Day-to-Day Health Plan
‘Out-of-hospital’ medical cover and benefits
A Day-to-Day, tailor-made health plan for the management and treatment of common daily illnesses, injury and essential medical requirements.
The Affinity Health Day-to-Day health insurance plan has been designed and tested to take the annoyances out of the small everyday illness bumps in your road – they help you cover your everyday costs of staying healthy; going to the doctor or dentist, getting a pair of reading glasses or even helping with chronic medication for any long term conditions.
We have all been there, getting sick or falling off a bicycle, and the chances are that in the next few months it could happen again – such is the nature of our active and stress-filled lives.
See benefit details below
General Doctor Consultations
You have unlimited, managed doctor consultations under this benefit with a Network GP, subject to Affinity Health’s Maximum Expenditure Formulary. Your doctor will provide healthcare services and dispense or prescribe medication according to the list of specified generic medications on our formulary. Medication is included as per the Affinity Health medication formulary.
Partial cover for out-of-network consultations should you need to visit a doctor (GP only) that is not on our network.
Casualty Room treatment for accident or illness up to R2,500 per annum. Must be pre-authorised and only available after hours.
1 Specialist visit per member per year up to R700 or R1,300 per family as referred by the Network GP only. (Subject to pre-authorisation.)
Unlimited prescribed acute medication is covered, linked to the GP consultation. No over-the-counter benefit is available. Acute medication is subject to the acute medication formulary and is usually dispensed by your network GP. If the GP is a scripting doctor, medication may be obtained from a network pharmacy (Clicks, Dischem or any Mediscor linked pharmacy).
Basic dentistry is covered including infection control, 1 scale and polish, full mouth assessment, 2 intra oral radiographs, extractions (Max 3 per year) and amalgam fillings. Treatment as per Affinity Health Dentistry protocols.
Includes an eye test per beneficiary, free lenses and frames every 24 months. Services must be obtained from SpecSavers. There is a limit in place on prescriptions of standard mono, multi and bifocal lenses with a basic frame.
Unlimited benefits when referred by a network-registered GP according to a list of approved codes from the radiology formulary. Includes only black and white X-rays .
Unlimited benefits when referred by a network GP according to a list of approved codes from the pathology formulary.
Family Funeral Benefit
Funeral Assistance cover as a result of death of a covered member up to the following amounts:
- Principal Member
- Spouse and Children over the age of 14
- Children – over the age of 6
- Children – birth to 6 years of age
- Stillborn – from 28 weeks
Cover available for over 23 different chronic conditions.
Linked to the doctor consultation dispensed by the Network Provider or obtained on script from a pharmacy linked to the Affinity Health Medicine Formulary.
6 Month waiting period.
We offer additional cover for Chronic Medication for four specific chronic illnesses over and above the Chronic Essential Medication benefit on our Day-to-Day plan.
Includes 2 GP consults and formulary blood tests.
1 Month waiting period.