Going to see a healthcare provider

We recognise that health providers play a critical role in helping you improve your health and wellbeing by sharing their expert knowledge. We believe that we have a responsibility to you, our member and our industry to use our experience, and expertise to help keep private healthcare affordable.

This is why we have entered into arrangements with specialists and GPs which offer them a higher rate of reimbursement while ensuring you have limited co-payments.

Our arrangements benefit you

You can benefit by using a healthcare provider who we have an arrangement with because we will cover their approved consultations and procedures in full.  We pay claims directly to the healthcare provider when we have an arrangement with them.

 

What is my cover for specialists and GPs?

GP consultations out-of-hospital are paid from your Member Savings Account.

Specialist consultations are paid from your Insured Benefit.

You are limited to nine (9) specialist consultations per beneficiary per year, these consultations need to be authorised in advance. If you do not authorise your consultation in advance then it will be paid from your Member Savings Account if there are funds available. If there are no funds available in your Member Savings Account then you will be responsible for the cost.

GP and specialist consultations and treatment in hospital is paid from your Insured Benefit. Admissions to hospital need to be authorised in advance in order to be paid from the Insured Benefit

 

What is my cover for the dentist?

Dentistry is paid from your Insured Benefit and is subject to a limit per family when done both in- and out-of-hospital.

 

Click here for your guide to visiting your doctor.

 

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