FREQUENTLY ASKED QUESTIONS

 

Through a national network of providers who have contracted with Unity Health, our health insurance administrator, you have access to more than 3 000 GP’s, 2 700 optometrists and various pharmacies, pathologists and radiologists.

Do the health insurance benefit options marketed by Stratum Benefits provide the same benefits as that of a medical aid?

No, not really. Although there are some similarities between the benefits offered by a medical aid plan and health insurance, for example day-to-day, emergency and accident cover, health insurance cover shouldn’t be compared or substituted for medical aid cover as the benefit and premium structures are completely different.

Can I sign up for health insurance and medical aid?

For sure! The health insurance benefit options complement your medical aid cover, or it can be taken as your primary health cover if you don’t have medical aid cover.

Can I add my dependants and extended family members to my health insurance policy?

We cover you, your spouse and your child dependants, as long as you are their parent or legal guardian. 

Can I visit any GP of my choice?

Sorry, no. You can’t go to just any GP.

Keeping to the network means you’ll get the most out of your cover.

You and your dependants can visit any GP in the network. We don’t expect you to nominate a GP. Cool, right?

You can also visit the nurse at your nearest Alpha Pharm, Clicks, Dis-Chem, Pick n Pay, Local Choice or Medicare pharmacy for minor illnesses.

Prefer a virtual consultation with a network GP? No problem. If the nurse feels it’s necessary, a virtual consultation can be arranged.

Where do I get acute medication from?

From your network GP, as long as they’re registered as a dispensing doctor. If they are, you’ll receive medication in the rooms during one of your visits.

If your network GP is registered as a non-dispensing doctor, you’ll be given a prescription that you can take to a Mediscor pharmacy, like Alpha Pharm,  Clicks, Dis-Chem, Local Choice, Pick n Pay or Medicare.

Medication that you receive in the rooms or that’s prescribed will be from a formulary and is unlimited. Yay!

What is a formulary?

It’s an approved list of acute or chronic medication covered under the Day-to-Day Benefit Option.

Formularies provide both generic and non-generic drugs. Formulary medication is chosen for its cost, effectiveness and safety.

Is over-the-counter medication covered?

Unfortunately, not.

We cover medication that’s provided to you in your network GP’s rooms and medication that your non-dispensing network GP prescribes.

When you visit the nurse at your nearest Alpha Pharm, Clicks, Dis-Chem, Pick n Pay, Local Choice or Medicare pharmacy, medication for up to schedule 2 medication can be prescribed.

Am I covered for chronic medication?

Chronic medication won’t be dispensed in the rooms, but your network GP will help to get your chronic medication registered.

After registration and approval, you can collect your medication from any Mediscor pharmacy, such as Alpha Pharm, Clicks, Dis-Chem, Pick n Pay, Local Choice or Medicare.

You get unlimited cover for specific chronic conditions or diseases.

You cover virtual GP consultations. That’s cool! How does it work?

The virtual GP consultations are available at approved pharmacies like Alpha Pharm, Dis-Chem and Medicare. When you go and see the nurse, they’ll determine if it’s necessary to consult with a GP and a virtual consultation will be  arranged if needed.

Must I obtain pre-authorisation for every GP, nurse or virtual GP consultation?

From the 1st to the 9th visit, you’re good to go.

From the 10th consultation you’ll need authorisation.

Let’s explain… if you visit your network GP 3 times, a nurse 5 times and have 1 virtual consultation, you’ll  have to get authorisation for the 10th consultation and every consultation after that.

How do I find a network doctor, recommended dentist, nurse or optometrist?

That’s easy!

Contact us on 011 781 4488 to speak to a consultant, or follow this link – http://bit.ly/2JBSI3o – to download the app from Google Play Store, or this link – https://apple.co/2LXbwMd – to download the app from Apple Store for iOS.

Who should I contact for pre-authorisation?

Our Call Centre on 011 781 4488.

For medical emergencies, call 010 205 3044 and you’ll be put through to a case manager.

Should I pay my network GP upfront?

Not at all.

Your network GP will submit an invoice directly to Unity Health, our health insurance administrator. If your network GP asks you for upfront payment, let them contact our Call Centre on 011 781 4488.

Can you give an overview of the benefits that are subject to pre-authorisation?

For you… anything!

 

  •  GP, Nurse & Virtual GP Consultations from the 10th visit and thereafter;
  • Specialist Consultations;
  • Dental Care;
  • Pre-Birth Consultations;
  • Emergency & Accident Cover;
  • Casualty Visits;
  • MRI & CT Scans; and
  • Physical Rehabilitation Care
Are planned medical procedures or events covered, like childbirth?

Sorry, no. Planned medical events aren’t covered.

Am I covered for accidents, like a motor vehicle accident?

We’ve got you! If you’re admitted to hospital for an accident, we’ll cover the cost of the admission and all the associated healthcare providers’ costs while you’re in hospital.

A benefit limit applies and pre-authorisation is required.

Will a medical emergency, like a heart attack, be covered?

We’ll cover the cost to transport you to the nearest hospital and the cost of stabilisation in the hospital’s emergency or casualty unit.

If you need further treatment after you’ve been stabilised, we’ll cover the cost to transfer you to a public hospital if you were transported to a private hospital, but any costs thereafter will be for your own pocket.

 A benefit limit applies and pre-authorisation is required.

Can I claim for a consultation with my specialist?

Yes! Your network GP must refer you and the specialist consultation must be pre-authorised.

We’ll refund you for the consultation fee up to the benefit limit that’s available.

Is dentistry covered?

That smile looks good on you. Let’s keep it that way.

You can visit any dentist of your choice, but treatment must be authorised. Ask your dentist to contact us to make sure the treatment you need is on our list of approved codes.

You’re covered for basic dentistry, like fillings and extractions, and for emergency dental treatment, like treatment for an abscess.

If you need urgent dental treatment because of an accidental event, like a broken tooth, we’ll cover that too.

A benefit limit applies.

Specialised dentistry, like orthodontic treatment, dentures and crowns aren’t covered.

Can I claim health insurance policy premiums back from SARS?

Unlike medical aids who issue annual tax certificates for income tax purposes, premiums for health insurance policies aren’t tax deductible because these policies are registered as short-term insurance policies.

Like what you see…

Can’t find the answer to your question, give us a call on 010 593 0981, pop us an email to yoursupport@stratumbenefits.co.za or drop us a message on Chat Box, and we will get back to you.

 

Our Health Insurance policy is not a medical aid, does not provide similar cover as that of a medical aid and cannot be substituted for medical aid membership.