The Specialist Benefit Explained

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See a Private Specialist Physician

3 Month Waiting Period
3 Benefit Levels
Nationwide Network

Sometimes, your network doctor needs to refer you to a specialist. Get cover for specialist visits with flexible annual amounts.

Specialist cover is part of the Day-to-Day Plan with cover for all of this and more.

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Choose Your Level of Cover

Flexible levels of cover mean you get to choose your benefit limits to suit your needs and budget.

Level 1

  • R1,000 per policy per year

Level 2

  • R1,500 per policy per year

Level 3

  • R2,000 per policy per year

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What is Covered?

The Specialist benefit has stated annual amounts to help cover the costs of specialist consultations. The 3 optional levels of cover let you decide what fits with your needs and budget.

The benefit, unlike the GP Visits benefit, is not unlimited. It is capped to the annual amounts as determined by your chosen level of cover.

Your specialist may prescribe medication which will be treated as an out-of-network medication script as part of the Medication Benefit.

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Is there a Network?

There is no specialist network, you can use any provider of your choice. The Network and Claims pages have all the information you need.

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Which Specialists are Covered?

The type of specialist you can visit is extensive and includes:

  • Dermatology
  • Obstetrics & Gynaecology
  • Pulmonology
  • Specialist Physician
  • Gastroenterology
  • Neurology
  • Cardiology
  • Psychiatry
  • Oncology
  • Opthalmology
  • Orthopaedics
  • Otorhinolaryngology
  • Rheumatology
  • Paediatrics
  • Physical Medicine
  • Neurosurgery
  • Plastic & Reconstructive Surgery
  • General & Cardio Thoracic Surgery
  • Urology
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Will There be Co-Payments?

There are no co-payments but the benefit limits are stated and the annual limits apply.

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A Network You Can Depend On

Access private healthcare when you need to see a doctor, visit a dentist, get medication or go to hospital.

Nationwide Network of Doctors & Dentists
Private hospitals across South Africa

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Simple & Efficient Claims

Find out how the claims process works for rapid and pain-free claims handling.

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No upfront payments
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Claims paid directly to providers
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Answers to Your Questions

What is the Specialist benefit waiting period?

The waiting period on the Specialist Benefit is 3 months.

This means that after the first 3 months of your policy's inception, you can use the benefit and visit a specialist doctor.

Is there a network of specialists?

There is no network of specialists practices, you can use any provider in South Africa. All you need is a referral script from a network doctor. The Network page has all the information needed.

How are claims paid?

Claims are paid directly to the medical providers. You can find all the details on our claims page.

What are the age limits?

All new members joining a policy must be younger than 65 years on date of application.

Child dependants must be younger than 21 years before they will need to start their own policy.

However, if your child is still a registered full-time student and unmarried, then they may stay on the policy as a child dependant until they turn 26.

How many people can be on a policy?

Episodic health insurance policies can include:

  • you
  • your spouse/partner
  • up to 6 children