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HOSPITAL OPTIMISER

Our Hospital Optimiser policy is designed as a stand-alone option to provide additional cover in the event that an overall annual hospital limit, imposed by a medical scheme, has been reached and can be taken in conjunction with any gap policy.

MONTHLY PREMIUM 2016

INDIVIDUAL . . . . . . . . . . . . . . . . . . . . . . . . R 75

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OVERVIEW

  • The medical scheme option’s overall annual hospital limit will be increased to R2 000 000per annum

EXAMPLE

Medical Scheme A has an overall annual hospital limit of R300 000. This limit could easily be reached by a prolonged hospital stay. Hospital Optimiser will ensure continuous private medical care by increasing the overall annual limit, thus providing additional cover of R1 700 000. The alternative could result in a forced transfer to a state facility.

UNDERWRITING CRITERIA

APPLICABLE FROM INCEPTION OF THE POLICY

  • 3 Months general waiting period (no claims can be submitted within the first 3 months of cover unless accidental)
  • 6 Months waiting period for tonsillectomy, myringotomy (grommets), adenoidectomy, hysterectomy (except where cancer is diagnosed), joint replacements (unless accidental), hernia repairs (unless an emergency), cataract surgery, endoscopic procedures and related surgery and
    dental procedures
  • 10 Months waiting period for pregnancy and childbirth
  • 10 Months waiting period for pre-existing medical conditions and related surgery

GENERAL

  • Entry age before 70th birthday
  • Children will be accepted as child dependants up to and including the age of 27, provided they are registered dependants on the medical scheme option of either the principal member or the spouse
  • From the age of 28, a child dependant will be regarded as an adult and will therefore be charged an adult dependant rate, provided that the dependant is registered on the medical scheme option of either the principal member or the spouse
  • Entry age for adult dependants before 70th birthday
  • The Stratum Benefits policy extends cover to all dependants as registered on the medical scheme option of either the principal member or the spouse