Premier

Premier 2018-01-18T17:05:33+00:00

Monthly premium:

R337 per family for under 65yrs

Monthly premium:

R458 per family for 65yrs+

Offering complete peace of mind, this is a comprehensive combination product with multiple benefits built into one policy. It provides cancer benefits and significantly enhances your medical scheme cover.

Benefits
In-hospital benefits Medical Expense Shortfall Cover Increases the medical aid rate up to 600%. (e.g. Specialists, GPs,
Anaesthetists, Radiology, Pathology, etc). Subject to the Overall Annual
Limit
Co-payment Cover R75 000 per admission per insured. Subject to the Overall Annual Limit
Non-DSP Hospital Penalty Cover R9 000 per admission. Limited to 1 claim per family per annum. Subject
to the Overall Annual Limit
Sub-limit Cover R20 000 per admission per insured. Subject to the Overall Annual Limit
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 the Overall Annual Limit
Biological Cancer Drug Cover Provides cover for Biological Cancer Drugs when the medical aid imposes a sub-limit. Subject to the Overall Annual Limit (See Formulary)
Out-of hospital benefits Co-payments for MRI, CT and PET scans R75 000 per admission per insured. Subject to the Overall Annual Limit
Sub-limit Cover for MRI, CT and PET scans R20 000 per admission per insured. Subject to the Overall Annual Limit
Casualty Benefit (Accidents only) R12 000 per event per insured. Subject to the Overall Annual Limit
Added benefits Cancer Diagnosis Benefit Once off payment of R20 000 for first diagnosis of cancer, provided that the insured is on an approved oncology treatment plan
Medical Scheme Contribution Waiver Up to R5 500 per month for 6 months; in the event of death or permanent and total disability as a result of an accident, of the medical scheme contribution payer
Gap Premium Waiver Pays the premium for your Premier policy for 6 months; in the event of 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, in the event of accidental death and permanent and total disability
International Travel Cover R5 000 000 per insured

Overall Annual Limit (OAL) – R150 000 per insured per annum

Biological Cancer Drugs

The lists below provide the cancer types that may require treatment through the use of a biological cancer drug covered under Premier.

Specific Cancer Categories

  • HER 2 + Breast Cancer
  • Acute myeloid leukaemia
  • Advanced hepatocellular carcinoma
  • Acute lymphoblastic leukaemia
  • Chronic myeloid leukaemia
  • Chronic lymphocytic leukaemia
  • Hairy cell leukaemia
  • Myelodysplasia
  • HER -ve breast cancer
  • Gastrointestinal stromal tumour
  • Multiple myeloma
  • Non-small cell lung cancer
  • Non-hodgkins lymphoma
  • Metastatic colorectal cancer
  • Advanced renal cell carcinoma
  • Head and neck cancer

List of Drugs

  • Herceptin
  • Nexavar
  • Sprycel
  • Velcade
  • Alimta
  • Avastin
  • Sutent
  • Mabthera
  • Mylotarg
  • Gleevec
  • Faslodex
  • Tarceva
  • Zevalin
  • Erbitux
  • Fludara

Waiting Periods

  • A 3-month general waiting period applies to all benefits, with exception of benefits providing cover up to 600% should the commencement of the policy be in line with the commencement date of the medical scheme
  • A 9-month waiting period on pregnancy/childbirth
  • A 12-month waiting period on: hysterectomy (except where malignancy can be proven), hysteroscopies and endometrial ablations; joint replacements and spinal investigations, treatment or surgery (except in the event of an accident); tonsillectomy, myringotomy, grommets, adenoids, wisdom teeth and treatment or surgery for a hernia (except as a result of emergency surgery), treatment and/or surgery for cataracts, gastroscopies, colonoscopies; treatment and surgery for rotator cuff repair; treatment and surgery for nasal and sinus surgery; knee surgery and pre-diagnosed cancer
  • Please note that this is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership.