Option 1 – Day 1
General Practitioner (GP) Visits
Unlimited but managed GP visits via the 1Doctor Health Network. You may visit your chosen network provider as many times as you need. Any medication prescribed according to the 1Doctor Health formulary will be covered. No cash payment is required and medication is included.
Specialist Visits
One specialist visit per year per family upon referral from your General Practitioner. Max R500 and subject to pre-authorization.
Acute & Chronic Medication
Both acute routine and chronic medication (unlimited according to formulary) are covered. The Network GP’s usually dispense the medication; however, if the GP is a scripting doctor, i.e. ‘does not dispense’, please call 1Doctor Health to find out which pharmacy you can use.
PLEASE NOTE: The benefit is only effective 30 days after inception of the plan, unless otherwise agreed. Chronic medication to be collected from any Mediscor Pharmacy. Subject to pre-authorization. Over the counter medication is not covered. (A 90 day waiting period applies on chronic medication if unknown and a 180 day waiting period applies if the member joins with a chronic condition.) Doctors are required to register patients diagnosed with a chronic disease onto the 1Doctor Health chronic management programme to enable the members to receive chronic medication directly.
Radiology
Unlimited Basic Radiology (black & white x-rays as referred by your chosen network provider and according to the 1Doctor Health formulary).
Pathology
Dentistry
You may only see a 1Doctor Health Network dentist. (Basic treatment includes preventative cleaning, pain control, fillings, emergency root canal and extractions) The member will be asked for their membership number. The benefit is only effective 30 days after inception of the plan, unless otherwise agreed.
Optometry
The optometry benefit covers you for an eye test every 12 months and you are allowed one set of glasses every 2 years with frames with a grey colour value code. The benefit is only effective 12 months after inception of the plan, unless otherwise agreed.
Identification
Plastic Identification Card included.
Waiting Period
A waiting period of 30 days after inception date of plan applies on all day to day benefits unless otherwise stated.
Out-of-Area Visits
If you are out of town and you cannot see your Network GP, the Prepaid Preventative Health (Day to Day) Plan will allow 3 out of area visits to a GP of your choice. You will have to pay for the consultations. Simply send Day1 Health a copy of the receipt and the agreed tariff will be reimbursed to you.