wesmart 2017 brochure v5 · root canal r370 each, 2 crowns at r480 each, 2 wisdom teeth (chair) at...

Good HealthEnsured

2017

Wesmart is a young and vibrant Health Insurance Underwriting Agency focusing on the delivery of holistic and well-priced solutions for both the private Introduction

Individual, family and all sizes of employer groups.

The healthcare landscape in South Africa is complex, intimidating and in a lot of cases inaccessible for a large majority of people. The supply and demand principles are completely skewed in favour of certain groups and this leaves massive gaps that needs to be filled. There is little co-operation between the state and the private sector in building these bridges which allows companies like Wesmart to become adopters and move towards becoming leaders in the health insurance market sector.

Wesmart has identified the need for the active lifestyle consumers and employer groups to be able to insure themselves and or their staff against the continuously escalating costs of healthcare in South Africa. Access to healthcare has always been for the select few who could afford the high costs of medical aid. It is with this in mind that Wesmart provides you with a product range which caters for most healthcare demands in a controlled and affordable manner. The rand / benefit ratio is extremely well balanced and policy holders can expect to receive effective cover for their hard earned money.

wesmart healthinsurance solutions

About Wesmart

The Wesmart product structure allows you to close any gap in your healthcare strategy when looking for alternative solutions. We continuously look at ways of improving our policy holders experience with us through enhanced efficiencies as well as additional benefit access. Wesmart provides both “off the shelf” and tailor made solutions to corporate employers who are looking to provide both primary and tertiary healthcare benefits for their employees. For the private individual and their families who are looking to manage their budgets, Wesmart provides a fantastic range of solutions to fit every pocket. The management and staff of Wesmart, are seasoned healthcare campaigners who are committed to providing policy holders with world class customer service as well as ensuring that policy holders are never compromised through every step of their journey with us and will be treated with dignity and professionalism at every point of contact.

Our PhilosophyWesmart channel to market is through our specialist broker network. Based on a “best of breed” health insurance product suite for both brokers and policy holders, the Wesmart philosophy is focused on providing solutions that are built on strong foundations of Transparency, Reliability, Quality and Affordability in order to provide brokers and policy holders with a dynamic and effective “home” where all stakeholders needs are considered.

Vision and MissionThe vision of Wesmart is to fill the massive gap in access to quality health care needs, by providing Health Insurance solutions that are real and specific to a prospective policy holders requirements. Wesmart will ensure that through the use of technology and a customer centric approach, clients and brokers will ALWAYS be treated fairly. Our mission is to ensure that we enable policy holders to insure themselves against any possible healthcare financial losses through the provision of holistic Health Insurance solutions.

Who isWESMART?

Benefits

COMPREHENSIVE

Accidental Death Benefit

Total Permanent Disability

Premium Waiver

Dread Disease

Trauma Counselling

R50 000 (Principal And Spouse) R20 000 (Per Child)

R75 000 (Principal And Spouse)

R5 000 (Individual) R8 000 (Family)

R20 000 (1 Event PA)

A 24 Hour Trauma Counselling Line In The Event

VALUE ADDED BENEFITS

Hospital Footprint

Maternity Benefit

In-Hospital Illness Benefit

Accident And Trauma Benefit

Hospital Booster

IN-HOSPITAL BENEFITS (Pre-Authorisation Required)

Private / State (Africa Assist)

Max R30 000 OAL ; Includes 3 Specialist

Incident Rate: R120 000 (Planned Event)

Incident Rate: R150 000 ( Accident And Trauma)

Limited To 2 Events PA Paid At R5 000 PD Max 4 Days Per Event

COMPLIMENTARY BENEFITS (Pre-Authorisation Required)

Level of Care Benefit

Pap Smear, Mammogram,

Specialised Radiology and Pathology (In and out of Hospital)

Included In Event Limit


One Claim Per Beneficiary PA Limited To R1 000

R12 000 OAL (Excess Per Scan R1 000 Excess Blood Tests R500)

PRIMARY BENEFITSNetwork Providers

Specialists

Optometry

24 Hour Emergency Service (EMS)

Casualty Benefit (Accident Only)

PAMC Africa Assist

Refunded At R250

Up To R350 Per Script. On A Refund Basis Only

At R250 Each, 2 X-rays At R65 Each, 2

Root Canal R370 Each, 2 Crowns At R480 Each, 2 Wisdom Teeth (Chair) At

R580 Each PPPA

Eye Test, 1 Consultation at R250, Frames And Lenses Up To R900 or

Contact Lenses Up To R900Every 24 Months

Africa Assist

R5 000 PA

R1 000 Per Beneficiary PA

Premium

R1 450 Individual MemberR975 Adult RateR425

Child Rate

Maximum Entry Age 65

Scripted Medication: Individual : R3 000

25 Per Family And 10 For An Individual Per Beneficiary PA Through Network (Individual

After 5th Consult R100 Co-pay, Family After 10 Consults R100 Co-pay)

Consultations Refunded At R850

At

At

Key: PA: Per Annum; PPPA: Per Policy Per Annum; OAL: Overall Annual Limit; PAMC: Pan African Managed Care

s

s


Maximum Of R6 000

Benefits

PremiumADVANCED R1 265

Per Month, Individual MemberR1 690

Per Month, Family Max 3R2 015

Per Month, Family Max 5OAL R1 000 000



Premium Waiver (Accident & Illness)

Dread Disease

R40 000 (Principal And Spouse) R15 000 (Per Child)





Hospital Footprint

Maternity Benefit


Hospital Booster



Max R25 000 OAL (Normal Delivery +

Maximum Incident Rate: R75 000

R40 000 (Paid Out At R2 500 PD) - Limited To 2 Events PA






R10 000 OAL (Excess Per Scan R1 000 Excess Blood Tests R500)

PRIMARY BENEFITS

Network Providers

Specialists

Optometry



PAMC Africa Assist

PA

R250 Per Policy

Up To R350 Per Script

At R250 Each, 2 X-rays At R65 Each, 2

Root Canal R370 Each, 2 Crowns At R480 Each, 2 Wisdom Teeth (Chair) At R580

Each PPPA

Africa Assist

R4 000 PA

R500 Per Beneficiary PA

2 Consultations At R250 Each, 2 Fillings

Key: PA: Per Annum; PPPA: Per Policy Per Annum; PD: Per Day; OAL: Overall Annual Limit; PAMC: Pan African Managed Care

Extractions At R210 Each, 2 Emergency

Eye Test, 1 Consultation at R250, Frames And Lenses Up To R900 or


Individual Option: 2 Consultations Refunded At R850. Family Option- 3

Consultations Refunded At R850 Each

R3 500


Maximum Of R6 000


Benefits

PremiumINTERMEDIATE R894 Per Month, Individual Member

R1 245

Per Month, Family Max 3R1 482

Per Month, Family Max 5



Premium Waiver

Dread Disease


R30 000 (Principal Only)




Hospital Footprint

Maternity Benefit


Hospital Booster



Max R22 000 OAL (Normal Delivery)

Day 1: R6 500Day 2: R6 000

Day 3 - 6: R3 000Day 4 Onwards: R1 500 To A Limit Of

R50 000 Per Event

R20 000 (Paid Out At R1 500 PD) - Limited To 2 Events PA

Extra 30% PD; High-care Extra




ICU15% PD

1 - 59 Mins: R3 50060 - 119 Mins: R7 000

120+ Mins : R9 500

R8 000 OAL (Excess Per Scan R1 000 And Excess Blood Tests R500)

PRIMARY BENEFITS

Network Providers

Specialists

Optometry



PAMC

3 Consultations Per Beneficiary PA

Africa Assist

Refunded At R750

Individual Option: 2 Consultations Refunded

Script.

Africa Assist

R2 000 PA

R500 Per Beneficiary PA

OAL R600 000

Key: PA: Per Annum; PPPA: Per Policy Per Annum; PD: Per Day; OAL: Overall Annual Limit; PAMC: Pan African Managed Care

2 Consultations at R250 Each, 2 Fillings At R250 Each, 2 X-rays At R65 Each, 2

Extractions At R210 Each, 2 Emergency Root Canal R370 Each, 2 Crowns At

R480 Each, 2 Wisdom Teeth (Chair) At R580 Each PPPA

Eye Test, 1 Consultation at R250, Frames And Lenses Up To R900 Or


R250 Per Policy1

Includes 3 Prenatal ConsultationsRefunded At R850

Maximum Of R6 000


Benefits

PremiumStart-upR410

Per Month, Individual Member

R620 Per Month, Family Max 3

R665 Per Month, Family Max 5

Hospital Footprint

Maternity Benefit


Hospital Booster



Max R20 000 OAL (Normal Delivery Only)

Day 1: R5 000Day 2: R4 500

Day 3 - 6: R3 000Day 4 Onwards: R1 500 To A Limit Of

R25 000 Per Event

R10 000 (Paid Out At R1 000 PD)Limited To 2 Events

Maximum Of R6 000

PA




R7 000 OAL (Excess per scan R1 000 and Excess of R500

for Blood Test)

ICU Extra 30% PD High Care Extra 15% PD

1-59 min R3 00060-119 min R6 000120+ min R9 000

healthinsurance

TipsDid you know? That all Wesmart policy holders have access to a clinical consultant to discuss both basic and

WESMART is a LEADING

At Wesmart, you are always treated as a client and not as a number

10000000000000000000000000124 / 7 Solutions ProviderKey: PA: Per Annum; PD: Per Day; OAL: Overall Annual Limit

OAL R300 000

Includes 2 Prenatal ConsultationsRefunded At R850

Accidental Death Benefit R15 000 (Principal Only)


24 Hour Emergency Service (EMS) Africa Assist

PRIMARYOut-Of-Hospital Benefits

PremiumR269 Per Month, Individual Member

R449 Per Month, Family Max 3R575 Per Month, Family Max 5

Network Providers

PAMC GP Network

Provided Referral Is Obtained From The Network GP Family R4 500. Up To R220 Per Script

Radiology

Limited To Black And White X-rays And/or 1 Scan To The Value Of R1 500 Per Policy

Optometry

Casualty Benefit (Accidents Only)

R2 000 PA

Maximum Entry Age

65

HIVFor HIV

HIVState Only

2 Consultations At R250 Each, 2 Fillings at R250 Each, 2 X-rays at R65 Each, 2 Extractions at R210

Each, 2 Emergency Root Canal R370 Each, 2 Crowns at R480 Each, 2 Wisdom Teeth (Chair) at R580 Each

20 Per Family And 8 For An Individual PA Through Network (Individual After 5th Consult R100 Co-pay,

Family After 10 Consults R100 Co-pay)

Key: PA: Per Annum; GP: General Practitioner

Eye Test, 1 Consultation At R250, Frames And Lenses Up

To R900 Or Contact Lenses Up To R900 Every 24 Months



CORPORATE

Age Limit

Cover Cease Age

GP Visits

24/7 Emergency Services

24/7 Personal Health Advisor

65

65

6

2

YES

YES

R30 000

65

65

12

4

YES

YES

R50 000

65

65

18

6

YES

YES

R70 000

INDIVIDUAL MEMBER FAMILY OPTION - MAX 3 FAMILY OPTION - MAX 5

Annual Limit Annual Limit Annual Limit

Benefits

Quality Care And Transparency Are Some OfThe Strong Pillars That Our Business Is Built On Health Insurance Is

Fast Becoming The South African Way Of Accessing Quality Healthcare

QUALITY CARE TRANSPARENCY

Key: GP: General Practitioner



Private

Age Limit

Cover Cease Age

GP Visits

Prescribed Medicines

24/7 Emergency Services


55

65

6

2

R600

YES

YES

R40 000

55

65

12

4

R1 200

YES

YES

R60 000

55

65

18

6

R1 800

YES

YES

R75 000

INDIVIDUAL MEMBER FAMILY OPTION - MAX 3 FAMILY OPTION - MAX 5

Benefits

Annual Limit Annual Limit Annual Limit

Key: GP: General Practitioner

We Have Partnered With Africa Assist To Provide An Effective And Professional Experience In The Following Areas: Emergency Medical Services (Air And Or Road)24 / 7 Medical Advisory ServicesPre-authorisation And Issuing Of Guarantee Of Payment (GOP) For All Hospital AdmissionsTrauma And Bereavement Counselling (24 Hour Access If Policy Holders Experience A Traumatic Event)Post HIV Exposure Management (Accidental Exposure To HIV)

Benefits

Premium

Ambulance & Emergency Services


Admission Fee

Accidental Death/Total Permanent Disability

Casualty Ward Benefit

Trauma Counselling

Mobility Cover

Unlimited Through DSP Only

Unlimited

R5 000

R7 500 (Principal)

R750

R750 Per Session. Max 5 Sessions

R25 000

DocSure SPORT

Knocked Out Teeth

Jaw Fracture

Major Broken Bone

R1 500

R5 000 Per Event

R7 000 Per Event

R750 Per Event

At

DocSure SPORTStated Benefits:

R119 Per Month, Individual MemberR195 Per Month, Family Max 3R255 Per Month, Family Max 5

Key: DSP: Designated Service Provider

REMEMBER TO ALWAYS PRE-AUTHORISE ALL HOSPITAL EVENTS PRIOR TO ADMISSION


Benefits

Premium

Ambulance & Emergency Services


Admission Fee

Accidental Death/Total Permanent Disability

Casualty Ward Benefit

Trauma Counselling

Mobility Cover

Lifestyle Adapter

Specialised Radiology

Unlimited Through DSP Only

Unlimited

R5 000

R5 000 (Child) R10 000 (Main Spouse)

R1500

R750 Per Session. Max 10 Sessions

R50 000

R25 000

R7 000 OAL

DocSure SPORT+

Knocked Out Teeth

Jaw Fracture

Major Broken Bone

Other Broken Bone

Stolen Kit

R3 000 Per Event

R7 500 Per Event

R7 000 Per Event

R3 000 Per Event

R750 Per Event

R1 000 (Limited To 1 Event Per Annum)

DocSure SPORT+Stated Benefits:

R149 Per Month, Individual MemberR209 Per Month, Family Max 3R295 Per Month, Family Max 5

For The Sports Enthusiast

Key: DSP: Designated Service Provider; OAL: Overall Annual Limit

At

Did You Know?If You Are Admitted To Hospital For Either An Accident Or Illness Related Event, WESMART Pays From The

1st

day


Wesmart Financial and Administration Solutions (Pty) Ltd is an authorised Financial Services Provider (FSP: 45769) Underwriting Agency for GENRIC Insurance Company Limited (FSP: 43638). GENRIC is an authorised Financial

Services Provider and registered Short-term insurer.

[email protected]

www.wesmart.co.za

Contact Centre

Emergency Services

010 599 1170

010 599 1172

010 599 1172

Join the Wesmart Family

Client Queries or Policy Updates

Claims

Do You Have Any Queries Or Need To Update Any Of Your Details?

Send Your Application To: [email protected]

Email Us At [email protected]

Submit Your Claim Electronically Via Email Or Fax To Our Dedicated Call Centre: [email protected] Or Fax 086 508 2292. Have A Complaint?Send Any Feedback To: [email protected]

wesmart 2017 brochure v5 · root canal r370 each, 2 crowns at r480 each, 2 wisdom teeth (chair) at...

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