Clientèle Health Standard H.E.L.P Plan
Overall, the Clientèle Health Standard H.E.L.P Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and maternity benefits to up to 3 Family Members. The Clientèle Health Standard H.E.L.P Plan starts from R500 ZAR.
| 🔎 Medical Health Plan | 🥇 Clientèle Health Standard H.E.L.P |
| 🌎 International Cover | None |
| 👤 Main Member Contribution | R500 |
| 👥 Adult Dependent Contribution | R500 |
| 🍼 Child Dependent Contribution | R500 |
| 🔁 Gap Cover | None |
| 📈 Annual Limit | R250,000 |
| 😷 Screening and Prevention | ✅ Yes |
| 💶 Medical Savings Account | None |
| 🏥 Hospital Cover | ✅ Yes |
Clientèle Health Standard H.E.L.P Plan – 7 Key Point Quick Overview
- ✅ Clientèle Health Standard H.E.L.P Plan Overview
- ✅ Clientèle Health Standard H.E.L.P Plan Monthly Premiums
- ✅ Clientèle Health Standard H.E.L.P Plan Benefits and Cover Comprehensive Breakdown
- ✅ Clientèle Health Standard H.E.L.P Plan Exclusions and Waiting Periods
- ✅ Clientèle Health Standard H.E.L.P Plan vs Medical Aid Plans
- ✅ Our Verdict on the Clientèle Health Standard H.E.L.P Plan
- ✅ Clientèle Health Standard H.E.L.P Plan Frequently Asked Questions
Clientèle Health Standard H.E.L.P Plan Overview
The Clientèle Health Standard H.E.L.P plan is one of 4, starting from R500. The Clientèle Health Standard H.E.L.P Plan is a comprehensive health insurance plan that covers hospitalization due to accidents or illnesses, dread disease, and maternity benefits. Gap Cover is available on the Clientèle Health Standard H.E.L.P Plan, along with 24/7 medical emergency assistance. According to the Trust Index, Clientèle Health has a trust rating of 8.5.
Clientèle Health has the following four plans:
Medical Insurance Clientèle Health Standard H.E.L.P Plan Monthly Premiums
Medical Insurance that is affordable :
| 🟥 Up to 18 Years | R500 per month per policyholder (2024) |
| 🟧 18 – 35 Years | R562 per month per policyholder (2024) |
| 🟨 36 – 45 Years | R662 per month per policyholder (2024) |
| 🟩 46 – 55 Years | R880 per month per policyholder (2024) |
| 🟦 61 Years> | R1,913 per month per policyholder (2024) |
READ more about the 10 Top Gap Covers in South Africa
Clientèle Health Standard H.E.L.P Plan Benefits and Cover Comprehensive Breakdown
| 💴 Daily Cash | Up to R2,500 if the member is hospitalized for more than 10 days |
| 💵 Maximum Payment | R250,000 per year |
| Maximum Lump Sum Pay-Out | Up to R25,000 per hospital stay, if the member is hospitalized for over 72 hours |
| 💶 Maternity Benefit | Available |
| 💷 Accidental Death Benefit | Up to R250,000 |
| 🪙 Accidental Disability Benefit | Up to R250,000 |
| 🪙 Dread Disease Benefit | Up to R250,000 |
| ⚠️ Pre-Existing Conditions | Covered after a 12-month waiting period |
| 4️⃣ Number of Children Covered | 4 – no extra cost |
| 🍼 Children Cover | The benefits for children covered by this policy are subject to limitations.
In addition, coverage for children under six is capped at R10,000 per year, and coverage for children between the ages of six and thirteen is capped at R30,000 per year. |
| 📊 Inflation Protection | Each year, the premiums and benefits will be evaluated and adjusted accordingly, with increases taking effect on January 1st.
Statistics South Africa reports that the annual inflation rate will determine the increased amount. |
| ➡️ Premium Guarantee | The premiums may change annually and will be assessed by December 1st of each year.
Members will be notified of any premium increases. |
Clientèle Health Standard H.E.L.P Plan Exclusions and Waiting Periods
Standard H.E.L.P Plan Exclusions
The exclusions of the Clientele H.E.L.P Standard Plan are as follows:
- Hospitalization that has not been authorized by Clientele or when reasonable notification has not been received.
- Hospitalization or treatment received for conditions excluded as per policy terms and conditions.
- Hospitalization is not recommended by a medical specialist.
- Hospitalization during a month when the premium has not been received.
- Hospitalization lasts for 3 days or less (except for maternity claims).
- Hospitalization due to illness during the waiting period.
- Claims that are fraudulent or exaggerated in any way.
- Hospitalization in a facility that does not meet the Clientele’s definition of a hospital.
Hospitalization is related to an illness where the length of stay exceeds the recommended number of days for such conditions, as per limits of coverage and definitions.
Standard H.E.L.P Plan Waiting Periods
Here are the waiting periods for the Clientele H.E.L.P Standard Plan:
- No waiting period for hospitalization due to an accident.
- A 3-month waiting period for illness.
- A 6-month waiting period for the dread disease.
- A 12-month waiting period for maternity benefits.
A 12-month waiting period for specific pre-existing conditions.
Clientèle Health Standard H.E.L.P Plan vs Medical Aid Plans
| 🔎 Medical Health Plan | 🥇 Clientèle Health Standard H.E.L.P | 🥈 Fedhealth FlexiFED Savvy | 🥉 Momentum Ingwe Plan |
| 🌎 International Cover | None | None | Up to R9.01 million |
| 👤 Main Member Contribution | R500 | R965 | R541 |
| 👥 Adult Dependent Contribution | R500 | R965 | R541 |
| 🍼 Child Dependent Contribution | R500 | R709 | R466 |
| 🔁 Gap Cover | None | None | ✅ Yes |
| 📈 Annual Limit | R250,000 | Unlimited Hospital Cover | None |
| 😷 Screening and Prevention | ✅ Yes | ✅ Yes | ✅ Yes |
| 💶 Medical Savings Account | None | ✅ Yes | None |
| 🏥 Hospital Cover | ✅ Yes | Unlimited | Unlimited |
READ more about Medimed Medical Aid
Our Verdict on the Clientèle Health Standard H.E.L.P Plan
The Clientèle Health Standard H.E.L.P Plan is an all-inclusive health insurance plan providing numerous benefits to policyholders. The plan covers hospitalization due to accidents or illnesses, dread diseases, and maternity care. Hospitalization not authorized by the company, hospitalization due to excluded conditions, hospitalization for less than three days, and hospitalization at an unapproved facility is, however, excluded from the plan. Certain benefits include a 3-month waiting period for illness, a 6-month waiting period for the dread disease, and a 12-month waiting period for maternity benefits and pre-existing conditions.
The absence of a premium refund benefit is one of the plan’s most significant drawbacks. Policyholders will not receive a refund if no claims are filed during the policy year. An additional disadvantage is that the premiums are subject to annual change, and policyholders will be notified of any increases.
Clientèle Health Standard H.E.L.P Plan Frequently Asked Questions
What is covered under the dread disease benefit of the Clientèle Health Standard H.E.L.P Plan?
Cancer, heart attack, and stroke are among the diseases covered by the dread disease benefit.
Is there a waiting period for maternity benefits under the Clientèle Health Standard H.E.L.P plan?
There is a 12-month waiting period before receiving maternity benefits.
What is the maximum length of stay for hospitalization coverage under the Clientèle Health Standard H.E.L.P plan?
The maximum length of stay for hospitalization coverage varies by condition. However, Clientèle Health pays up to R25,000 as a lump sum for hospital stays of more than 72 hours, or R2,500 per day if hospitalization is more than 10 days.
Are pre-existing conditions covered under the Clientèle Health Standard H.E.L.P Plan?
Yes, existing conditions are covered. However, they are covered after a 12-month waiting period.
What is the premium payback benefit for the plan?
The Clientèle Health Standard H.E.L.P. Plan does not offer a premium reimbursement benefit.
Are there any exclusions to the hospitalization coverage under the plan?
Yes, there are exclusions, under the Clientèle Health Standard H.E.L.P such as hospitalizations that the employer does not authorize and shorter than three days.
Can I choose my own hospital or healthcare provider under the Clientèle Health Standard H.E.L.P plan?
Yes, you can select your hospital or healthcare provider, provided they meet the plan’s requirements.
