www.affinityhealth.co.

za

Simple, cost-effective and

reliable health insurance.
Welcome to our comprehensive guide to health insurance, where your well-being is our top priority.
At Affinity Health, we understand the importance of having the right cover to protect you and your loved
ones when it ma�ers most.

BENEFIT SUMMARY

24/7 Telephonic Medical Consul�ng Hotline Over-the Counter Medica�on Immediate Emergency Casualty Room Treatment

Registered Nurse Consulta�ons Radiology Casualty Room Treatment

Doctor Consulta�ons Pathology HIV Chronic Medica�on Management **

DAY-TO-DAY

Out-of-Network Doctor Visits Den�stry Diabetes Management **

Specialist Visit Optometry Chronic Medica�on**

In-Room Doctor Procedures Maternity Management Programme

Healthcare Screening Maternity Scans & Blood Tests

Acute Medica�on Trauma Support Services

Accident Hospital Cover Diagnos�c Procedures 24-Hour Emergency

Daily Illness Hospitalisa�on Motor Vehicle Accident Benefit Casualty Room Treatment
HOSPITAL

Sub-Acute Hospitalisa�on Workmen`s Compensa�on Benefit Major Trauma

Serious Illnes Hospital Benefit Post-Hospital Private Home Nursing Immediate Hospital Accident Cover

Maternity Hospital Home Care Benefit Intensive Care Benefit**

Day Clinic Procedures Trauma Support Services Hospital Accident**

This icon indicates a benefit that requires
Pre-Authorisa�on.
For more informa�on about benefits, please
consult the Affinity Health Benefit Guides.
Person joining over the age of 54 will be
subject to increased premiums. Maximum of
7 dependants per policy.
**Addi�onal features or benefits that are
op�onal and can be included to enhance the
overall value of your plan.
Wai�ng Periods commence on the
Commencement Date, unless otherwise stated.
Pre-exis�ng Condi�ons are subject to a 12
months wai�ng period from Commencement
Date.

Contact us 24/7 to u�lise benefits and to ensure you are referred to the appropriate medical
professional for consulta�on and confirma�on of benefits.
Call Centre Customer Care (WhatsApp) Casualty/Hospital Pre-Auth (WhatsApp) Email Address

0861 11 00 33 079 479 3230 071 314 5862 info@affinityhealth.co.za

Disclaimer: This is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a subs�tute for medical scheme membership. Subject to Demarca�on
regula�ons, the Insurer does not refuse membership on the basis of any means of discrimina�on.

Affinity Health, a product of Na�onal Risk Managers (Pty) Ltd (FSP 47132), the Underwri�ng Managing Agency; Affinity Life Ltd (FSP 49986),
the Insurer. This policy shall be voidable in the event of misrepresenta�on, misdescrip�on or non-disclosure of any par�cular material fact
to this insurance by or on behalf of an insured person. Terms and condi�ons as contained in the policy document apply.
 Day-to-Day Plan
Main Member Spouse/Adult Child
R809pm R739pm R389pm

The Day-to-Day Plan has been designed to help you cover the everyday costs of staying healthy such as going to the doctor or den�st, obtaining
prescribed acute medica�on or receiving a pair of reading glasses. You also receive service from any Medical Society Centre for primary healthcare
and medical treatment.

HEALTHCARE BENEFITS
Unlimited telephonic consulta�ons with a Nurse, Doctor or Mental Health Professional. Consulta�ons - No Wai�ng Period
24/7 Telephonic Medical Includes Acute Medica�on recommended by the Nurse, Doctor or Mental Health Professional
Consul�ng Hotline Medica�on - 1 Month Wai�ng Period
subject to the Formulary.
Registered Nurse Unlimited, managed visits at a Medical Society Centre. Includes all medica�on dispensed by 1 Month Wai�ng Period
Consulta�ons the Registered Nurse subject to the Affinity Health Formulary.

Unlimited, managed Doctor consulta�ons within the Affinity Health Provider Network when Pre-authorisa�on is required
Doctor Consulta�ons referred by a designated Nurse Prac��oner. 1 Month Wai�ng Period

Out-of-Network Doctor Unlimited, subject to the Affinity Health Formulary. Member must pay the Doctor and claim
back up to R300 per consulta�on. 1 Month Wai�ng Period
Visits
One Specialist visit per member, per year as referred by an Affinity Network Doctor (subject to
Specialist Visit pre-authorisa�on). Up to R1 700 per single member policy per year or up to R3 500 per family 3 Month Wai�ng Period
policy per year.

In-Room Doctor Procedures Unlimited cover for minor procedures that can be performed in Doctor Rooms, subject to sub-
limits per procedure. 1 Month Wai�ng Period

Healthcare Screening One healthcare screening visit per member per annum conducted by a Nurse prac��oner at a No Wai�ng Period
Medical Society Centre.

Unlimited and linked to the Doctor consulta�on, medica�on dispensed by the Network 1 Month Wai�ng Period
Acute Medica�on Provider or obtained on script from a pharmacy subject to the Affinity Health Formulary.

Over-the-Counter Over-the-Counter Medica�on up to R500 per member policy per year or R1 000 per family 1 Month Wai�ng Period
Medica�on policy per year, subject to pre-authorisa�on by the Nurse prac��oner.

Radiology Unlimited basic Radiology according to Affinity Health's Formulary if referred by a Network 1 Month Wai�ng Period
Doctor.

Pathology Unlimited basic Pathology as referred by a Network Doctor, subject to the Affinity Health 1 Month Wai�ng Period
Formulary.

Den�stry 1 Full mouth assessment and 1 scale and polish every 6 months. Infec�on control, 2 intraoral 3 Month Wai�ng Period
radiographs, 3 extrac�ons and 3 fillings per member per year.

Optometry One eye test and one set of standard frames and lenses per member per 24 months. This 12 Month Wai�ng Period
benefit is only available through a Spec-Savers outlet.
Support for Members, throughout pregnancy and up to six weeks post-delivery. Includes the 3 Month Wai�ng Period
Maternity Management provision of medical advice and monitoring. An addi�onal specialist visit for members 12 Month Wai�ng Period
Programme registered for the maternity management programme up to the maximum benefit limit of for pre-exis�ng condi�ons
R1 000. No hospitalisa�on available on the Day-to-Day Plan.
3 Month Wai�ng Period
Maternity Scans & Blood Two growth sonars and relevant blood tests as referred by your network Doctor, subject to 12 Month Wai�ng Period
Tests the Affinity Health Formulary. for pre-exis�ng condi�ons

24/7 EMERGENCY SERVICES BENEFITS

Telephonic trauma support counselling and mental health wellness support by qualified and
Trauma Support Services dedicated professionals for trauma�c events such as sexual assault, crime, gender-based No Wai�ng Period
violence, death, a�empted suicide; and domes�c violence.

Immediate Emergency 1 Emergency Casualty Room treatment event as a result of an accident only, ac�vated as you No Wai�ng Period
Casualty Room Treatment apply, up to R1 000 per policy.

Casualty Room Treatment Emergency Casualty Room treatment for medical condi�ons and accidental injuries up to 1 Month Wai�ng Period
R3 500 per policy per year.

OPTIONAL BENEFITS**
The HIV/AIDS programme caters to the medical and lifestyle needs of members living with 3 Month Wai�ng Period
HIV Chronic Medica�on HIV/AIDS and provides them with suitable treatment and tools to live a healthier life. 12 Month Wai�ng Period
Management Programme Chronic condi�on registra�on is required for this benefit. for pre-exis�ng condi�ons
The Diabetes Management Programme assists members in the management of their diabetes 3 Month Wai�ng Period
Diabetes Management condi�on and provides them with tools to improve their overall Health. 12 Month Wai�ng Period
Programme Chronic condi�on registra�on is required for this benefit. for pre-exis�ng condi�ons
This benefit covers 24 Specific Chronic Condi�ons according to the Affinity Chronic Medica�on 3 Month Wai�ng Period
Chronic Medica�on Benefit Formulary. R119pm per member per chronic condi�on. 12 Month Wai�ng Period
Chronic condi�on registra�on is required for this benefit. for pre-exis�ng condi�ons
 Hospital Plan Main Member
R1 258pm
Spouse/Adult
R1 168pm
Child
R378pm

The Affinity Health Hospital Plan provides you with a wide range of benefits in the event of hospitalisa�on as a result of an accident, illness, or
medical emergency. Accidents happen when you least expect them, and even the healthiest among us can fall vic�m to disease, illness or an
unfortunate accident.

HEALTHCARE BENEFITS

Accident Hospital Cover Up to R275 000 per single member per event or R325 000 per family per event. Covers both No Wai�ng Period
casualty and any hospital admission costs. Accidents are covered from Commencement Date.

1st Day 2nd Day 3rd Day 4th Day 5th Day
R22 000 R22 000 R22 000 R11 000 R11 000 3 Month Wai�ng Period
Daily Illness R27 000* R27 000* R27 000* R14 000* R14 000* 12 Month Wai�ng Period
Hospitalisa�on for pre-exis�ng condi�ons
therea�er R3 500 per day, up to a maximum of 21 days per member per illness event.
*ICU Booster cover applicable when admi�ed to ICU.

Access to a Sub-Acute Facility that is affiliated with Affinity Health. R20 000 per member per 3 Month Wai�ng Period
Sub-Acute Hospitalisa�on year.
12 Month Wai�ng Period
for pre-exis�ng condi�ons
The maximum Serious Illness Benefit will be R300 000 for the life�me of the policy, however 3 Month Wai�ng Period
Serious Illness Hospital the maximum benefit amount for confirmed Strokes, Aneurysms and Cancer will be R150 000 12 Month Wai�ng Period
Benefit for the life�me of the policy. for pre-exis�ng condi�ons

Maternity Natural, Home and Water Birth R25 000 12 Month Wai�ng Period
Maternity C-Sec�on R35 000

Access to the Affinity Network of Day Clinics for procedures up to R25 000 per member per 3 Month Wai�ng Period
Day Clinic Procedures year. Subject to Sub-limits per procedure. 12 Month Wai�ng Period
for pre-exis�ng condi�ons
Diagnos�c Procedures from the Affinity Health Diagnos�c Formulary covered up to R20 000 3 Month Wai�ng Period
Diagnos�c Procedures per single member policy or R25 000 per family policy per year. Subject to member co- 12 Month Wai�ng Period
payment and benefit limits. for pre-exis�ng condi�ons

Motor Vehicle Accident This benefit offers assistance with claiming from the Road Accident Fund. Affinity Health has a
Network of a�orneys that will assess the accident at no cost to the member and will facilitate No Wai�ng Period
Benefit any reimbursement from the Road Accident Fund on behalf of the member.
The benefit offers cover for occupa�onal related injuries or diseases. Affinity Health also
Workmen's Compensas�on offers third party recovery services, such as advice and administra�ve assistance, keeping the No Wai�ng Period
Benefit member updated on the progress of the claim.
Post-Hospital Private Home Up to R11 000 per single member policy or R13 000 per family policy per year for the Included in all the plans.
Nursing assistance of a private nurse. No Wai�ng Period

Hospital Home Care services combines in-home and virtual visits with remote monitoring 3 Month Wai�ng Period
Hospital Home Care Benefit offering pa�ents �mely, hospital-level care in their homes.
12 Month Wai�ng Period
for pre-exis�ng condi�ons
Trauma Cover for condi�ons rela�ng to paraplegia, quadriplegia, severe burns, internal and
Major Trauma external head injuries, polytrauma and loss of limb. Up to a maximum of R1 100 000 for the Benefit sub-limits apply
life�me of the policy. No Wai�ng Period

Immediate Hospital Hospitalisa�on as a result of an accident is covered from the Applica�on Date* up to No Wai�ng Period
Accident Cover R100 000 per single member policy and R150 000 per family policy.

24/7 EMERGENCY SERVICES BENEFITS

Telephonic trauma support counselling and mental health wellness support by qualified and
Trauma Support Services dedicated professionals for trauma�c events such as sexual assault, crime, gender-based No Wai�ng Period
violence, death, a�empted suicide; and domes�c violence.

Immediate Emergency 1 Emergency Casualty Room treatment event as a result of an accident only, ac�vated as you No Wai�ng Period
Casualty Room Treatment apply, up to R1 000 per policy.

Casualty Room Treatment Emergency Casualty Room treatment for medical condi�ons and accidental injuries up to 1 Month Wai�ng Period
R3 500 per policy per year.

OPTIONAL BENEFITS**
Up to R27 000 cover per day in ICU for the first 3 days and R14 000 for the 4th day and 3 Month Wai�ng Period
Intensive Care Benefit R14 000 for the 5th day. For illness events only. 12 Month Wai�ng Period
for pre-exis�ng condi�ons
Single Cover R129pm
Family Cover R259pm

Op�onal benefit to increase the amount provided under the Accident Hospital Cover benefit. 3 Month Wai�ng Period
Hospital Accident Benefit Accidents are covered from Applica�on Date for the Hospital Plan. 12 Month Wai�ng Period
for pre-exis�ng condi�ons
Single Cover Family Cover
Up to R350 000 R129pm Up to R500 000 R229pm Accident Booster has no wai�ng period
Up to R450 000 R258pm Up to R650 000 R458pm and is applicable from the Commencement
Up to R550 000 R387pm Up to R800 000 R687pm Date.
Up to R650 000 R516pm Up to R950 000 R916pm
Up to R750 000 R645pm Up to R1 100 000 R1 145pm
Up to R850 000 R774pm
Up to R950 000 R903pm
Up to R1 050 000 R1 032pm
Up to R1 150 000 R1 161pm
 Combined Plan
Main Member Spouse/Adult Child
R1 838pm R1 688pm R638pm

A Combined Plan comprises of all the benefits available on the Day-to-Day and Hospital Plans and offers the same op�onal benefits as the
standalone plans.

Registered Nurse Consulta�ons Casualty Room Treatment HIV Chronic Medica�ons Programme

Healthcare Screening Pathology Diabetes Management Programme

DAY-TO-DAY

Telehealth Consul�ng Acute Medica�on Maternity Management Programme

Doctor Consulta�ons Over-the Counter Medica�on

Out-of-Network Doctor Visits Radiology

In-Room Doctor Procedures Den�stry

Specialist Visits Maternity Scans

Accident Hospital Cover Motor Vehicle Accident Benefit Major Trauma

Daily Illness Hospitalisa�on Workmen`s Compensa�on Benefit Immediate Hospital Accident Cover

Sub-Acute Hospitalisa�on Post-Hospital Private Home Nursing

HOSPITAL

Serious Illness Hospital Benefit Hospital Home Care Benefit

Increased Casualty Room Treatment
Maternity Trauma Support Services
R4 500
Day Clinic Procedures 24-Hour Emergency per policy per year.

Diagnos�c Procedures Casualty Room Treatment

DAY-TO-DAY HOSPITAL
OPTIONAL

HIV Chronic Medica�on Management** Intensive Care Hospital Benefit**

Diabetes Management** Hospital Accident Benefit**

Chronic Medica�on Benefits**

PLAN PREMIUMS

DAY-TO-DAY PLAN PREMIUM HOSPITAL PLAN PREMIUM COMBINED PLAN PREMIUM

Main Member Main Member Main Member

R809pm R1 258pm R1 838pm
Spouse/Adult Spouse/Adult Spouse/Adult
R739pm R1 168pm R1 688pm
Child Child Child
R389pm R378pm R638pm

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@affinityhealth.za @affinityhealthcoza www.affinityhealth.co.za

Disclaimer: This is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a subs�tute for medical scheme membership. Subject to Demarca�on
regula�ons, the Insurer does not refuse membership on the basis of any means of discrimina�on.

Affinity Health, a product of Na�onal Risk Managers (Pty) Ltd (FSP 47132), the Underwri�ng Managing Agency; Affinity Life Ltd (FSP 49986),
the Insurer. This policy shall be voidable in the event of misrepresenta�on, misdescrip�on or non-disclosure of any par�cular material fact
to this insurance by or on behalf of an insured person. Terms and condi�ons as contained in the policy document apply.