How does a member access a Primary Care provider?
The member calls the call centre (during office hours) Monday to Friday 8:00am to 5:00pm and Saturdays 8:00am to 1:00pm who provides a list of providers in the area the member lives or works. The member selects one of the provides proposed.
What are the notable exclusions of the policy?
The netwok general practitioner will assist the member. No paperwork requested. Investigations tratment surgery for cosmetic purposes. Suicide attempted suicide or intentional self-injury. The taking of any drug or narcotic unless prescribed by and taken in accordance with the insturctions of a registered medical practitioner. Drug addicttion. An event directly attributable to the insured person where the alchohol content in the blodd exceeds the legal level permitted by law. Participation in any form of mechanical race or speed test. The Insured person's failure to comply with the conditions of the policy. This exclusion does not apply to emergency treatment where the medical assistance was necessary for life preservation. Investigations treatment or surgery for insemination or hormone treatment for infertility.
Can the product be used to augment cover for those who belong to a registered medical scheme?
Yes, this product can be added as a "top-up"benefit with a medical scheme.
How does the client cancel the cover?
What are the tax benefits to the employer?
The employer may deduct the entire iHealth premium payment as an expense and receive corporate tax relief of 28%
Will the policy premium be adjusted and how frequently will it be adjusted?
Premiums are rated annually with adjustments taking effect on 1 November every year. Adjustments are based on various factors including but not limited to medical inflation provider disposition (the likelihood of a medical practitioner to increase charges) as well as a study of the various benefit components and any necessity to improve or change the benefit structure. We do reserve the right to adjust the premium with 30 days written notice.
What happens if the employer does not pay premium on time?
The responsibility rests with the employer to ensure that the premium is paid. Should the employer fail to pay premium in two consecutive months no attempts will be made to collect arrear premiums and the policy will be effectively cancelled.
If I wish to dispute the claims assessment what procedures do I need to follow and within what time frame?
A claim may be disputed by: Making representation to the Insurer indicated in the Disclosure Notice attached to the policy wording within 90 days of receipt of hte benefit letter / rejection letter. The insurer is obliged to provide you with feedback wihtin 45 days. You may also contract the Financial Services Ombud indicated in the Disclosure Notice attached to the policy wording should you not be staisfied with the response of the Insurer.The FAIS Ombud may also be contacted for any complaints against your broker. The Ombud for either Long-Term or Short-Term Insurance may also be contracted for any complaints against the Insurer. You may also constitute legal action should the matter not be resolved by either the insurer or the relevant Ombud. The claim will prescirbe 6 months after expiry of the 90 day period indicated above (no further claims will be payable for the specific claim.)