FAQ

Frequently Asked Questions
How is this product different?

Healthwise is a self-care and wellness driven solution that covers the important preventative care that every human being requires like simply visiting the Doctor, Dentist or Optometrist.

How will the Emergency Medical Information benefit help me or my family?

Lifesaving medical advice can be accessed via ER24 on 084 124 where a medically trained professional will be able to guide you through a medical crisis.

Can I go to any Doctor, Dentist or Optometrist and are the visits unlimited?

You can go to any registered service provider of your choice.If you don`t have one, Halo Dr. from Europ Assistance will find you a service provider close by, book your appointment, arrange what you have to pay and also sort our your discount voucher. All this a mere phone call away. The visits are limited per your choice of plan – see the comparison table and choose a plan to suit you and your budget.

Can I go to a Hospital?

Healthwise covers day to day and outpatient visits to service providers. For hospital expenses contact us and we’ll assist you in finding the right hospital plan for you and your loved ones to compliment Healthwise perfectly.

I am not a South African citizen, can I still join?

Yes!

What happens if I am ill and out of town?

You can call the ER24 hotline (084 124) 24/7 to get the assistance you need, be it getting ill or having a medical emergency and they will take care of you. In other words, you can go to a GP of your choice, you will receive your discount voucher or you can provided you pay for the consultation and afterwards reclaim the benefit payable from Healthwise.

What if the Service Provider charges more than my discount voucher value?

Please note that, should your GP charge a higher rate than the discount voucher benefit payable on your plan, you shall be responsible for payment of the difference. Please also request your GP to prescribe medication within our formulary. The member is responsible for payments for all medication that is not within our formulary. This also applies to pathology and radiology.

Complete a claim form, attach a copy of your receipt and you will be reimbursed the lower of the voucher value of the claimed amount.

If I am not a member, can I apply to add my dependents only?

No, there must be a principal member that is 18 years or older.

Can I have this product with a Medical Aid or another product?

Yes you may. Healthwise is a separate product and you still qualify for vouchers as per normal.

How long does it take for Payment of Claims?

Within 48 hrs of voucher encashment – our administrators process voucher settlements every day.

Can I take a plan out for my sister, her being the principal member, but with my banking details?

Yes!

What happens if I fall Ill outside of South Africa?

Submit your claim and expense and the medical panel will consider the merits on a case by case basis.

You are only covered in South Africa, but if or fall ill in one of the immediate neighboring countries, being Swaziland, Lesotho, Botswana, Namibia, Mozambique or Zimbabwe, you will have to travel to the nearest South African border post and request assistance by calling 010 205 3134.

What is the difference between Wellness, Medical Aid and Medical Insurance?

Medical Aid cover is based on tariff codes and procedures, and Medical Insurance is based on events and stated benefits. They are regulated by different Acts (see comparison of medical aid/medical insurance).

There is a vast array of medical aids and insurance based product out in the market place. To assist you in considering what is best for you please see the comparison below:

 

WELLNESS

HEALTH INSURANCE

MEDICAL AID

This is a service driven solution catering for day to day needs Health Insurance is event based risk cover i.e in the event you have to see a G.P Medical Aid cover is based on tariff codes and procedures
Governed by consumer protection act Health Insurance is legislated under the Short-term Insurance Act Medical Aid schemes are governed by the Medical Schemes Act
Consumer protection act Health Insurance is governed by the FSB (Financial Services Board) Medical Aid schemes are governed by the Council for Medical Schemes
Provides a discount voucher for out patient services with any registered medical service provider Health Insurance does not cover PMB’s (Prescribed Minimum Benefits) Medical Aid schemes must by law cover PMB’s (Prescribed Minimum Benefits)
Vouchers provide a fixed discounted amount as stipulated Health Insurance covers health events at fixed or specific amounts which is defined per specific identifiable events as per policy schedules Medical Aid schemes have got specific and yearly limits prescribed
Wellness covers services for day to day health needs Health Insurance includes Personal Accident risk cover such as disability and loss of limbs cover, inability to work, salary protection. Medical Aid schemes are not allowed to include any Personal Accident disability and loss of limbs cover
There is no death cover, disability benefits is. This is a service product with discount vouchers Health Insurance’s are allowed to and may include death dread disease, disability and / or funeral covers Medical Aid schemes are not allowed to include death and / or funeral covers as part of the Medical Aid Scheme
Vouchers are redeemable by the authorised recipient Health cover pays directly to the Insured Day-to-day benefits are paid according to the National Recommended Price List (NHRPL)
Wellness arranges a health service and a discount voucher towards expenses Health Insurance pays a cover amount according to the limit as per the plan selected to cover events as per the policy wording Medical Aids pay in-hospital benefits according to NHRPL and limited to the benefits as per the plan
Wellness can be used alone or in conjunction with medical insurance or medical aid Health Insurance may be used in conjunction with your medical aid to cover any shortfalls that you may have Medical Aids often have shortfalls due to the difference between NHRPL and SAMA (South African Medical Association) rates which is what healthcare professionals charge

 

If I choose a GP that is not the network, do I make an appointment or do I just go there and sit and wait?

You can make an appointment yourself without the Health Advisor, but then you need to claim manually.

How do I get my Wellness Service?

You call the Healthwise Pre-authorisation Number 087 135 4104, or log your claim via the MySOS app.

 

If I am already on a Medical Aid is there still a waiting period?

Yes, please also refer to our terms and conditions relating to being a member of a medical aid and the cover applicable under this program. This is not a “hospital cash back” product.

Are Specialist visits covered and how does advanced wellness work?

Specialists are covered under the advanced wellness benefit, but require authorisation. Advanced wellness benefits cover specialists, screening (blood tests and X-rays),optometry and other authorised services. Call 087 135 4104 for assistance.

If we are living together but not married, can we still sign up as a couple?

Yes!

Can I buy my Medication over the counter?

No, your Network GP or Dentist has to prescribe Medication in accordance to the rules and a discount voucher will be provided to settle the pharmacist. If your Network Doctor is a non-dispensing practitioner i.e. a scripting practitioner, your GP will provide you with a script to be submitted to a Clicks, Dischem or Mediscor pharmacy. In that case you will have to pay the difference between the voucher value and the pharmacy bill.

If I had a Heart Attack 10 years ago, does the pre-existing waiting period of 12 months still apply to me?

Yes.

If I am a Member and I turn 75, will my membership cease?

The wellness cover plan will cover you for as long as you remain a member. Healthwise extends membership indefinitely for existing members, although the overall annual limits decrease from age 61 onward.