Unlimited visits at any Unity Health GP Network.

A R65.00 co-payment is payable for each visit

Minor procedures in doctors’ rooms are included in GP visits e.g., wound stitching, applying a cast to a broken arm, circumcision, etc.

Nurse consultations available at approved pharmacies (Clicks, Dischem & Pick n Pay) for minor ailments. In many practices, nurses can provide scripts for minor ailments for up to schedule 2 medications.

Pre-authorization required for 10 or more GP or Nurse visits per person per annum. consequatur.

Limited to R1 350 per visit with an overall limit of R2 800 per family per year. Referral by Unity Health Network GP and pre-authorization required.

Dispensing GP: This means your GP dispenses medication and will provide you with the necessary medication.

Non-Dispensing GP: Unlimited

Limited to medication prescribed during your Network GP visits.

This means your Network GP does not provide you with medication but will provide you with a prescription to collect your medication.

Available at approved pharmacies (Clicks, Dischem & Pick n Pay).

Chronic Medication Programme: 27 Listed “high impact” Conditions2 HIV/AIDS included. Chronic condition: A condition / disease that lasts for an extended period of time.

Chronic Medication Programme: Your Network GP will assist you to register on the Chronic Medication Programme with Mediscor. Your prescribed chronic medicines will be covered according to a set formulary. Find the chronic medication formulary (list) on Mediscor’s website: www.mediscor.co.za. Approved pharmacies include Clicks, Dischem, Pick n Pay & Medicross.

Asthma; Chronic Obstructive Pulmonary Disorder; Diabetes Type 1&2; Epilepsy; HIV/AIDS; Hyperlipidemia; Hypertension; Tuberculosis; Addison’s Disease; Bi-polar Mood Disorder; Bronchiectasis; Cardiac Failure; Cardiomyopathy Disease; Chronic Renal Disease; Coronary Artery Disease; Crohn’s Disease; Diabetes Insipidus; Dysrhythmias; Glaucoma; Hemophilia; Hypothyroidism; Multiple Sclerosis; Parkinson’s Disease; Rheumatoid Arthritis; Schizophrenia; Systemic Lupus Erythematosus; Ulcerative Colitis.

Limited to R1 350 per person per incident

Treatment includes full mouth assessment, intra oral radiographs, scale & polish, extractions, emergency root canal treatment, fillings, pain and sepsis treatment.

Only available at Unity Health Dentists. Specialized dentistry/treatment, such as bridgework or crowns; orthodontic treatment; and dentures are not covered.

One eye test per person per year.

A standard frame to the value of R254 and one pair of clear standard spectacle lenses per person per 24 months. Available at PPN Network Optometrists.

Basic list of blood tests at a Designated Service Provider.

Your Network GP must ask for these tests to be done. E.g., blood sugar or cholesterol tests

Black & white X-rays only at a Designated Service Provider. Your Network GP has to refer you to have X- rays done. Specialized radiology such as MRI / CT scans is not covered.

2 gynecologists visits, 2 ultrasound scans per year. Limited to R3 425 per family per annum. Pre-authorization is required.

1-month general waiting period, no pre-existing condition exclusions

Available once every 3 years after the age of 21 at Approved pharmacies (Clicks, Dischem & Pick n Pay). Your Network GP may offer Pap Smears.

Influenza: Available annually – needs to be administered by 31 May each year. Tetanus: Available once every 10 years. Hepatitis A & B: Available once-off.

Pneumococcal: Available once every 5 years for those aged 60 or older and for those individuals with medically proven compromised immune system.

Available at Approved pharmacies (Clicks, Dischem & Pick n Pay)

No Overall Annual Limit

The actual cost of hospitalization as an in-patient, including all associated services during the hospital admission at a private facility in the event of injuries sustained due to an accident. “What is an accident?

An accident means bodily injury caused by violent accidental and external physical means. E.g. Severe injuries resulting from a vehicle accident or working with factory machinery.”

Limited to R1 250 000 per person per incident. Pre-authorization is required.

The actual cost of hospitalization as an in-patient, in the event of an emergency that necessitates the stabilization of the patient before the patient is transferred to a public hospital.

Medical procedures are excluded.

“What is an emergency?

An event or unexpected health condition, which if not treated immediately would result in death or serious bodily impairment. E.g., Heart attack/stroke.”

Limited to R26 500 per person per incident. Pre-authorization is required.

An accident means bodily injury caused by violent accidental and external physical means. E.g. Severe injuries resulting from a vehicle accident or working with factory machinery.”

Limited to R1 250 000 per person per incident. Pre-authorization is required.

The benefit payable for injuries sustained,enro as a result of a minor accident shall be limited to treatment received in a hospital emergency unit. Pre-authorization is required.

Limited to R6 850 per person per incident. Pre-authorization is required.

The actual cost of a MRI or CT scan, necessitated as a result of an injury sustained due to an accident. Limited to R18 000 per person per year. Pre-authorization is required

Physiotherapy & Occupational therapy following an in-patient hospitalization due to an accident.

Limited to a period of 3 months following the discharge from an in-patient hospitalization incident and limited to R3 425 per person per year. Pre-authorization is required.

Limited to R25 000 per principal insured and first spouse dependent and R5,000 per child dependent.

Emergency Evacuation, including ambulance services (air or road) Inter- hospital transfers

Repatriation of mortal remains

Telephonic Medical advice (Ask a Doctor, ask a Nurse)

Unity Health push to call emergency dialing and find a provider app