Elixi - Affordable Medical Aid Alternatives

THE BENEFITS EXPLAINED

Edit Content

Unlimited Network GP Visits Coverage
Access to Unity Health Network General Practitioners, at the consulting rooms of the GP during the normal consulting hours of the Network GP. Minor GP procedures are included in your visits to the GP. For example stitching of a wound, application of a cast to a broken limb etc.

There are over 3500 Network GP’s nationwide.
Unlimited visits per person, per year.
Pre-authorisation is required for ten (10) or more GP, Out-of-Network GP or nurse consultations, telemedicine and Intercare video based GP consultations per Insured Person per policy year.

Intercare
Access to unlimited online GP visits via the Unity Health App or Unity Health Member portal through Intercare.

Out-of-Network GP Visits
Access to an out-of-network general practitioner for a maximum of 2 visits per person per year, refundable to a limit of R300 per visit. Members can claim back from Unity Health for out-of-network GP visits. The out-of-network GP visits will not cover medication or referrals for pathology and radiology.

Nurse Consultations
Access to a network of Nurse practitioners, during the normal consulting hours at approved pharmacy clinics (Alpha Pharm, Clicks, Dischem, Local Choice, Medicare or Pick n Pay Pharmacy) for minor ailments. The number of consultations per Insured Person per Policy Year is not limited, but Pre-authorisation is required for ten (10) or more general practitioner or nurse consultations per Insured Person Per Year. In many practices’ nurses can provide scripts for minor ailments for up to schedule two (2) medications.

Telemedicine Consultations:
Virtual GP consultations per Family per year are available through approved pharmacies that has a nurse clinic (Alpha Pharm, Dischem and Medicare). If the nurse believes a virtual GP consultation is necessary, the nurse will facilitate the GP consultation through a video conference link. Pre-authorisation required for 10 (ten) or more visits to a GP, Out-of-Network GP, Nurse, Telemedicine and Intercare Video based GP consultations.

Acute Medication
A dispensing Network general practitioner will dispense acute medication for acute illnesses at one or more of the consultations referred to above, if required. A non-dispensing Network general practitioner will provide prescriptions for collection at a network pharmacy which are subject to availability and the Medicine Formulary approved by the Underwriting Manager for acute illnesses and Formulary Reference Pricing (FRP), as amended from time to time.
The benefit for prescribed acute medication is not limited.

Basic Pathology Blood Tests
Access is limited to diagnostic pathology tests on referral by a Network general practitioner at one or more of the consultations referred above, if required, and subject to a defined list of basic pathology tests approved by the Underwriting Manager, available through a pathologist Identified by the Underwriting Manager (Ampath, Lancet and Pathcare). The prescribed Pathology Request Form can be obtained on the Unity Health website, the digital App or the Unity Health Call Centre on 0861 366 006.

Basic Radiology X-rays
Basic X-rays (black & white) are covered on referral by a Network GP. YourNetwork GP will advise you if X-rays are needed. Subject to a list of X-ray procedures. Specialised radiology such as MRI, CT scans are not covered.

Pre-Birth Maternity
All plans cover limited Gynaecologist visits and limited ultrasound scans per family, per year. You may go to any gynaecologists. Upfront payment may be required by will be reimbursed to you. If you prefer to have an ultrasound scan at your Network GP, we will not count this as an additional Network GP visit. Limits apply- per family per year. This benefit is only payable if Pre-authorisation is requested and approved.

Covid-19 Screening

The benefit is payable if you test positive for COVID-19 and only if Pre-authorisation and referral by a network GP is done (Rapid tests are not covered)

Accidental Death Benefit

A benefit is payable in the event of the death of the principal insured person and/or the spouse, or children of the principal insured person due to an accident.

Wellness Screenings
Wellness Screenings at approved pharmacies include health checks for:
– Blood pressure
– Cholesterol
– Glucose levels
– Body mass index (BMI)
– Waist circumference
– HIV and pre & post-test counselling

Limited to one screening per person, per year.

Chronic Medication
Black and Gold Plans offer access to chronic medication. Covers medication for the following specified “high-impact” chronic conditions:

1. Asthma
2. Chronic obstructive pulmonary disorder
3. Diabetes (type 1&2)
4. Epilepsy
5. HIV/AIDS
6. Hyperlipideamia
7. Hypertension
8. Tuberculosis
9. Hypothyroidism (Black Plan only)
10. Glaucoma (Black Plan only)

Basic and Emergency Dentistry

Access is limited to a dental practitioner or dental therapist for basic and emergency dental treatment and restoration. The defined list of dental procedures approved by the Underwriting Manager. Pre-authorisation is required for all dental fillings.

Basic Optometry
Access to an optometrist approved by the Underwriting Manager for an optometric wellness examination, and when required a basic pair of frames
and clear plastic single vision or bifocal lenses approved by the Underwriting Manager, every twenty-four (24) months per Insured Person

Specialist Visits
Subject to Network GP referral. Specialist visits limited per family, per year.

Pap Smears
Available once every 3 years after the age of 21. Available at all approved pharmacies. Your Network GP may or may not offer Pap Smears.

PSA Screening
Prostate-Specific Antigen (PSA) Screening will be available once every 2 years after the age of 50. Subject to availability. PSA Screenings done at a laboratory will not be covered.

Vaccination Programme
Available at approved Dischem and Clicks pharmacies. Influenza: Available annually and needs to be administered by 31 May each year. Tetanus: Available once every 10 years. Hepatitis A & B: Available once-off. Pneumococcal: Available once every 5 years for those aged 60 or older and for those individuals with a medically proven compromised immune system. Pre-authorisation required.

Assistance Progamme
Unlimited telephonic and skype counselling services are provided by registered counsellors who follow specific procedures and clinical protocols. The service is available 24 / 7 and includes counselling for:

– Critical incidence / trauma counselling
– HIV counselling
– Legal Advice
– Financial Advice

Face to face counselling can be arranged for the member’s own account.

HOSPITAL CARE

Edit Content

Emergency Stabilisation Benefit
A benefit equal to the cost of treatment in a hospital emergency unit, provided that such treatment is in the event of an Emergency. Inter -hospital transfer in an appropriate road and/or air response will be undertaken utilising an ambulance, and/or rapid response vehicle, and/or helicopter and/or a fixed wing aircraft (all of which are manned by appropriately qualified and experienced emergency care practitioners, paramedics, or medical doctors). No limitation applies to inter-hospital transfers. This benefit is only payable if Pre-authorisation is requested and approved.

Inpatient Hospital Treatment (Accident Only):
A benefit equals to the cost of inpatient hospital treatment, provided that such treatment is in the event of an Accident. Inter-hospital transfer in an appropriate road and/or air response will be undertaken utilising an ambulance, and/or rapid response vehicle, and/or helicopter and/or a fixed wing aircraft (all of which are manned by appropriately qualified and experienced emergency care practitioners, paramedics or medical doctors). No limitation applies to inter-hospital transfers. This benefit is only payable if Pre-authorisation is requested and approved.

Out-Patient Casualty Unit – Accident Only
The benefit payable for injuries sustained in the event of an accident shall be limited to treatment received in a hospital emergency unit. Limited per insured person, per incident. Pre-authorisation is required.

Medical Emergency Services
Emergency evacuation, including:
• Ambulance services (air or road)
• Telephonic medical advice
• Inter-hospital transfers
• Repatriation of mortal remains within the borders of South Africa
• Unity Health push to call emergency dialling, geo-locating and find a provider mobile app

MRI & CT Scans – Accident Only
The actual cost of an MRI or CT scan necessitated as a result of an injury sustained due to an accident. Pre-authorisation is required. Limited per insured person, per year.

Physio & Occupational Therapists – Accident Only
Physiotherapy & Occupational Therapy following an in-patient hospitalisation due to an accident. Limited to a period of 3 months following the discharge from an in-patient hospitalisation incident. Pre-authorisation is required. Limited per insured person, per year.

Accidental Death Benefit
A benefit is payable in the event of the death of the principal insured person and/or the spouse due to an accident, or children of the principal insured person due to a motor vehicle accident.

VALUE ADDED SERVICES

Edit Content

Crisis Centre
State-of-the-art crisis management centre, available 24 hours a day, 7 days a week. Provides expert crisis assistance and emergency coordination for all services as well as public services.

Household Assistance
This service will provide members with a callout and up to one hour’s labour (initial fault only), for emergency events that relate to plumbing, electrical faults, faults with appliances, damage to external windows, and emergencies where a locksmith is required.

C5 HIV Prevention Programme
In the event that an ELIXI policy holder is exposed to HIV through a trauma or assault, the member will have access to: 24 hour telephonic HIV advice and counseling line, emergency evacuation to HIV treatment facility (ER24 only), medical consultation, 3 day starter pack, 25 day antiretroviral HIV treatment including, sexually transmitted disease therapy and pathology tests.