FREQUENTLY ASKED QUESTIONS
FREQUENTLY ASKED QUESTIONS
Through a national network of providers who’ve contracted with Unity Health, our health insurance administrator, you have access to more than 3 745 GPs and various pharmacies, pathologists and radiologists.
Can I visit any GP of my choice?
You and your dependants can visit any network GP as often as needed. We don’t expect you to nominate a GP. Cool, right?
Keeping to the network means you’ll get the most out of your cover, but when you can’t or prefer to see a GP of your choosing, you get 2 out-of-network GP consultations per person per year.
You can also visit the nurse at your nearest Alpha Pharm, Clicks, Dis-Chem, Local Choice, or Medicare pharmacy for minor illnesses. If the nurse feels it’s necessary for you to consult with a GP, a virtual consultation can be arranged.
There’s also an Intercare Online GP Consultation Benefit you can claim from. These unlimited consultations can be accessed via the Unity Health Mobile App.
You cover virtual GP consultations. That’s cool! How does it work?
Virtual consultations are available under the Telemedicine GP Consultation Benefit at approved pharmacies, namely Alpha Pharm, Dis-Chem and Medicare. When you visit a nurse at your nearest network pharmacy clinic, the nurse will determine if a virtual GP consultation is necessary and help set it up.
The Intercare Online GP Consultation Benefit offers unlimited access to as many virtual GP consultations as needed. These consultations can be accessed via the Unity Health App.
Must I obtain pre-authorisation for every GP, nurse or virtual GP consultation?
Pre-authorisation for each network GP consultation is required. Add the GP PRE-AUTH WAIVER for an additional premium of R 39 per person per month to see your network GP without prior approval.
Good to know: If you don’t add this benefit when you join, you can do so for the new benefit year beginning 1 January 2025.
Pre-authorisation for the following benefits is not required:
- Out-of-network GP Consultations
- Intercare Online GP Consultations
- Telemedicine GP Consultations
- Nurse Consultations
Who should I contact for pre-authorisation?
Our Call Centre on 011 781 4488.
For medical emergencies, call 0861 366 006 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.
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, 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, 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, Local Choice or Medicare.
You get unlimited cover for specific chronic conditions or diseases.
Is dentistry covered?
That smile looks good on you. Let’s keep it that way.
You may visit any dentist for basic treatment, like extractions and fillings.
Dental fillings must be pre-authorised. Ask your dentist to contact us to ensure the fillings you need are on the list of approved codes.
When you need emergency dental treatment, like draining an abscess or root canal treatment, or when you’ve lost a tooth because of an accident, you’re also covered.
A benefit limit applies.
Specialised dentistry isn’t covered, like orthodontic treatment, dentures, and crowns.
If you prefer to use a recommended dentist on the Unity Health dentist network, call us, and we’ll help you find the nearest dentist.
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.
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.
Can I claim for a consultation with my specialist?
Yes! Your network GP must refer you when the medical treatment provided fails, and the specialist consultation must be pre-authorised.
Can you give an overview of the benefits that are subject to pre-authorisation?
For you… anything!
- GP Consultations, Telemedicine GP Consultations, Intercare Online GP Consultations and Nurse Consultations from the 10th visit and thereafter;
- Specialist Consultations;
- Dental Care | Fillings;
- Pre-Birth Consultations;
- Pneumococcal vaccination;
- Emergency & Accident Cover;
- Casualty Visits;
- MRI & CT Scans; and
- Physio and Occupational Therapy
Which day-to-day benefits require both a GP referral and pre-authorisation?
- Covid-19 Screening Test; and
- Specialist Consultations
Which day-to-day benefits require only a GP referral?
- Blood tests; and
- X-rays
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 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 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.
Can I add my dependants and extended family members to my health insurance policy?
We cover you, your spouse, and your child dependants of whom you’re the parent or legal guardian.
Extended family members don’t qualify for cover.
Can’t find the answer to your question, give us a call on 011 781-4488, pop us an email to yoursupport@stratumbenefits.co.za send a message on Chat Box, or WhatsApp us and we’ll get back to you right away.
Health Insurance isn’t medical aid cover, doesn’t provide similar cover as that of a medical aid and can’t be substituted for medical aid membership.
