Day-to-Day Health Plan
‘Out-of-hospital’ medical cover and benefits
A Day-to-Day health plan for the management and treatment of common daily illnesses, injury and essential medical requirements.
The Affinity Health Day-to-Day plan has been designed to help you cover the everyday costs of staying healthy such as going to the doctor or dentist, obtaining prescribed acute medication or receiving a pair of reading glasses. You also receive service from any Medical Society Centre for healthcare and medical treatment.
Basic radiology and pathology are also covered when recommended by your Medical Practitioner*.
An Affinity Health Day-to-Day plan can provide you with:
* Medication, Radiology and Pathology subject to Affinity Health’s formulary.
See benefit details below
Telehealth Consulting
Unlimited, telephonic consultations with an Affinity Health Nurse, Doctor or Mental Health Professional. Includes medication subject to the Affinity Health Formulary.
No waiting period
Medication is subject to a 1 Month waiting period
Healthcare Referrals
Unlimited GP consultations when referred by a designated Nurse, Doctor or Mental Health Professional.
1 Month waiting period
Doctor Consultations
You have unlimited, managed doctor consultations under this benefit with a Network GP, subject to Affinity Health’s Formulary. Your doctor will provide healthcare services and dispense or prescribe medication according to Affinity Health’s formulary.
Out-of-network visits
Unlimited, subject to the Affinity Health Formulary. Member must pay the GP and claim back up to R300 per consultation.
1 Month waiting period
In-Room GP Procedures
Unlimited cover for minor procedures that can be performed in GP Rooms, subject to the formulary per procedure. Pre-authorisation is required.
1 Month waiting period
Medical Consultations
Unlimited, managed medical consultations with a Nurse Practitioner at a Medical Society Centre.
1 Month waiting period
Healthcare Screening
One healthcare screening visit per member per annum conducted by a Nurse Practitioner at a conveniently located Medical Society Centre.
No waiting period
Casualty Room Treatment
Casualty Room treatment for accident or illness up to R3 500 per policy per year. Must be pre-authorised.
Immediate Casualty Room Treatment
1 Casualty room treatment event as a result of an accident activated as you apply, up to R1 000 per policy.
1 Month waiting period
Trauma Support Services
Telephonic trauma support and counselling by professional and dedicated staff member for any of the following events: sexual assault,
crime, trauma-related gender-based violence, death, attempted suicide and domestic violence.
No waiting period
Maternity Scans
Two growth sonars referred by your network GP, subject to the Affinity Health Formulary.
3 Month waiting period
12 Month pre-existing waiting period
Maternity Management Programme
Support for expectant mothers through the provision of medical advice and monitoring pregnancy through to birth and up to six weeks
post-delivery.
3 Month waiting period
12 Month pre-existing waiting period
Specialist Visit
Up to R1 700 per single member policy or R3 500 per family policy per year as referred by a GP. Subject to Pre-authorisation.
3 Month waiting period
Acute Medication
Unlimited, prescribed acute medication is covered if linked to the GP consultation and dispensed by the GP or obtained on script from a pharmacy linked to the Affinity Health formulary.
1 Month waiting period
Over-the-counter Medication
Up to R500 per single member policy or R1 000 per family policy per year, subject to pre-authorisation by a designated Nurse, Doctor or Mental Health Professional.
1 Month waiting period
Dentistry
1 full mouth assessment and 1 scale and polish every 6 months. Infection control, 2 intraoral radiographs, 3 extractions and 3 fillings per member per year.
3 Month waiting period
Optometry
One eye test and one set of standard frames and lenses per member per 24 months. This benefit is only available through a Spec-Savers outlet.
12 Month waiting period
Radiology
Unlimited, when referred by a Medical Practitioner according to a list of approved codes from the radiology formulary. Includes only black and white X-rays .
1 Month waiting period
Pathology
Unlimited when referred by a Medical Practitioner according to a list of approved codes from the pathology formulary.
1 Month waiting period
Optional Benefits
Chronic Essential Medication Benefit
Cover available for over 24 different chronic conditions.
Linked to the doctor consultation and obtained on script from a pharmacy linked to the Affinity Health formulary.
3 Month waiting period.
HIV Chronic Medication Management Programme
The HIV/AIDS programme caters to the medical and lifestyle needs of members living with HIV/AIDS and provides them with suitable treatment and tools to live a healthy life.
3 Month waiting period.
Members are required to register as a Chronic Member for this Benefit.
Diabetes Management Programme
The Diabetes Management Programme assist members in the management of their diabetes condition and provides them with tools to improve their overall health.
3 Month waiting period.
Members are required to register as a Chronic Member for this Benefit.
Remember, you can view the additional booster costs on our policy rates page.
Persons joining Affinity Health over the age of 54 will be subject to increased premiums.
Persons joining Affinity Health Junior over the age of 18 will be subject to increased premiums.