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Your Questions

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Can I go to any Doctor and are the visits unlimited?

The Network doctor you choose will become your regular GP. The GP visits are unlimited. Alternatively, unlimited visits to GP of your choice, where you are required to pay your GP and we will reimburse you up to the amount payable on your chosen plan. It is important that your out of network GP dispenses or prescribes medicine according to the Affinity Health medicine formulary. The member is responsible for payments for all medication that is not within our formulary. This also applies to pathology and radiology. Send Affinity Health a copy of your receipt and you will be reimbursed the agreed stated insured benefit for the consultation.

 

When I see a GP/ Dentist, do I have to pay cash for the Consultation?

Only when making use of an out of network GP. In this case, you are responsible to pay the difference of the GP consultation fee and the reimbursement fee.

 

How long does it take for payment of claims?

Within 30 days.

 

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

Yes. Affinity Health offers a Junior Cover Plan that applies to the child only (0 — 17yrs), not the proposer (principal member).

 

What happens if I am ill and out of town?

The Affinity Health Day-to-Day Plan caters for unlimited out of area visits, provided they are within South Africa. In other words, you can go to a GP of your choice, provided you pay for the consultation and afterwards reclaim the benefit payable from Affinity Health. Please note that should your GP charge a higher rate than the 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.
Send Affinity Health a copy of your receipt and you will be reimbursed the agreed stated insured benefit for the consultation

 

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

Yes

 

Can I go to any Hospital?

With an Affinity Health Hospital Plan you can go to any hospital i.e. Private or State, but remember the Stated Benefits as described in the brochures, will be paid to you and you will be responsible for settling with the hospital. You may select any hospital of your choice, however, our preferred hospitals are Life and Mediclinic. You may also cede your benefit to the hospital and Affinity will guarantee payment.

 

What happens if I am ill and I am admitted to hospital for less than 24 hours?

A member has to be admitted to hospital for 24 hours before the benefits are payable.

 

If I am a member and I turn 56 will my membership cease?

The policy makes provision for membership to expire at age 65 but Affinity Health extends membership indefinitely.

 

If I have had a heart attack 10 years ago, does the pre-existing waiting period of 24 months still apply to me?

Yes

 

Can I buy my medication over the counter?

No, your Network GP or dentist has to prescribe medication in accordance to the medication formulary 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, Dis-chem or Mediscor pharmacy.

 

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

Yes

 

Will my baby be covered from birth?

Your new born baby is covered from birth with no waiting periods, unless the baby was born within the 12 month pregnancy waiting period where the usual 3 month waiting period will apply.

 

Are Specialist visits covered?

One Specialist visit per family per annum as referred by the Network doctor at agreed tariff. Covering rate R600.00 for single member or R1200 per family.

 

If I am already on a medical aid is there still a waiting period?

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

 

How do I claim my hospital benefits?

Following your discharge from hospital, you can either download a claim form from Affinity Health website or you can call Affinity Health on 0861 11 00 33 and request that a claim form be faxed to you. Once the claim form is completed, return it to fax number 086 690 4818. Any claim form received after 90 days following discharge from hospital, will be declined.

 

What happens if there isn’t a Network doctor in my area? Can I nominate my own GP?

Call Affinity Health on 0861 11 00 33 to nominate your own doctor. Please bear in mind that your doctor has to agree to be part of the Network. Alternatively, you may keep your own GP. We allow unlimited visits to you own GP where you are responsible to pay the difference of the GP consultation fee and the reimbursement fee. Alternatively, you may keep your own GP. We allow unlimited visits at a rate of R233.00 per consultation.

 

How do I get admitted to hospital?

You call the Affinity Health 24hr pre-authorization Number 0861 11 00 33 as displayed on your Affinity Health ID Card. Quote your policy number and/or the reason for your admission (more than likely you will have a doctor’s note which you can relay to the Authorisation clerk). Always remember to carry your Affinity Health ID card with you and the emergency stickers provided should be displayed on your windscreen/cell phone.

 

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

You can make an appointment

 

What is the difference between 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.

 

What happens if I fall III or have an accident outside SA?

You are only covered in South Africa, but if you have an accident 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 (if critical).

 

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

Yes

 

What happens if I am admitted to hospital following an accident and I only end up being in hospital for a few hours, will I still be covered?

For accident events. there is no time restriction. Your benefits will respond even if you are admitted for one (1) hour. You need to be admitted for a minimum period of 24hours to be able to claim for the hospital daily benefit or it will be treated as an out of area visit. Accidents need to always be reported to Affinity Health or the hospitals will not assist you.