Clicks Flexicare: Affordable Health Insurance for South Africans (2024)

In-person GP consultations

Description

This benefit provides access to visit a network GP, and such visits will be covered at 100% of the Agreed Rate in the following instances:

• You can substitute your visits to a network GP with online consultations
• You have cover for a defined list of medical procedures that can be done in a network GP's rooms,such as biopsies,wound care and stitching

Limit

Unlimited

Online consultations

Description

This benefit provides access to an online consultation via the Discovery website.You can substitute your visit to network GP with an online consultation

Limit

Unlimited

Dental Care

Description

This benefit is only covered when making use of network dentist

• Consultations
• Preventive treatments include cleaning, scaling, polishing and fluoride treatment
• Restorations and composite fillings
• Extractions
• Oral radiography
• Additional dentistry benefits

Limit

1. A single consultation for a full mouth examination for each member every year
2. Limited to one for each member every year
3. Pre-authorisation is required for four or more restorations (repairs to teeth), or five or more composite fillings per family every year
4. For a single tooth extraction a maximum of 1 per quadrant per 365 days. Extraction of each additional tooth in the same quadrant, 1 per member per 365 days
5. Maximum quantity of 7 per year according to dental protocol
6. Additional dentisry benefits:

• Diagnosis and treatment of pain and sepsis
• Infection control
• Oral hygiene advice on how to keep the mouth and teeth clean to prevent
• dental problems
• Local anaesthetic

Acute medicine(prescribed or short-term medicine)

Description

This benefit provides access to acute medicine. Cover is at 100% of the Agreed Rate if the following conditions are met:

• The medication must be on the medicine list (formulary) for acute medicine and will be available with no co-payment
• The acute medicine must be provided by either a dispensing network GP or by a network pharmacy (if the prescribing GP is part of the network but does not dispense medicine)
• The acute medicine will not be covered if it is prescribed by a non-network GP or if obtained from a non-network pharmacy

Limit

Over-the-counter(OTC) medicine

Description

Limit

Flu vaccine

Description

Limit

Chronic medicine (long-term medicine)

Description

Limit

Blood tests (Pathology)

Description

Pathology tests are limited to the list of approved pathology codes and are paid at 100% of the Agreed Rate

The tests must be requested by a network doctor (GP) and the tests must be done by a pathology laboratory in the network - Ampath, Lancet, Pathcare. You have to take the pathology request form to the pathology lab

Limit

Unlimited

In-person GP consultations

Description

The HIV Programme is designed to optimise the health and wellbeing of HIV-positive patients. The HIV Management Programme includes:

• Voluntary counselling and testing
• Antiretroviral therapy, prophylactic antibiotics and supplements
• Treatment support and guidance
• Pathology and monitoring (including CD4, viral load, liver enzymes, cholesterol glucose, urine tests), according to protocols
• Emergency post-exposure medicine is provided if the accidental exposure is brought to the attention of the network doctor (GP)
• within 72 hours

Limit

Unlimited HIV medicine is covered from the date of registration of your chronic medicine by your network doctor (GP) or allocated doctor (GP)

X-rays (Radiology)

Description

The Radiology Benefit provides access to black-and-white X-rays and soft-tissue ultrasounds according to a list of the approved codes and are paid at 100% of the Agreed Rate A network doctor (GP) must request the radiology tests and you have to take the Radiology request form to the radiologist.

Limit

Unlimited

Eye care (Optometry)

Description

1. Eye examinations: The Optometry Benefit is subject to availability at a network optometrist only.
2. Spectacles and lenses: The Optometry Benefit is subject to availability at a network optometrist only
3. Frames: The Optometry Benefit is subject to availability at a network optometrist only

Limit

1. Eye examinations are limited to one for each member every year and includes a visual evaluation, screening and a diagnosis
2. Spectacles and lenses will be limited to one pair for each member in a 24-month period. The benefit includes standard, high-quality clear plastic lenses, single-vision lenses and bi-focal lenses. Qualifying norms will apply
3. Frames will be limited to a single frame for each member in a 24-month period. You have full cover for approved frames at a provider in the network. If you choos a frame that is not part of the approved selection, you will have to pay the extra cost

Trauma

Description

We cover treatment for the following trauma conditions:

• Burns Head injuries, chest injuries or severe fractures as a result of a fall Loss of an arm, hand, leg or foot Near-drowning Poisoning or a serious allergic reaction that may cause death Injuries resulting from a crime, sexual assault, a car accident or an injury at work

The Trauma Benefit is optional