ACCESS TO THE HIGHEST QUALITY PRIMARY HEALTHCARE AT AFFORDABLE PRICES
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1 ACCESS TO THE HIGHEST QUALITY PRIMARY HEALTHCARE AT AFFORDABLE PRICES WELCOME TO ELIXI MEDICAL INSURANCE PURPLE PLAN - PRIMARY AND HOSPITAL CARE Elixi Medical Insurance aims to make private healthcare affordable and accessible to everyone. When you join Elixi Medical Insurance, you get a range of plans that have been specifically designed to ensure your most essential and basic healthcare needs are taken care of. From unlimited GP visits and hospital care, to a range of value added services that include trauma counselling and call a GP or nurse for 24hr medical advice. A description of your Purple Plan benefits has been provided in this brochure and a full list of benefits can be found in your policy wording. WHO YOU WILL BE DEALING WITH Talksure: Talksure Trading (Pty) Ltd is an authorised financial services provider (FSP 42788), and offers broker and intermediary solutions with a range of insurance products, including medical insurance. Talksure takes great pride and responsibility in being an FSP and created the Elixi Medical Insurance brand to meet growing customer demand in the medical insurance space. Unity Health: Unity Health is a division of Ambledown Financial Services (Pty) Ltd (FSP 10287). Unity have partnered with Elixi Medical Insurance to help create quality healthcare at an affordable price. Unity are the underwriting managers on behalf of the insurer Constantia Insurance Company Limited (FSP 31111). Unity Health administers the policies sold under the Elixi Medical Insurance brand and manage the network of service providers offered by Elixi Medical Insurance. ER24: Unity Health and Elixi Medical Insurance have partnered with one of South Africa s top providers of emergency medical services. Their services to Elixi Medical Insurance members includes a 24-hour call centre to deal with emergencies, in-patient and out-patient hospital admissions, verifying membership, and issuing guarantee of payments (GOPs) to Elixi Medical Insurance members.
2 PURPLE PLAN PRIMARY CARE GP Visits Unlimited visits per person per year. There are over 1700 network GP s nationwide. To find the nearest network GP to you, please call us on GP Procedures Minor procedures are included in your visits to the GP. E.g. stitching of a wound, application of a cast to a broken limb etc. ACUTE MEDICATION Prescribed medication is limited to R2 750 per person, per year. This is limited to medication prescribed during GP visits. All acute medication is subject to a formulary. Dispensing GP: If your GP dispenses medication, you will get everything that you need during your visit. Non-dispensing GP: If your GP does not dispense medication. You will receive a prescription, which you can collect from the pharmacy. What is an acute condition? A short-term condition or illness like a chest infection, sinusitis or the flu. Your GP can give you acute medication to treat your condition / illness, or write a script for you to get the medication at a pharmacy. What is a formulary? A medicine formulary is a list of approved medicines. Only medications that are on this list will be covered. This ensures that premiums stay affordable. BASIC PATHOLOGY BLOOD TESTS Unlimited blood tests are provided if you receive a referral from your GP. Basic list of blood tests e.g. cholesterol, glucose test. During your visit, your GP will advise you if blood tests are necessary. BASIC RADIOLOGY X-RAYS Basic X-rays (black & white) are covered. Your GP will advise you if X-rays are needed. Specialised radiology such as MRI, CT scans are not covered. PRE-BIRTH MATERNITY 2 gynaecologist visits and 2 ultrasound scans per year are covered. Maximum value of up to R2 600 per family, per year. You may go to any gynaecologist, but upfront payment may be required, but 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 GP visit. ACCIDENTAL DEATH BENEFIT A benefit equal to R is payable in the event of the death of the principal insured person and / or the spouse of the Principal Insured Person due to an accident. The benefit is limited to one spouse. WELLNESS SCREENINGS Wellness Screenings include health checks for: blood pressure, cholesterol, glucose levels, body mass index (BMI), waist circumference, HIV and pre and post test counselling. Available at your nearest Dischem and Clicks pharmacies. Limited to one screening per person per year.
3 PURPLE PLAN HOSPITAL CARE EMERGENCY STABILISATION - IN-PATIENT EMERGENCY OR CASUALTY UNIT ONLY Limited to R per insured person, per incident. The actual cost of hospitalisation as an in-patient, in the event of an emergency that necessitates the stabilisation of the patient in an emergency unit before the patient is transferred to a public hospital. IN-PATIENT HOSPITALISATION - ACCIDENT ONLY Limited to R per insured person, per incident. The actual cost of hospitalisation as an in-patient, including all associated services during the hospital admission at a private facility in the event of injuries sustained due to an accident. Planned medical procedures are not covered; e.g. hysterectomy, hip replacement. OUT-PATIENT CASUALTY UNIT - ACCIDENT ONLY Limited to R5 000 per incident. The benefit payable for injuries sustained in the event of an accident shall be limited to treatment received in a hospital emergency unit. ACCIDENT & EMERGENCY - ER24 Hospital pre-authorisation and guarantee of payment to the treating facility. Ambulance services (air or road). Inter-hospital transfers. Repatriation of mortal remains within the borders of South Africa. WHAT IS AN EMERGENCY? An event or unexpected health condition, which if not treated immediately, would result in death or serious bodily impairment. E.g. heart attack or stroke. WHAT IS AN ACCIDENT? An accident means bodily injury caused by violent accidental and external physical means. E.g. Motor vehicle accident, burns, injuries from a crime, snake bite or injuries from a fall.
4 VALUE ADDED SERVICES CALL A GP OR NURSE The 24 hour GP helpline is staffed by medical professionals. This critical service provides advice and assistance to all ELIXI MEDICAL INSURANCE PURPLE members. Members will be able to discuss a number of medical related matters with a qualified GP and or nurse on the following: medical advice, second opinion, confirmation and clarity of medical diagnosis, guidance on drug regime, guidance to a specialist GP, guidance and advice on the side effects of prescribed treatment, telephonic follow up after diagnosis and treatment. C5 HIV PREVENTION PROGRAMME In the event that an ELIXI MEDICAL INSURANCE PURPLE policy holder is exposed to HIV through a trauma or assault, the member will have access to: 24 hour Telephonic HIV advice and counselling 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, pathology tests. TRAUMA COUNSELLING In the event that an ELIXI MEDICAL INSURANCE PURPLE member in involved in a traumatic event or is witness to a traumatic event the member will have access to: unlimited telephonic counselling, referral to a qualified counsellor, face to face counselling with a qualified counsellor limited to R3 000 per event. To access any of the above benefits, please call us on PURPLE PLAN PRICING Principal Senior Principal Adult Dependent Senior Dependent Child Dependent R394 R532 R256 R394 R133 CONTACT DETAILS TALKSURE CUSTOMER SERVICES/BILLING UNITY HEALTH CLAIMS/QUERIES ER24 ACCIDENT & EMERGENCY Elixi 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 substitute for medical scheme membership. The benefits are subject to waiting periods and applicable limits. These are outlined in the policy wording which you are required to read and understand. T&Cs apply. This document is not your policy wording and for the full disclaimer please go to Talksure Trading (Pty) Ltd - an authorised FSP Insurer Constantia Insurance Company Ltd - an authorised FSP
5 Elixi Medical Insurance FAQ s What is the procedure to follow in the event of a medical emergency or serious accident? Call ER24 on The number is also on your Unity Health membership card. ER24 will verify the membership of the person in need of help, whether it be you or your dependant. ER24 will assist you with advice, and emergency transportation to your nearest in-patient hospital facility. ER24 will issue the hospital with a guarantee of payment and you will be admitted for treatment. Please ensure that you have your Unity Health membership card and ID for verification purposes. Unity Health will then settle the account directly with the provider. I did not receive my membership card, who do I contact? Unity Health dispatches the cards once your first premium is collected. Talksure provides the membership certificate which will be used in the interim. Should you not receive your card 45 days after your first premium, please contact Unity Health on or membership@unityhealth.co.za, alternatively, Talksure on or client.services@talksuresa.co.za. What are the waiting periods? Two (2) month waiting period for all benefits, except emergency and accidents which is covered from date of inception. Twelve (12) month waiting period for chronic medication and optometry benefits. Nine (9) month waiting period applicable to pre-birth maternity benefits. Who can be covered under my policy? Immediate family - spouse and children. What process do I follow to add my doctor to the GP list? Call Talksure on or Unity Health on Networks@unityhealth.co.za. Please ensure that you provide us with the doctors name, practice number and contact details. Unity Health will invite the doctor to join the network. The Doctor either rejects or accepts the proposal and it is entirely at the doctors discretion to join. An update will be sent via informing of you of any actions or response. Is Elixi Medical Insurance a medical aid scheme? No, Elixi Medical Insurance is not a medical aid scheme and the cover is not the same as a medical aid scheme. Elixi Medical Insurance is classified as short term medical insurance. Can I go to any doctor across South Africa? We have a network of doctors in the 9 provinces. For more information on the location of the doctors, please contact Talksure on What is an emergency? An event or unexpected health condition, which if not treated immediately, would result in death or serious bodily impairment. E.g. Heart attack or stroke. What is an accident? An accident means bodily injury caused by violent accidental and external physical means. E.g. Motor vehicle accident, burns, injuries from a crime, snake bite or injuries from a fall. Elixi Medical Insurance recently launched a chronic medication benefit, how do I receive this benefit and how does it work? The Gold Plan offers the chronic medication benefit which covers medication for the following specified conditions: Asthma, Chronic Obstructive Pulmonary Disorder, Diabetes Type 1&2, Epilepsy, HIV/AIDS, Hyperlipidemia, Hypertension, and Tuberculosis. Should you wish to upgrade your policy to the Gold Plan, please contact Talksure on or alternatively us on client.services@talksuresa.co.za
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