The Specialist Benefit Explained

Limited cover for Specialists


See a Private Specialist

Your network dentist may need to refer you to a specialist doctor. Get limited cover to pay for the consultation fees.

The benefit is available as a standard part of the Day-to-Day Plan but you get a choice in which benefit level suits you best.

3 Month Waiting Period
3 Benefit Levels
Included in Day-to-Day Plan

Choose Your Level of Cover

Flexible levels of cover mean you get to build your plan to suit your needs and budget.

Level 1

R1,100 per policy per year

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Level 2

R1,650 per policy per year

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Level 3

R2,200 per policy per year

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How Does It Work?

Find answers to the most common questions about this benefit. Browse our Help pages and Blog posts for more information.

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 is not unlimited like the GP Benefit. 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. They may also refer you for Pathology or Radiology.

Note that the benefit is limited under Day-to-Day Plans. If you need to see a specialist when admitted to hospital then the various benefits in the Hospital Plan might apply.

What is the waiting period?

There is a 3 month waiting period before any new member on a policy can claim under this benefit.

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
  • Ophthalmology
  • Orthopaedics
  • Otorhinolaryngology
  • Rheumatology
  • Paediatrics
  • Physical Medicine
  • Neurosurgery
  • Plastic & Reconstructive Surgery
  • General & Cardio Thoracic Surgery
  • Urology

Will there be co-payments?

There are no co-payments but the benefit is limited to the stated values of your chosen benefit level.


What Health Plan are you going to build?

Get a quote and find out. Talk to us or build your own.


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