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086 111 3499

Gap Cover & Health Insurance for Real People

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 2 700 GP’s, 2 700 optometrists and various pharmacies, pathologists and radiologists.

DO THE STRATUM BENEFITS HEALTH INSURANCE BENEFIT OPTIONS PROVIDE THE SAME BENEFITS AS THAT OF A MEDICAL AID?

Although we provide day-to-day benefits for GP visits, acute and chronic medication, blood tests, x-rays and dentistry as well as hospital cover for emergencies and accidents, to name but a few, our benefit options do not provide similar cover as that of a medical aid and cannot be substituted for medical aid membership.

CAN I BELONG TO A STRATUM BENEFITS HEALTH INSURANCE BENEFIT OPTION AND A MEDICAL AID PLAN AT THE SAME TIME?

For sure! Our 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 ALL MY DEPENDANTS, INCLUDING EXTENDED FAMILY MEMBERS, TO MY BENEFIT OPTION?

We cover you, your spouse and your child dependants of whom you are the parent or legal guardian

CAN I VISIT ANY GP?

You and your registered dependants may visit any network GP as many times as needed. You may also visit  the on-site nurse at your nearest Clicks, Dis-Chem or Pick n Pay clinic for unlimited consultations for  minor illnesses.

 When you visit your network GP or a nurse for 10 or more times, pre-authorisation will be required for  every visit.

WHAT IS A FORMULARY?

A formulary is an approved list of acute and/or chronic medication covered under our Day-to-Day Benefit Option.

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

CAN MY NETWORK GP DISPENSE ACUTE MEDICATION?

If your network GP is registered as a dispensing doctor, you’ll receive acute 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 any Mediscor pharmacy, such as Clicks, Dis-Chem or Pick n Pay.

 Acute medication is provided or prescribed according to a formulary and has no benefit limit.

CAN MY NETWORK GP DISPENSE CHRONIC MEDICATION?

Your network GP cannot dispense chronic medication from their rooms but can diagnose your chronic condition and/or illness and help register your chronic medication on the chronic illness programme through Mediscor.

 After registration and approval, you can collect your chronic medication at any Mediscor pharmacy, such as Clicks, Dis-Chem or Pick n Pay.

IS OVER-THE-COUNTER MEDICATION COVERED?

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

 When you visit the on-site nurse at your nearest Clicks, Dis-Chem or Pick n Pay clinic, the nurse can prescribe medication for up to Schedule 2 medication.  

IS DENTISTRY COVERED?

We provide benefits for basic dentistry, such as fillings and extractions as well as emergency dental treatment, such as treatment of an abscess.

 We also cover dentistry for accidental events when you require urgent dental treatment for a physical injury, such as a broken tooth.

 We do not cover specialised dentistry, such as orthodontic treatment, dentures and/or crowns.

HOW DO I FIND A NETWORK DENTIST?

You can visit any dentist of your choice, but your treatment must be pre-authorised. Ask your dentist to contact us before any treatment is provided to make sure of the tariff codes that we cover.

WILL A MEDICAL EMERGENCY, SUCH AS A HEART ATTACK, BE COVERED?

We cover the transport cost to your nearest private hospital and the cost of stabilisation in the hospital’s emergency or casualty unit when you’re admitted as an in-patient up to a benefit limit.

 If you need further treatment after stabilisation, we’ll cover the cost to transfer you to a public hospital and any costs thereafter will be for your own pocket.

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WILL INJURIES FROM A MOTOR VEHICLE ACCIDENT BE COVERED?

We cover the cost of your hospital admission and all associated healthcare providers’ costs during your stay in hospital up to a benefit limit.

 Medical treatment for a physical injury caused by a minor accidental event will be covered at your nearest private hospital’s casualty facility up to a benefit limit.

WILL I BE COVERED FOR A PLANNED MEDICAL PROCEDURE, SUCH AS CHILDBIRTH?

Planned procedures, such as childbirth, are not covered.

CAN I CLAIM MY MONTHLY POLICY PREMIUMS BACK FROM SARS?

Unlike medical aids who issue annual tax certificates for income tax purposes, premiums for Health Insurance policies are not tax deductible as these policies are registered as Short-Term insurance policies.

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Can’t find the answer to your question, give us a call on 086 111 3499, 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.