospital | R 25 000 per person per event. Subject to pre-authorisation

ACCIDENT COVER

Medical treatment due to an accident at nearest private hospital | R 1 200 000 per person per event. Subject to pre-authorisation

CASUALTY VISITS

Immediate medical treatment due to a minor accident | R 6 500 per person per event. Subject to pre-authorisation

MRI AND CT SCANS

Required during hospitalisation due to an accident | R 17 000 per person per year. Subject to pre-authorisation

PHYSICAL REHABILITATION CARE

Physical therapy following hospitalisation due to an accident | Treatment within 3 months from discharge | R 3 250 per person per year.

Subject to pre-authorisation

24-HOUR MEDICAL EMERGENCY SERVICES

24-Hour national emergency contact centre | Includes services like emergency transport, repatriation, and telephonic medical advice

PAYOUT BENEFIT

ACCIDENTAL DEATH

R 15 000 Principal Insured | R 15 000 Spouse

WELLNESS BENEFITS

EMPLOYEE WELLNESS ASSESSMENT

1 On-site assessment per employee per year during an Employee Wellness Day | Health checks like blood pressure, cholesterol, and glucose levels

Employees who miss the Wellness Day can visit their nearest Clicks, Dis-Chem, Pick n Pay, Local Choice or Medicare pharmacy for their assessment

PREVENTATIVE CARE

Vaccinations and tests, like 1 flu vaccination per person per year; 1 hepatitis A and B vaccination once-off per person; 1 pap smear once every

3 years for females aged 21 years or older; and 1 prostate specific antigen screening once every 2 years for males aged 50 years or older

Available at Clicks, Dis-Chem, Pick n Pay, Local Choice or Medicare pharmacies

ESSENTIAL ASSISTANCE PROGRAMME (EAP)

Unlimited 24/7 telephonic advice and counselling services through Reality Wellness Group

LIFESTYLE BENEFIT

04

FUEL REWARDS

22 Cents per litre diesel and 15 cents per litre petrol. Subject to change without prior notice

MONTHLY PREMIUM

Determined by a number of factors, like the number of employees joining and whether cover is compulsory or voluntary for employees

05

ESSENTIAL PRIMARY PLUS & CORPORATE ESSENTIAL | PREMIUMS

ESSENTIAL PRIMARY PLUS & CORPORATE ESSENTIAL

PREMIUMS

PREMIUMS FOR INDIVIDUALS

WHO¡¯S COVERED?

Joining as a family? One Health Insurance policy covers you, your spouse, and any child dependant as long as you are their parent or

legal guardian.

DAY-TO-DAY BENEFIT OPTION

If you take the Day-to-Day Benefit Option on its own the following

premiums will apply:

PRINCIPAL

INSURED

SPOUSE

ADULT

DEPENDANT

CHILD

DEPENDANT

55 or younger

R 390

R 260

R 260

R 115

56 or older

R 573

R 443

--

--

ENTRY AGE

EMERGENCY & ACCIDENT BENEFIT OPTION

If you take the Emergency & Accident Benefit Option on its own the

following premiums will apply:

PRINCIPAL

INSURED

SPOUSE

ADULT

DEPENDANT

CHILD

DEPENDANT

60 or younger

R 167

R 90

R 90

R 37

61 or older

R 210

R 133

--

--

ENTRY AGE

ESSENTIAL PRIMARY PLUS & CORPORATE ESSENTIAL

The individual and corporate Essential options provide healthcare solutions that complement your medical aid cover, or it can be taken

as your primary health cover if you don¡¯t have medical aid cover.

CHOOSE BETWEEN 3 BENEFIT OPTIONS:

DAY-TO-DAY, EMERGENCY & ACCIDENT BENEFIT OPTION

If you take the Day-to-Day Benefit Option and combine it with the

Emergency & Accident Benefit Option, the following premiums will apply:

PRINCIPAL

INSURED

SPOUSE

ADULT

DEPENDANT

CHILD

DEPENDANT

55 or younger

R 495

R 355

R 355

R 138

56 or older

R 708

R 568

--

--

? DAY-TO-DAY BENEFIT OPTION

? EMERGENCY & ACCIDENT BENEFIT OPTION

? DAY-TO-DAY, EMERGENCY & ACCIDENT BENEFIT OPTION

ENTRY AGE

DAY-TO-DAY BENEFIT OPTION

Through a national network of providers who¡¯ve contracted with Unity Health, our health insurance

administrator, you have access to more than 3 000 GP¡¯s, 2 700 optometrists and various pharmacies,

pathologists, and radiologists.

Visit practice.unitywellness.co.za or contact us to find your nearest provider.

Unity Health has contracted with the following pharmacies:

EMERGENCY & ACCIDENT BENEFIT OPTION

Unity Health has contracted with some of the major hospital groups to ensure you get the cover you need when it matters most.

OPEN ENROLMENT,

COMMUNITY

RATING AND CROSSSUBSIDISATION

The Health Insurance

benefit options are

subject to open

enrolment, community

rating and

cross-subsidisation.

This means that

cover is available to

everyone, there¡¯s no

discrimination based

on factors like race

and gender, and that

all premiums received

are paid into one

risk pool from where

claims are paid.

These Health Insurance benefit options aren¡¯t medical aid options, don¡¯t provide

similar cover as that of a medical aid and can¡¯t be substituted for medical aid

membership.

ESSENTIAL PRIMARY PLUS | PREMIUMS FOR INDIVIDUALS

If you¡¯re 56 or older and apply for cover on the Day-to-Day Benefit Option or the Day-to-Day, Emergency & Accident Benefit Option, or

if you¡¯re 61 or older applying for cover on the Emergency & Accident Benefit Option, you¡¯ll pay a higher premium unless you can prove

that you¡¯ve been on medical aid or primary healthcare cover for 15 or more consecutive years from the age of 35 onward.

Children aged 20 years or younger pay child dependant premiums.

Children aged 21 years or older can be added to your policy and remain on your policy if they¡¯re full-time students or if they¡¯re financially

dependent on you, and proof is submitted every year. Children aged 21 years or older pay adult dependant premiums.

What proof can be submitted? Proof from the educational facility or stamped copies of your child¡¯s bank account statements of the past 3 months.

PREMIUMS FOR CORPORATES

You¡¯re covered for authorised emergencies and accidents at your nearest private hospital and the hospital¡¯s casualty facility, but

planned medical procedures, like childbirth or having cataracts removed, aren¡¯t covered.

DAY-TO-DAY, EMERGENCY & ACCIDENT BENEFIT OPTION

For complete peace of mind, choose the best of both options by combining the Day-to-Day Benefit Option and the Emergency &

Accident Benefit Option.

06

ASK FOR A CORPORATE ESSENTIAL QUOTE!

Employer groups are covered if 2 or more employees join through their employer.

Ask your employer if your spouse and/or dependants may also join.

Premiums for employer groups are determined by factors like the number of

employees joining and if cover for employees is compulsory or voluntary.

WANT

FUNERAL COVER?

THIS CAN

BE ADDED TO

YOUR QUOTE.

07

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