Everyone deserves access to quality healthcare
With Flexicare you can have access to affordable private healthcare cover and a world-class suite of digital tools to help you manage your membership and access your benefits on the go. Flexicare is a health insurance product, not a medical aid.
Flexicare benefits
In-person GP consultations
Description
This benefit provides access to visit a network GP, and such visits will be covered at 100% of the Agreed Rate in the following instances:- You can substitute your visits to a network GP with online consultations
- You have cover for a defined list of medical procedures that can be done in a network GP's rooms,such as biopsies,wound care and stitching
Limit
UnlimitedOnline consultations
Description
This benefit provides access to an online consultation via the Discovery website.You can substitute your visit to network GP with an online consultationLimit
Unlimited
Dental Care
Description
This benefit is only covered when making use of network dentist- Consultations
- Preventive treatments include cleaning, scaling, polishing and fluoride treatment
- Restorations and composite fillings
- Extractions
- Oral radiography
- Additional dentistry benefits
Limit
- A single consultation for a full mouth examination for each member every year
- Limited to one for each member every year
- Pre-authorisation is required for four or more restorations (repairs to teeth), or five or more composite fillings per family every year
- For a single tooth extraction a maximum of 1 per quadrant per 365 days. Extraction of each additional tooth in the same quadrant, 1 per member per 365 days
- Maximum quantity of 7 per year according to dental protocol
- Additional dentisry benefits:
- Diagnosis and treatment of pain and sepsis
- Infection control
- Oral hygiene advice on how to keep the mouth and teeth clean to prevent
- dental problems
- Local anaesthetic
Acute medicine(prescribed or short-term medicine)
Description
This benefit provides access to acute medicine. Cover is at 100% of the Agreed Rate if the following conditions are met:- The medication must be on the medicine list (formulary) for acute medicine and will be available with no co-payment
- The acute medicine must be provided by either a dispensing network GP or by a network pharmacy (if the prescribing GP is part of the network but does not dispense medicine)
- The acute medicine will not be covered if it is prescribed by a non-network GP or if obtained from a non-network pharmacy
Limit
UnlimitedOver-the-counter(OTC) medicine
Description
e OTC medicine may only be obtained at a network pharmacy and on advice of the pharmacist. OTC medicine must be on the medicine list (formulary).Limited to R105 per quarter to a maximum of R420 for each member every year. Subject to the medicine list (formulary)Limit
The OTC medicine benefit is limited to R105 in each quarter, up to a maximum of R420 for each member every yearFlu vaccine
Description
The following members have cover for one flu vaccination every yearLimit
The OTC medicine benefit is limited to R105 in each quarter, up to a maximum of R420 for each member every yearChronic medicine (long-term medicine)
Description
Chronic medicine will be covered in full (100% of Agreed Rate) if the prescribed medicine is on the medicine list (formulary) for chronic medicine You can get your chronic medicine at a network pharmacyLimit
- Addison's disease
- Asthma
- Bipolar mood disorder
- Bronchiectasis
- Cardiac failure
- Cardiomyopathy
- Chronic renal disease
- COPD (chronic obstructivepulmonary disease)
- Cornery artnery disease
- Crohn's disease
- Diabetes insipidus
- Diabetes mellitus type 1
- Diabetes mellitus type 2
- Dysrhythmias
- Epilepsy
- Glaucoma
- Haemophilia
- HIV (see details in section below)
- Hyperlipidaemia (high cholesterol)
- Hypertension (high blood pressure)
- Hypothyroidism (underactive thyroid)
- Multiple sclerosis
- Parkinson's disease
- Rheumatoid arthritis
- Schizophrenia
- Systemic lupus erythematosus
- Ulcerative colitis
Blood tests (Pathology)
Description
Pathology tests are limited to the list of approved pathology codes and are paid at 100% of the Agreed Rate
The tests must be requested by a network doctor (GP) and the tests must be done by a pathology laboratory in the network - Ampath, Lancet, Pathcare. You have to take the pathology request form to the pathology labLimit
Unlimited
In-person GP consultations
Description
The HIV Programme is designed to optimise the health and wellbeing of HIV-positive patients. The HIV Management Programme includes:- Voluntary counselling and testing
- Antiretroviral therapy, prophylactic antibiotics and supplements
- Treatment support and guidance
- Pathology and monitoring (including CD4, viral load, liver enzymes, cholesterol glucose, urine tests), according to protocols
- Emergency post-exposure medicine is provided if the accidental exposure is brought to the attention of the network doctor (GP)
- within 72 hours
Limit
Unlimited HIV medicine is covered from the date of registration of your chronic medicine by your network doctor (GP) or allocated doctor (GP)
X-rays (Radiology)
Description
The Radiology Benefit provides access to black-and-white X-rays and soft-tissue ultrasounds according to a list of the approved codes and are paid at 100% of the Agreed Rate A network doctor (GP) must request the radiology tests and you have to take the Radiology request form to the radiologist.Limit
Unlimited
Eye care (Optometry)
Description
- Eye examinations: The Optometry Benefit is subject to availability at a network optometrist only.
- Spectacles and lenses: The Optometry Benefit is subject to availability at a network optometrist only
- Frames: The Optometry Benefit is subject to availability at a network optometrist only
Limit
- Eye examinations are limited to one for each member every year and includes a visual evaluation, screening and a diagnosis
- Spectacles and lenses will be limited to one pair for each member in a 24-month period. The benefit includes standard, high-quality clear plastic lenses, single-vision lenses and bi-focal lenses. Qualifying norms will apply
- Frames will be limited to a single frame for each member in a 24-month period. You have full cover for approved frames at a provider in the network. If you choos a frame that is not part of the approved selection, you will have to pay the extra cost
Trauma
Description
We cover treatment for the following trauma conditions:- Burns Head injuries, chest injuries or severe fractures as a result of a fall Loss of an arm, hand, leg or foot Near-drowning Poisoning or a serious allergic reaction that may cause death Injuries resulting from a crime, sexual assault, a car accident or an injury at work
The Trauma Benefit is optional
ClubCard members earn 10% cashback
on your monthly Flexicare premium by signing up through ClubCard
Monthly premiums
| Flexicare | Main Member | Adult Dependant | Child Dependant | Monthly Premium | Cashback |
|---|---|---|---|---|---|
Main member |
R435 | R435 | R43.50 | ||
Main member + Spouse |
R435 | R400 | R835 | R83.50 | |
Main member + Spouse + Child |
R435 | R400 | R229 | R1064 | R106.40 |
Flexicare & Trauma cover (R400 000) |
|||||
Main member |
R609 | R609 | R60.90 | ||
Main member + Spouse |
R609 | R574 | R1183 | R118.30 | |
Main member + Spouse + Child |
R609 | R574 | R294 | R1477 | R147.70 |
Flexicare & Trauma cover (R1 million) |
|||||
Main member |
R679 | R679 | R67.90 | ||
Main member + Spouse |
R679 | R644 | R1323 | R132.30 | |
Main member + Spouse + Child |
R679 | R644 | R337 | R1660 | R166.00 |
* There is no limit to the number of children that will be allowed on the policy. Each child will be charged for separately and can stay on Flexicare if they depend on you financially. Child dependants who turn 21 will be charged adult rates from the month after their birthday.
** The Trauma Benefit is optional. If you activate this benefit, it will apply to you and your dependants on Flexicare. You must select a cover limit of either R400 000 or R1 million. The Trauma Benefit applies to you and your registered dependants.
Flexicare is not a medical scheme. The cover is not the same as that of a medical scheme and is not intended to be a substitute for medical scheme membership. Flexicare is administered by Discovery Health (Pty) Ltd, registration number 1997/013480/07 an authorised financial services provider and underwritten by Auto & General Insurance Company Limited, registration number 1973/016880/06, an authorised non-life insurer and financial services provider. Terms, conditions and limits apply.
Discovery Vitality (Proprietary) Limited, registration number: 1999/007736/07. Terms, conditions and limits apply.
The Trauma Benefit is a non-life insurance policy, underwritten by Discovery Insure Ltd, registration number 2009/011882/06, a licensed non-life insurer and an authorised financial services provider. Flexicare is a separate non-life insurance policy and is not conditional on the purchase of a Trauma Benefit policy.
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