Medicall Healthcare is an affordable Primary Healthcare Plan designed to provide quality Private Primary Healthcare that is accessible to all South Africans.
Medicall Healthcare Optima Extend series is a Private Primary Healthcare option that is available to dependants of Members who are on one of the Optima Series plans.
| Benefit | Service | Optima Core | Optima Establish | Optima Enhance |
| GP VISITS | Members can choose from any Medicall Healthcare Network GP only. Benefits include unlimited medically necessary consultations and specified minor trauma treatment from the Network GP. Referral by Network GP to state facility if required. subject to 30 day waiting period (waiting period can be waivered) |  | | |
| MATERNITY GP | Pre and post-natal care, supervision of an uncomplicated pregnancy up to week 20 including one 2D sonar scan per pregnancy. Referral by Network GP to a state facility if required. | | | |
| BASIC PATHOLOGY | Basic blood tests as requested by Medicall Healthcare provider; subject to Medicall protocols and approved list of codes. | | | |
| BASIC RADIOLOGY | Basic Black and White X-Rays as requested by Medicall Healthcare provider, subject to Medicall protocols and approved list of codes. | | | |
| ACUTE MEDICATION | As dispensed by a Medicall Healthcare Network GP or via prescription through a Network Pharmacy according to the Medicall Healthcare medication formulary. | | | |
| HIV BENEFIT | Included in cost of day-to-day benefits. HIV Elisa blood test, Symptomatic treatment due to HIV Infection. Referral by Network GP to state facility required. | | | |
| CHRONIC MEDICATION | 26 Chronic Conditions covered. Subject to registration and approval from Medicall Clinical Department and issued according to the Medicall Healthcare medicication formulary. (Waiting Periods Apply) 6 Month Waiting Period from the commencement date of the cover | | | |
| HIV CHRONIC MEDICATION | Subject to quote request by employer. (Waiting Periods Apply) | | | |
| ONSITE NURSING | Chronic disease management, primary health and wellness management. Subject to group size. Refer to On Site Nursing table below. | | | |
| BASIC DENTISTRY (Waiting Periods Apply) | Members can choose from any Medicall Healthcare Network Dentist. Benefit includes consultations, fillings extractions, infection control, cleaning and polishing of teeth. Subject to a list of approved dental codes. 6 Month Waiting Period from the commencement date of the cover. | | | |
| BASIC OPTOMETRY (Waiting Periods Apply) | Members may choose from any Medicall Healthcare Network Optometrist. Benefits include one optical test per beneficiary, per 24 months, one pair of standard mono or bi-focal lenses in a standard frame or contact lenses to the value of R585.00 Medicall protocols apply. SUBJECT TO A 6 MONTH WAITING PERIOD. | | | |
| HOSPITAL TRAUMA ** (Stabilisation following emergency) | An Emergency Room / Trauma Room Benefit is payable in the event of a life threatening incident, as assessed and authorized by Medicall Healthcare, up to a maximum of R20,000 per member. This benefit is limited to one incident per year, per member. Subject to a 30 day waiting period from the commencement date of cover. | | ||
| ACCIDENTAL IN-HOSPITAL BENEFIT ** | Payable per accident for transportation and emergency medical treatment. Up to R100,000 per accidental event to a maximum of R500,000 per annum. | | ||
| ACCIDENTAL DEATH ** | Up to R100,000 where accidental bodily injury results in the death of a member. | | ||
| ACCIDENTAL DISABILITY ** | Up to a limit of R100,000 where accidental bodily injury results in the permanent total disability of a member as defined in the policy definition. | | ||
| DAILY BENEFIT ** | Daily cash benefit for non-medical expenses as a result of hospitalisation following accidental bodily injury up to a maximum limit of R1000 per day / 20 days per annum. Requires hospital confinement of more than 24 hours. * Subject to pre-authorisation. | | ||
| AMBULANCE | All members enjoy the benefit of ambulance services when an ambulance service is required for an accident or life threatening emergency as assessed by the emergency call centre. Up to R35,000 per event. | | ||
| FUNERAL BENEFIT (Waiting Periods Apply) | COSTS QUOTED BELOW ARE PER MEMBER Death Benefit of R10,000 for Principal Member. 6 month waiting period from the commencement date of cover | | | |
| ** – Underwritten byLionHeart Risk Management (Pty) Ltd, a licensed life insurer in terms of the Insurance Act. | ||||
Dependants of Members who are on an Optima Series Plan.
Dependants may only be on an equivalent or lower plan than the Employee on Optima.
A maximum limit of 1 Spouse and 6 Dependant Children applies.
Dependant children between the ages of 18 and 25 must be unmarried, not pregnant and in full time education in order to qualify for the child rate.
Children below the age of 6 months will not be covered for the Trauma or Accident Benefits under Optima Extend Enhance.
Maximum age 64
All dependants will be underwritten individually.
Pre-existing conditions may result in an endorsement being applied.
A Registration Fee of R75 per Optima Extend Contract applies. This is to cover take-on and delivery of Membership Welcome Pack. There is a R20 fee for any additional card required.
A Registration Period applies to all Optima Extend Plans. The Registration Period is one month. Cover and applicable waiting periods begin on completion of the Registration Period.
No nursing service applies to Optima Extend Series.
30 Day Waiting period for Hospital Trauma. 6 Month Waiting period for Chronic, Dentistry and Optometry.
Amendments on plan upgrades or downgrades allowed once annually on the 1st of January, with notice of change to Medicall confirmed no later than the 30th of November of the preceding year.
Medicall Healthcare Providers — National Coverage.
PROVIDER SEARCH 0860 077 722 and / or www.medicallhealth.co.za
Medicall Healthcare is a product of Xperia Financial Services (PTY) Ltd, a Licenced Financial Services Provider, registered with the FSCA (Financial Sector Conduct Authority) FSP Number 45551 with demarcation exemptions DM1051 and hospital benefits is underwritten by Lion of Africa Life Assurance Company Ltd (FSP: 15283).
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