Extended Family Cover

Extended Family Cover 2018-08-09T08:36:38+00:00

The “Family” means the Principal Insured person and the eligible spouse, and eligible children, who have not attained the age of 26 years unless mentally or physically disabled and unable to earn any form of income. Any dependents falling under this definition are included at no additional cost.

If you have extended family or an additional dependent registered on your medical aid and they do not qualify in terms of our definition of a “Family” as per the definition above, you may add them onto your policy. The cost per each additional extended family member or dependant is detailed below.

Product Ages 26 – 64 (incl)
Rate Per Person
Ages 65 – 79 (incl)
Rate Per Person
Ages 80+
Rate Per Person
Premier R93.82 R288.51 R367.20
Optimal R81.71 R230 R293.55
Synergy R78.68 R213.85 R273.38
Launch R22.20 R32.28 R51.45
Benefits
in-hospital benefits Private Rate Cover Increases the medical aid rate up to 600%. Subject
to OAL
Co-payment Cover R75 000 per admission per insured. Subject to OAL
Non-DSP Hospital Penalty
Cover
R9 000 per admission. Limited to 1 claim per family per
annum, subject to the OAL
Sub-limit Cover R20 000 per admission per insured. Subject to OAL
in-hospital
and out-of hospital
Benefits
Traditional Cancer Cover Pays for treatment in a private facility, including sub-limits,
deductibles or co-payments related to cancer treatment
(R200 000 excess). Subject to OAL.
Biological Cancer Drug Cover Provides cover for Biological Cancer Drugs when the
medical aid imposes a sub-limit. Subject to OAL
out-of hospital benefits Co-payment cover for MRI, CT
and PET scans
R75 000 per admission per insured. Subject to OAL
MSub-limit Cover for MRI, CT and
PET scans
R20 000 per admission per insured. Subject to OAL
Casualty Benefit (Accidents
only)
R12 000 per event per insured. Subject to OAL
Cancer Diagnosis Benefit Once off payment of R20 000 for first diagnosis of cancer,
provided that the member is on an approved oncology
treatment plan
Medical Scheme Contribution
Waiver
Up to R5 500 per month for 6 months, covers
death or permanent and total disability (due to an
accident), of the medical scheme contribution payer
Gap Premium Waiver Pays the premium for your Premier policy for 6 months;
covers death or permanent and total disability as a result
of an accident, of the contribution payer
Personal Accident Benefit R25 000 per insured on the policy, covers accidental
death or permanent and total disability
Travel Cover R5 000 000 per insured

Optimal

$R256 per family for under 65yrs R344 per family for 65yrs+
  • Increases the medical aid rate up to 500%. Subject to OAL
  • R55 000 per admission per insured. Subject to OAL
  • R15 000 per admission per insured. Limited to R50 000 per family per annum, subject to OAL
  • 20% co-payment cover per admission (R200 000 excess). Subject to OAL
  • Provides cover for Biological Cancer Drugs when the medical aid imposes a sub-limit. Subject to OAL
  • R55 000 per admission per insured. Subject to OAL
  • R7 000 per event per insured. Subject to OAL
  • Up to R5 500 per month for 6 months, covers death or permanent and total disability (due to an accident), of the medical scheme contribution payer
  • Pays the premium for your Optimal policy for 6 months; covers death or permanent and total disability as a result of an accident, of the contribution payer
  • R5 000 000 per insured

Synergy

$R195 per family for under 65yrs R263 per family for 65yrs+
  • Increases the medical aid rate up to 500%. Subject to OALature 1
  • R50 000 per admission per insured. Subject to OAL
  • R5 000 per admission. Limited to 1 claim per family per annum, subject to the OAL
  • R15 000 per admission per insured. Limited to R50 000 per family per annum, subject to OAL
  • R50 000 per admission per insured. Subject to OAL
  • R6 500 per event per insured. Subject to OAL
  • Up to R5 500 per month for 6 months, covers death or permanent and total disability (due to an accident), of the medical scheme contribution payer
  • Pays the premium for your Synergy policy for 6 months; covers death or permanent and total disability as a result of an accident, of the contribution payer
  • R5 000 000 per insured

Launch

R99 per family for under 65yrs R155 per family for 65yrs+
  • Increases the medical aid rate up to 350%. Subject to OAL and an excess of R350 per event
  • R3 000 per event per insured. Subject to OAL and an excess of R350 per event
  • Up to R5 500 per month for 6 months, covers death or permanent and total disability (due to an accident), of the medical scheme contribution payer
  • Pays the premium for your Launch policy for 6 months; covers death or permanent and total disability as a result of an accident, of the contribution payer
  • R5 000 000 per insured

Exceptions

  1. Nuclear weapons or nuclear material or by ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the purpose of this exception combustion shall include any self-sustaining process of nuclear fission;
  2. LASIK or Lasik (laser-assisted in situkeratomileusis) surgery or any type of refractive surgery for correcting myopia, hyperopia, and astigmatism;
  3. Investigations, treatment or surgery for obesity its sequela or cosmetic surgery or surgery directly or indirectly caused by or related to or in consequence of cosmetic surgery other than as a result of an insured event otherwise insured. For the purpose of this exception cosmetic surgery shall include surgery for breast reduction or reconstruction unless necessitated as a result of treatment for cancer;
  4. Routine physical or any procedure of a purely diagnostic nature or any other examination where there are no objective indications of impairment in normal health and laboratory diagnostic or X-ray examinations except in the course of a disability established by prior call or attendance of a Medical practitioner;
  5. Suicide, attempted suicide or intentional self-injury;
  6. The taking of any drug or narcotic unless prescribed by and taken in accordance with the instructions of a Medical Practitioner (other than the Insured person) or drug addiction;
  7. An event directly attributable to the Insured person having an alcohol content exceeding the legal limit or the Insured person suffering from alcoholism or any illness caused by the use of alcohol;
  8. Participation in:
    • Active military duty police duty police reservist duty civil commotion labour disturbances riot strike or the activities of locked-out workers
    • Aviation other than as a passenger
    • Any form of race or speed test (other than on foot or involving any non-mechanically propelled vehicle vessel craft or aircraft);
  9. Investigations, treatment or surgery for artificial insemination or hormone treatment for infertility;
  10. No benefits are payable which should be provided by the Medical Aid Scheme, this exception includes ward fees, expenses;
  11. No benefits shall be payable in the event of fraudulent submission by the claimant;
  12. No benefits shall be payable in the event the insured did not pre-authorise, make use of a Designated Service Provider (this is not applicable to the Non-DSP Hospital Penalty Cover on Premier and Synergy) or any condition set by the Insured’s Medical Aid Scheme;
  13. No benefits shall be payable in the event there is no benefit for the treatment and/or the condition or if it is excluded and/or declined by the Insured’s Medical Aid Scheme or if the Medical Aid Scheme pays less than tariff for benefits associated with costs incurred above Medical Scheme
    Tariff;
  14. No benefit shall be payable in respect of any medical or surgical treatment unless such treatment occurred during the period of hospital confinement as an in-patient or as an out-patient (as defined);
  15. The table of benefits applies in the territory of the RSA and no benefits are payable for expenses incurred for transport charges or for services rendered whilst being transported in any emergency vehicle, vessel or aircraft;
  16. No ward fee benefits shall be payable in respect of any additional costs incurred as a result of confinement to a private ward if such confinement to a private ward was requested by the Insured person.
  17. Treatment resulting from failure to carry out the instructions of a Medical Practitioner
  18. Any condition for which the Insured person received treatment or advice prior to the date of inception, or any medical conditions that resulted from an injury that occurred prior to the date of inception for the emergency casualty benefit.
  19. Any costs associated with a hip or knee replacement for the emergency casualty benefit.
  20. Injuries arising from professional sport or any other recreational activity which is not commonly recognised as a sport and/or involves uncontrolled competition, unusual skill or violent activity and is generally considered to be inherently dangerous for the emergency casualty benefit (as defined in the policy document) provided in a hospital out-patient emergency facility.
  21. ADDITIONAL EXCEPTIONS APPLICABLE ONLY TO PREMIER AND OPTIMAL OPTIONS
  22. No benefits shall be payable for any pre-existing condition, meaning any form of cancer occurring or manifesting itself prior to the Commencement Date for any cancer specific benefits, unless the Insured person is in complete remission (as defined) for a period of 12 months as determined from the Commencement Date of the policy.
  23. ADDITIONAL EXCEPTIONS APPLICABLE ONLY TO PREMIER, OPTIMAL AND SYNERGY OPTIONS
  24. Psychiatric conditions including but not limited to depression, insanity, mental and or stress related conditions for co-payment, sub-limit and stated benefits;
  25. Investigations, treatment or surgery for dental implants or any surgical implant of an artificial tooth root used in dentistry to support restorations that resemble a tooth or group of teeth for co-payments and sub-limits;
  26. All dental procedures, unless due to reconstructive surgery as a result of an accident, while on the policy or impacted wisdom teeth for all benefits other than co-payments and sub-limits.
  27. Additional Exceptions Applicable to Launch Option
  28. The first R350 per event will be the liability of the Principal Insured Person.