Dis-Chem Health MyHealth Plus Plan
Overall, the Dis-Chem Health MyHealth Plus Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and Gap coverage to up to 3 Family Members. The Dis-Chem Health MyHealth Plus Plan starts from R699 ZAR. Dis-Chem Health has a trust rating of 3.2.
| 🔎 Medical Health Plan | 🥇 Dis-Chem Health MyHealth Plus |
| 🌎 International Cover | None |
| 👤 Main Member Contribution | R699 – R763 |
| 👥 Adult Dependent Contribution | R699 – R763 |
| 👶 Child Dependent Contribution | R439 – R493 |
| 🔁 Gap Cover | ✅ Yes |
| 😷 Screening and Prevention | ✅ Yes |
| 💶 Medical Savings Account | None |
| 💙 Maternity Benefits | ✅ Yes |
| 🍼 Pre- and Postnatal Care | None |
Dis-Chem Health MyHealth Plus Plan – 7 Key Point Quick Overview
- ✅ Dis-Chem Health MyHealth Plus Plan Overview
- ✅ Dis-Chem Health MyHealth Plus Plan Premiums
- ✅ Dis-Chem Health MyHealth Plus Plan Benefits and Cover Comprehensive Breakdown
- ✅ Dis-Chem Health MyHealth Plus Plan Exclusions and Waiting Periods
- ✅ Dis-Chem Health MyHealth Plus Plan vs Plans offered by Other Providers or Medical Aid Schemes
- ✅ Our Verdict on the Dis-Chem Health MyHealth Plus Plan
- ✅ Dis-Chem Health MyHealth Plus Plan Frequently Asked Questions
Dis-Chem Health MyHealth Plus Plan Overview
The Dis-Chem Health MyHealth Plus plan is one of 4, starting from R649, and includes day-to-day and accident cover, with the option of Value-Added Services at an additional cost. Dis-Chem MyHealth Plus is a comprehensive medical insurance policy that provides access to the same benefits as the Core Plan, with several additions such as Out-of-Network consults, dentures, after-hours dentistry, and more.
Gap Cover is available on the Dis-Chem Health MyHealth Plus Plan, along with 24/7 medical emergency assistance. According to the Trust Index, Dis-Chem Health has a trust rating of 3.2.
Dis-Chem Health Insurance offers the following plans:
✅ Dis-Chem Health Accident Cover
✅ Dis-Chem Health MyHealth Core
✅ Dis-Chem Health MyHealth Plus
Dis-Chem Health MyHealth Plus Plan Premiums
| 🔎 Option | 👤 Adult Dependent | 🍼 Child Dependent |
| ❤️ MyHealth Plus Day-to-Day | R649 | R439 |
🧡 Combination:
Day-to-Day + Accident Cover
Value-added Services (R75) | R699 | R454 |
💛 Combination:
Day-to-Day + Accident Cover
Medical Emergency Illness Buy-up
Value-Added Services (R75) | R763 | R493 |
Dis-Chem Health MyHealth Plus Plan Benefits and Cover Comprehensive Breakdown
| 🟥 General Practitioner (GP) Visits | Covered up to 100% of the agreed rate during office hours.
Includes minor medical procedures performed in the doctor’s office as part of the consultation, subject to an approved list of procedures.
Unlimited visits.
Ask A Doctor for authorization is required from the fourth GP visit. |
| 🟧 “Ask a Doctor” | Ask A Doctor telephone or video call consultations are compensated at 100% of the Agreed Rate and include the prescribing of Acute and Chronic Medications (when necessary).
Unlimited consultations are available. |
| 🟨 Out-of-Network and After Hour Doctor Visits | Limited to one visit per insured per year, with two overall visits per family.
Visits are paid at cost and are limited to R1,100 per visit. |
| 🟩 Nurse Visits | Minor illnesses, such as coughs and colds, are treated by a Network Pharmacy Clinic nurse.
You may use your Over-the-Counter (OTC) Medicine Benefit for medications prescribed by a registered nurse from the OTC Medicine Formulary.
The following limits apply:
General colds and flu – 4 visits
Bronchitis, Asthma – 2 visits
Diabetes – 2 visits
HIV Testing – 2 events |
| 🟦 Health Screening | Limited to 2 health screenings at a Network Pharmacy Clinic for the following:
Height, weight, and body mass index (BMI)
Glucose
Blood Pressure
Cholesterol
HIV Screening
Pre and Post-test counseling for HIV |
| 🟪 Specialist Visits | Visits to specialists are covered at cost and are limited to R2,000 per visit, with an annual maximum of R2,000 per Insured Party or R4,000 per family. This includes the consultation and related expenses, such as X-rays, blood tests, and medication.
You may see any Specialist, but prior authorization is required. The validity of pre-authorization is one month.
You must pay in advance and submit a claim for a refund.
Any amount above the visit maximum is not covered. |
| 🟥 COVID-19 Testing | Cover for COVID-19 pathology tests, limited to R859 per insured party per year, for positive results.
Upfront payment is required for testing.
If the test is positive, the insured can complete the refund request form and submit it with the claim, test results, and proof of payment. |
| 🟧 Acute Medicine | Covered up to 100% of the agreed rate if the following conditions are met:
Prescribed by a Prime Cure Network Healthcare Provider.
Provided by a dispensing Prime Cure Network Doctor or Network pharmacy.
Unlimited Cover.
Pre-approval is required for a prescribing doctor visit. |
| 🟨 Over-the-Counter (OTC) Medication | Covered up to 100% of the Agreed Rate when the medicine is collected at a Prime Cure Network Pharmacy.
Limited to R115 per quarter and up to R460 per insured per year. |
| 🟩 Flu Vaccines | Limited to one flu vaccine for all insured parties per annum, including the following:
Children 6 months – 6 years.
Pregnant insured members.
Insured persons 65>
Adults and children registered for Chronic Medicine Benefits for the following:
Lung Disorders
Heart Disorders
Kidney or metabolic disorders
Immune system conditions |
| 🟦 Chronic Medicine | Limited to 27 conditions.
Covered up to 100% of the Agreed Rate if the following is met:
Prescribed medicine is on the Chronic Medicine Formulary.
The insured member has registered to have their medicine covered. |
| 🟪 HIV Program | Unlimited cover.
Blood tests, antiretroviral (ARV) medication, post-exposure prophylaxis (PEP), and treatment of infections per the HIV Formulary and Treatment Guidelines are covered.
You must register for the program with your Prime Cure Network Healthcare Provider by completing an HIV Disease Management Programme Registration form. |
| 🟥 Basic Dentistry | Limited to one consultation per Insured per year with a Prime Cure Network dentist for a comprehensive oral exam and oral hygiene advice.
Limited to 1 preventive treatment consisting of cleaning, scaling, and polishing.
Fluoride Treatment is covered for children under 12 years of age.
No authorization is required before the consultation.
Limited to one preventive treatment consisting of cleaning, scaling, and polishing. Fluoride Treatment is covered for children under 12 years of age.
The following is covered:
Restorations and composite fillings – Prior authorization is required for four or more tooth repairs or five or more composite fillings per family year.
Extractions – Five or more extractions require prior authorization.
Oral radiography per the Formulary – Maximum of four X-rays per family per year; Prior Authorisation is required beginning with the third X-ray.
Diagnosis and treatment for pain and septic shock
Local anesthesia and infection control.
Cover root canal emergencies during office hours for only pain and sepsis. Pre-approval is required. |
| 🟧 Dentures | Cover for dentures made of plastic or acrylic for Insured Parties over the age of 21 per the Formulary.
You must pay the dentist and laboratory 20% of the total bill in advance (Co-Payment). |
| 🟨 After-Hours Dentistry | After-Hours Care is restricted to one annual visit per family for pain and sepsis.
You can visit any dentist.
You might be required to pay the provider in advance and submit a claim for a refund. |
| 🟩 Eye Examination | Limited to one eye examination per insured year at a Prime Cure Network optometrist.
Pre-authorization is not required. |
| 🟦 Glasses and Contact Lenses | Limited to one pair of glasses every 2 years per insured.
This includes standard, clear plastic lenses, single-vision and bifocal lenses, and a range of approved frames.
Pre-authorization is required, and the benefit is subject to availability.
Glasses are only approved if the following are met:
Visual acuity of less than 6/9 on the Snellen scale for distance and near vision when viewed without aid.
Both the distance vision and near vision Qualifying Norms apply to both eyes for bifocals. |
| 🟪 X-Rays and Scans | Covers black-and-white X-rays and ultrasounds of soft tissue, according to a list of approved codes (Formulary).
Paid up to 100% of the Agreed Rate.
A Prime Cure Network Doctor must complete a Radiology Referral form to refer you to a Prime Cure Network radiologist.
Unlimited cover.
Tests must be pre-approved by Ask A Doctor beginning with the fourth doctor visit for cover. |
| 🟥 Pathology | Pathology tests are restricted to an approved list of pathology codes (Formulary).
Covered up to 100% of the Agreed Rate.
The tests must be ordered by a Network GP using a Pathology Referral form.
A Network pathology laboratory, such as Ampath, Lancet, Pathcare, or Lab24, must perform them.
Unlimited cover.
Tests must be pre-approved by Ask A Doctor beginning with the fourth doctor visit for cover. |
| 🟧 Maternity Scans | Limited to 2 2D sonograms per pregnancy, year, and the insured party.
The scans can be performed by a Prime Cure Network Healthcare Provider or radiologist when referred by a Prime Cure Network physician. |
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Dis-Chem Health MyHealth Plus Plan Exclusions and Waiting Periods
Dis-Chem Health MyHealth Plus Plan Exclusions
The policy will not cover claims or benefits related to the following:
- ✅ Suicide, attempted suicide, or self-injury.
- ✅ Use of illegal drugs or non-prescription drugs not taken according to healthcare provider’s instructions.
- ✅ Failure to follow medical advice.
- ✅ Participation in certain activities such as flying or hazardous sports.
- ✅ Civil commotion, war, terrorism, or other violent or politically motivated acts.
- ✅ Nuclear weapons or radiation exposure.
- ✅ The policy will also not cover certain procedures, services, or events, including:
- ✅ Cosmetic surgery.
- ✅ Specialized dental procedures.
- ✅ Rehabilitation, frail care, or hospice services.
- ✅ Criminal acts or fraud.
- ✅ Services obtained from non-network providers without pre-authorization.
- ✅ Services received outside of South Africa.
Child immunizations are excluded except for flu vaccinations for children aged six months to six years old.
Dis-Chem Health MyHealth Plus Plan Waiting Periods
Dis-Chem Health provides the following information regarding waiting periods in their policy:
- ✅ General and Condition-Specific Waiting Periods are outlined in the Policy Schedule.
- ✅ Waiting periods are served concurrently.
- ✅ Newborns, Eligible Children/Spouses will not have waiting periods applied if registered within 90 days of birth/marriage date or Policy Start Date.
- ✅ Waiting periods may be waived for Policyholders/Dependents with proof of previous medical insurance for at least 12 months with less than 3 months break in cover.
- ✅ Failure to provide proof of previous cover within the first three months of policy inception may affect claim eligibility.
- ✅ If Policyholder/Dependent served less than 12 months with the previous insurer or less than 3 months since the resignation, a Condition-Specific Waiting Period will apply.
If the Insured Party served less than three months on their previous policy, a General Waiting Period would also apply. The insurer may change the application of waiting periods with 31 days’ notice.
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Dis-Chem Health MyHealth Plus Plan vs Plans offered by Other Providers or Medical Aid Schemes
| 🔎 Medical Health Plan | 🥇 Dis-Chem Health MyHealth Plus | 🥈 Clientèle Health Ultimate H.E.L.P | 🥉 Oneplan Health Blue |
| 🌎 International Cover | None | None | None |
| 👤 Main Member Contribution | R649 – R763 | R546 | R955 |
| 👥 Adult Dependent Contribution | R649 – R763 | R546 | R1,835 for a couple |
| 👶 Child Dependent Contribution | R454 – R493 | R546 | R1,505 (Single adult + 1 Child) – R2,380 (Couple + 1 child) |
| 🔁 Gap Cover | ✅ Yes | None | None |
| 😷 Screening and Prevention | ✅ Yes | ✅ Yes | None |
| 💶 Medical Savings Account | None | None | None |
| 💙 Maternity Benefits | ✅ Yes | ✅ Yes | ✅ Yes |
| 🍼 Pre- and Postnatal Care | None | ✅ Yes | ✅ Yes |
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Our Verdict on the Dis-Chem Health MyHealth Plus Plan
The Dis-Chem MyHealth Plus plan is a comprehensive health insurance policy that covers medical expenses, including hospitalization, chronic medication, and dental care, among other services. The plan offers different tiers of cover with varying annual limits and benefits, as well as the option to add additional benefits such as maternity and optometry.
The plan’s drawbacks include waiting periods for certain services and limited coverage for certain conditions and treatments. Additionally, the plan has specific exclusions, such as cosmetic procedures and experimental treatments, that may not be covered.
Dis-Chem Health MyHealth Plus Plan Frequently Asked Questions
What is the Dis-Chem MyHealth Plus policy?
Dis-Chem MyHealth Plus is a comprehensive health insurance policy that covers medical expenses, including hospitalization, chronic medication, and dental care, among other services.
What is the coverage for chronic medication under the MyHealth Plus policy?
The MyHealth Plus policy covers chronic medication, subject to certain limits and requirements, such as pre-authorization and designated service providers’ use.
Does MyHealth Plus policy provide dental care insurance?
Yes, the MyHealth Plus policy covers dental care, subject to certain limits and requirements, such as pre-authorization and using designated service providers.
What are the hospitalization benefits under the MyHealth Plus policy?
The MyHealth Plus policy provides hospitalization benefits, including cover for hospital accommodation, theatre fees, and doctor’s fees, subject to certain limits and requirements.
What are the waiting periods for health insurance under the MyHealth Plus policy?
The waiting periods for health insurance under the MyHealth Plus policy vary depending on the specific benefit and tier of cover selected. Generally, waiting periods range from 3 to 12 months.
Does the MyHealth Plus policy provide cover for specific conditions?
Yes, the MyHealth Plus policy covers certain conditions, subject to certain limits and requirements, such as pre-authorization and the use of designated service providers.
Does the MyHealth Plus policy include maternity benefits for health insurance?
Yes, the MyHealth Plus policy includes maternity benefits, subject to certain limits and requirements, such as waiting periods and pre-authorization.
What are the exclusions under the MyHealth Plus policy?
The MyHealth Plus policy has specific exclusions, such as cosmetic procedures and experimental treatments, that may not be covered. Therefore, it is important to review the policy documents and consult with the insurer for a full list of exclusions.
