Affinity Health Combined Medical Insurance Plan
Overall, the Affinity Health Combined Medical Insurance Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and additional benefits to up to 3 Family Members. The Affinity Health Combined Medical Insurance Plan starts from R1,838 ZAR.
| 👤 Main Member Contribution | R1,838 |
| 👥 Adult Dependent Contribution | R1,688 |
| 🍼 Child Dependent Contribution | R638 |
| 🔁 Gap Cover | None |
| 💶 Prescribed Minimum Benefits | ✅ Yes |
| 😷 Screening and Prevention | ✅ Yes |
| 💵 Medical Savings Account | None |
| 👶 Maternity Benefits | ✅ Yes |
| 😷 Disease Prevention Program | ✅ Yes |
| 🧠 Mental Healthcare Program | ✅ Yes |
Affinity Health Combined Plan – 7 Key Point Quick Overview
- ✅ Affinity Health Combined Plan Overview
- ✅ Affinity Health Combined Plan Contributions
- ✅ Affinity Health Combined Plan Benefits and Cover Comprehensive Breakdown
- ✅ Affinity Health Combined Plan Exclusions and Waiting Periods
- ✅ Affinity Health Combined Plan vs Similar Plans from Other Medical Schemes
- ✅ Our Verdict on the Affinity Health Combined Plan
- ✅ Affinity Health Combined Plan Frequently Asked Questions
Affinity Health Combined Plan Overview
The Affinity Health Combined Plan is one of 3, starting from R1,838, and includes both day-to-day and hospital cover, additional benefits, and access to 24/7 emergency services. Gap Cover is available on the Affinity Health Combined Plan, along with 24/7 medical emergency assistance. According to the Trust Index, Affinity Health has a trust rating of 9.9.
Affinity Health has the following three options to choose from:
Health Insurance Affinity Health Combined Plan Contributions
Health Insurance that is affordable :
| 🔍 Category | 👤 Policyholder | 👥 Spouse | 💙 Adult Dependent | 🍼 Child Dependent |
| 🥇 Typical | R1,838 | R1,688 | R1,688 | R638 per child |
| 🥈 Junior | n/a | n/a | n/a | R1,728 first child
Additional children – R638 each |
| 🥉 Senior | R2,098 | R1,908 | R1,908 | R638 per child |
Affinity Health Combined Plan Benefits and Cover Comprehensive Breakdown
Combined Plan In-Hospital Benefits
| ⚠️ Accidental Hospital Cover | Limited to R175,000 per individual or R275,000 per family per event.
Covers casualties and hospitalization. |
| 💛 Daily Illness Hospitalisation | This benefit provides covers as follows:
Day 1 to 3 – Up to R22,000 or R27,000 when the patient is admitted to the ICU.
Day 4 and 5 – Up to R10,000 or R14,000 when the patient is admitted to the ICU.
From the 6th day, the benefit pays R3,000 and covers up to 21 days per insured person per illness event. |
| 🟨 Sub-Acute Hospitalisation | Members have access to Affinity Health-affiliated sub-acute care.
Limited to R20,000 per member annually. |
| 🟡 Serious Illness Hospital Benefit | The maximum Serious Illness Benefit for the lifetime of the policy is R300,000.
The maximum benefit for confirmed Strokes and Cancer is R150,000. |
| 🍼 Maternity | Natural, home, and water birth is limited to R25,000 per birth.
Maternity C-Sections are covered up to R35,000. |
| ☀️ Day Clinic Procedures | Affinity Day Clinics for procedures up to R25,000 per member per year.
Procedure-specific sub-limits will apply. |
| 📈 Diagnostic Procedures | Affinity Health Diagnostic Formulary procedures covered up to R20,000 per single member or R25,000 per family policy per year.
Benefit limits and co-payment apply. |
| 🚕 Motor Vehicle Accident Benefit | This aids Road Accident Fund claims.
Affinity Health’s attorney network will assess the accident at no cost to the member and assist with Road Accident Fund reimbursement. |
| 🅰️ Workmen’s Compensation Benefit | This benefit covers occupational injuries and diseases.
Affinity Health advises and assists members with third-party recovery, informing them of claim progress. |
| 🅱️ Post-Hospital Private Home Nursing | Private nurse assistance is covered up to R11,000 per single member policy or R13,000 per family policy per year. |
| ☑️ Hospital Home Care Benefit | In-home and virtual visits with remote monitoring provide patients with timely, hospital-level care at home. |
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Combined Plan Day-to-Day Benefits
| 👩⚕️ Registered Nurse Consultations and Referrals | Nurse Practitioner referrals for unlimited GP visits. |
| ☎️ 24/7 Telephonic Medical Consulting | Unlimited nurse, doctor, or mental health professional phone consultations.
Includes Formulary-approved Nurse, Doctor, or Mental Health Professional-recommended acute medication. |
| 💗 Registered Nurse Consultations | Unlimited, managed Medical Society Centre visits.
Includes Registered Nurse-dispensed Affinity Health Formulary medications. |
| 👨⚕️ Doctor Consultations | Unlimited, managed Affinity Health Provider Network GP consultations. |
| ➡️ Out-of-Network GP visits | Unlimited, per Affinity Health Formulary.
Member pays GP and claims up to R250 per consultation. |
| ↪️ Specialist Visits | Limited to one Affinity Network Doctor-referred specialist visit per member per year (subject to pre-authorization).
Limited to R1,700 per single policy or R3,500 per family policy per year. |
| ✔️ In-room GP procedures | Unlimited cover for minor GP-room procedures with sub-limits. |
| 📌 Healthcare Screening | Limited to one annual nurse practitioner health screening per member at a Medical Society Centre. |
| 📍 Acute Medicine | Unlimited and linked to the GP consultation, Network Provider, or pharmacy-dispensed Affinity Health Formulary medication. |
| 🅰️ Over-the-Counter (OTC) Medication | Over-the-counter medication up to R500 per member policy or R1,000 per family policy per year, subject to Nurse practitioner pre-authorization. |
| 🅱️ Radiology | Unlimited basic Radiology from Affinity Health’s Formulary for Network GP referrals. |
| 🩺 Pathology | Subject to the Affinity Health Formulary, unlimited basic pathology from Network GPs. |
| 🦷 Dentistry | Limited one full mouth assessment and scale and polish every six months.
Includes infection control, 2 intraoral radiographs, 3 extractions, and 3 fillings per member annually. |
| 🤓 Optometry | Limited to one eye exam and standard frames and lenses per member every 24 months.
Only Spec-Savers stores offer this benefit. |
| 🍼 Maternity Management Program | Includes pregnancy and six weeks of postpartum support for Members.
Includes medical advice and monitoring.
Includes an additional specialist visit for maternity management program members up to the R1,000 benefit limit. |
| 💙 Maternity Scans and Pathology | Your network GP may order two growth sonars and relevant blood tests under the Affinity Health Formulary. |
| 💜 Post-hospital Private Home Nursing | Private nurse assistance is covered up to R11,000 per single member policy or R13,000 per family policy per year. |
Combined Plan Optional Benefits
| 🟪 HIV Chronic Medication Management Program | The HIV/AIDS program treats and equips HIV-positive members to live healthier lives.
Benefits require chronic condition registration. |
| 🟦 Diabetes Management Program | Members can manage their diabetes and improve their health with the Diabetes Management Programme.
Benefits require chronic condition registration. |
| 🟩 Intensive Care Benefit | Limited to R27,000 per day in ICU for the first 3 days, R14,000 for the 4th, and R14,000 for the 5th.
Single Cover costs an additional R119 per month.
Family Cover costs an additional R239 per month. |
| 🟨 Hospital Accident Booster | This is an optional booster to increase the Accident Hospital Cover benefit. |
Combined Plan 24/7 Emergency Services
| 🔴 Trauma Support Services | Telephonic trauma support counseling and mental health wellness support for sexual assault, crime, gender-based violence, death, attempted suicide, and domestic violence by qualified and dedicated professionals. |
| 🟠 24-Hour Emergency | This includes 24/7 medical advice, ambulance services, inter-hospital transfers, hospital pre-authorization, and treating facility authorization. |
| 🟡 Major Trauma | Trauma covers paraplegia, quadriplegia, severe burns, internal and external head injuries, polytrauma, and limb loss.
The cover is up to R1,000,000 for the policy’s duration. |
| 🟢 Immediate Emergency Casualty Room Treatment | Limited to 1 ER Accident-related room treatment up to R1,000 per policy. |
| 🔵 Casualty Room Treatment | Emergency Room treatment for medical conditions and accidents up to R3,500 per policy per year. |
Affinity Health Combined Plan Exclusions and Waiting Periods
Combined Plan Exclusions
The Affinity Health Combined Plan will not cover any of the following:
- If a pre-existing condition causes injury within the first 12 months of cover.
- If an injury is due to suicide, intentional self-injury, or exposure to obvious risk (excluding attempts to save human life).
- If an injury is caused by alcohol, drugs, or narcotics (unless prescribed by a medical professional).
- If an injury is caused by exposure to atomic energy or nuclear reaction.
- If an injury occurs while traveling by air, participating in riots, civil commotion, or war, or during professional sports.
- If an injury results from mountaineering, rock climbing, skydiving, or similar activities unless agreed upon by the Assurer.
- If an injury is caused while committing intentional unlawful acts or driving a vehicle without proper authorization.
- If an injury results from a gradually operating condition known to the Assured Person.
- If an injury is due to congenital abnormalities, chronic diseases, or disorders.
- If an injury is related to regular medical treatments, contraceptive medication, or fertility-related therapies.
- If an injury results from elective cosmetic surgery, corrective optical or laser surgery, or treatment.
- If an injury results from male or female birth control, infertility, or assisted reproduction.
- If an injury is due to a pandemic or epidemic.
- If an unregistered healthcare professional provides the treatment.
- If a superbug or multi-drug-resistant illness causes an injury.
- If the Assured Person(s) is covered by a statutory body for a defined event, the policy will pay only the maximum benefit amount.
- If the Assured Person(s) does not follow a doctor’s medical advice or instructions.
- If fertility treatment leads to multiple births.
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Combined Plan Waiting Periods
Affinity Health applies the following waiting periods to the Combined Plan:
- Benefits have a waiting period of 3 months from the Commencement Date unless mentioned otherwise.
- Pre-existing Conditions have a waiting period of 12 months from the Commencement Date.
- Each Benefit may have its specific Waiting Period according to the policy.
Health Insurance Comparisons – Affinity Health Combined Plan vs Similar Plans from Other Medical Schemes
| 🔎 Medical Aid Plan | 🥇 Affinity Health Hospital | 🥈 Sizwe Hosmed Essential Copper | 🥉 Medimed Alpha |
| 👤 Main Member Contribution | R1,838 | R1,870 | R1,680 |
| 👥 Adult Dependent Contribution | R1,688 | R1,870 | R1,680 |
| 🍼 Child Dependent Contribution | R638 | R829 | R660 |
| 🔁 Gap Cover | ❎ None | ❎ None | ✅ Yes |
| 🤓 Optometry Benefit | ✅ Yes | ✅ Yes | ✅ Yes |
| 🦷 Dentistry Benefit | ✅ Yes | ✅ Yes | ✅ Yes |
| 🧠 Mental Healthcare Program | ✅ Yes | ✅ Yes | ✅ Yes |
| ➡️ Screening and Prevention | ✅ Yes | ✅ Yes | ✅ Yes |
| 💶 Medical Savings Account | ❎ None | ❎ None | ❎ None |
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Our Verdict on the Affinity Health Combined Plan
The Affinity Health Combined Plan is a comprehensive healthcare plan that offers a range of benefits to members. The plan includes hospital cover and primary care benefits, providing members with access to in-hospital and out-of-hospital medical services. The hospital cover includes unlimited hospitalization at network hospitals. In contrast, primary care benefits cover a range of services, such as GP consultations, specialist consultations, and medication. One of the key benefits of the Affinity Health Combined Plan is its affordability. The plan is competitively priced and provides excellent value for money, particularly for families or individuals who require frequent medical care.
In addition, the plan offers a range of benefits such as emergency medical evacuation, trauma counseling, and coverage for chronic conditions. However, there are some drawbacks to the plan. One potential issue is the limited network of hospitals and medical professionals members can access. This may make it difficult for members to find a healthcare provider that meets their needs. Overall, the Affinity Health Combined Plan is a good option for individuals or families who require comprehensive healthcare coverage at an affordable price. While the plan has some limitations, the benefits and value for money make it a solid choice for those needing healthcare coverage.
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Affinity Health Combined Plan Frequently Asked Questions
What is the Affinity Health Combined Plan?
The Affinity Health Combined Plan is a healthcare plan that offers its members both hospital coverage and primary care benefits.
What is included in the primary care benefits?
The primary care benefits of Affinity Health Combined Plan include GP consultations, specialist consultations, and medication.
Does the Affinity Health Combined Plan cover chronic conditions?
Yes, the plan provides coverage for chronic conditions.
Are emergency medical evacuation and trauma counseling included in the plan?
Yes, both emergency medical evacuation and trauma counseling are included in the Affinity Health Combined Plan.
Does the plan limit the network of hospitals and medical professionals members can access?
Yes, the Affinity Health Combined Plan plan has a limited network of hospitals and medical professionals that members can access.
How affordable is the Affinity Health Combined Plan?
The plan is competitively priced and offers excellent value for money, starting from R1,728 for the policyholder.
Can individuals and families both join the Affinity health Combined plan?
Yes, both individuals and families can join the plan.
Can members choose their own healthcare providers?
Members of Affinity Health Combined could be limited to using healthcare providers within the plan’s network.
How does the Affinity Health Combined Plan compare to other healthcare plans?
It is important to carefully compare the plan to other options on the market based on individual healthcare needs and preferences.
