Stratum Benefits Essential Primary Plus Day-to-Day Plan

 

Overall, the Stratum Benefits Essential Primary Plus Day-to-Day Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and GP consultations to up to 3 Family Members. The Stratum Benefits Essential Primary Plus Day-to-Day Plan starts from R410 ZAR.  Stratum Benefits has a trust score of 4.1.

 

🔎 Medical Health Plan	🥇 Stratum Benefits Essential Primary Plus Day-to-Day
🌎 International Cover	None
👤 Main Member Contribution	R410
👥 Adult Dependent Contribution	R329
🍼 Child Dependent Contribution	R130
🔁 Gap Cover	✅ Yes
📉 Annual Limit	✅ Yes
💙 Hospital Cover	None
😷 Screening and Prevention	✅ Yes
💶 Medical Savings Account	None

 

 

 

Stratum Benefits Essential Primary Plus Day-to-Day Plan – Key Point Quick Overview

 

1. ✅ Stratum Benefits Essential Primary Plus Day-to-Day Plan Overview
2. ✅ Stratum Benefits Essential Primary Plus Day-to-Day Plan Premiums
3. ✅ Stratum Benefits Essential Primary Plus Day-to-Day Plan Benefits and Cover Comprehensive Breakdown
4. ✅ Stratum Benefits Essential Primary Plus Day-to-Day Plan Exclusions and Waiting Periods
5. ✅ Stratum Benefits Essential Primary Plus Day-to-Day Plan vs Plans Offered by Other Providers or Medical Aid Schemes
6. ✅ Our Verdict on the Stratum Benefits Essential Primary Plus Day-to-Day Plan
7. ✅ Stratum Benefits Essential Primary Plus Day-to-Day Plan Frequently Asked Questions

 

 

Stratum Benefits Essential Primary Plus Day-to-Day Plan Overview

 

The Stratum Benefits Essential Primary Plus Day-to-Day plan is one of 4, starting from R410, and includes day-to-day cover for specialist and GP consultations, pre-birth consults, acute and chronic medicine, and more.

Gap Cover is available on the Stratum Benefits Essential Primary Plus Day-to-Day Plan, along with 24/7 medical emergency assistance. According to the Trust Index, Stratum Benefits has a trust rating of 9.

 

Stratum Benefits Health Insurance has the following four plans to choose from:

✅ Stratum Benefits Corporate Essential Day-to-Day Plan
✅ Stratum Benefits Corporate Essential Emergency/Accident Plan
✅ Stratum Benefits Essential Primary Plus Day-to-Day Plan
✅ Stratum Benefits Essential Primary Plus Emergency/Accident Plan

 

 

 

Stratum Benefits Essential Primary Plus Day-to-Day Plan Premiums

 

🔎 Eligible Age	👤 Principle Member	👥 Spouse	#️⃣ Adult Dependent	🍼 Child Dependent
<55 Years	R410	R329	R329	R30
56 Years>	R619	R538	n/a	n/a

 

Consider adding GAP cover? Read more about the 5 Best Gap Cover Options for Under R300

 

 

Stratum Benefits Essential Primary Plus Day-to-Day Plan Benefits and Cover Comprehensive Breakdown

 

Unity Health, the health insurance administrator, offers access to over 3,745 general practitioners and various pharmacies, pathologists, and radiologists through a nationwide network of contracted providers.

Individuals can download the Unity Health mobile application from the Google Play Store or the App Store to locate a nearby provider. Alternatively, they can contact Unity Health for further assistance.

 

Unity Health has formed agreements with several pharmacy networks, which are as follows:

 

• Alpha Pharm
• Clicks
• Dis-Chem
• The Local Choice
• Medicare

 

Essential Primary Plus Day-to-Day Benefits

 

🟥 Consultation Cover	Pre-authorization is required for 10 or more consultations per person. This applies to the following benefits: GP consultation Out-of-network GP consultation Telemedicine GP consultation Intercare online GP consultation Nurse consultation For the 10th consultation and every consultation after that with any of the above-mentioned benefits, pre-authorization is required. The consultation can be with either a network or out-of-network GP, a telemedicine GP consultation at an approved pharmacy clinic, an online Intercare GP consultation, or a nurse consultation.
🟧 GP Consultations and Medical Procedures In-Room	Unlimited GP visits within the network. If it is on the approved list of tariff codes, basic medical and surgical procedures can be performed in the doctors’ rooms, including wound care, applying a cast, etc.
🟨 Out-of-Network GP Consultations	Members can visit any GP. Limited to R310 per consult and 2 consultations per insured per year.
🟩 Telemedicine GP Consultations	Virtual GP consultations can be arranged during a nurse consultation. The nurse will decide if a GP consultation is required and set up a virtual consultation via video conference. You can have as many virtual GP consultations as you need through approved pharmacy clinics such as Alpha Pharm, Dis-Chem, or Medicare.
🟦 Intercare Online GP Consultations	You can have unlimited virtual GP consultations with an Intercare healthcare provider. These consultations are available through the Unity Health online portal or the app.
🟪 Nurse Consultations	A nurse at a network pharmacy clinic can treat minor ailments. In some practices, they can prescribe medication up to Schedule 2. You can see the nurse as many times as necessary. There is no rand amount limit on prescribed medication if it is on the approved formulary.
🟥 Specialist Consultations	You require a GP referral to see a specialist. You can be refunded up to R1,500 per consultation, with a limit of R3,150 per family per year. Call the provided number for pre-authorization before seeing the specialist. The Blood Tests and X-Rays Benefit covers blood tests or X-rays referred to by the specialist if they are on the approved codes list. If not on the list, it will be covered by the Specialist Consultation Benefit up to the limit. The Acute Medication Benefit covers medication the specialist prescribes if it is on the approved formulary. If not on the formulary, it will be covered by the Specialist Consultation Benefit up to the available limit.
🟧 Pre-Birth Consultations	You can visit any gynecologist of your choice for check-ups. You will be refunded for 2 consultations and 2 ultrasound scans, limited to R3,800 per family per year. Call the provided number for pre-authorization before seeing the gynecologist.
🟨 Medicine Benefits	–
🟩 Acute Medicine	The network GP can dispense medication for everyday illnesses. Unlimited coverage is offered. Non-dispensing network GPs give prescriptions to collect medication from any network pharmacy. Acute medication prescribed by the network GP, nurse, or specialist or during virtual consultations will be covered if it is on the approved Mediscor formulary, an agreed list of medicines to be fully covered. The cost will be the patient’s responsibility when non-formulary medicines are necessary, and no generic equivalent is available.
🟦 Chronic Medication	Members are covered for chronic medication prescribed by a network GP from the Mediscor formulary. The following chronic conditions are covered: Asthma Diabetes Type 1 Diabetes Type 2 Hyperlipidaemia HIV/AIDS Chronic Obstructive Pulmonary Disorder Epilepsy Hypertension Tuberculosis
🟪 Pathology, Radiology, Dentistry, and Optometry	–
🟥 Pathology and Radiology	Blood tests such as cholesterol or glucose tests require a referral from your network GP to the nearest pathology facility, including Ampath, Lancet, or Pathcare. A Covid-19 PCR screening test is also covered if your network GP refers you, pre-authorization is obtained, and if you test positive for Covid-19. It is limited to one positive test per person per year. Basic black-and-white X-rays, like chest X-rays, are covered when your network GP refers you to a radiology facility during one of your visits. There is no rand amount limit on blood tests and X-rays as long as they are on the approved list of codes.
🟧 Dentistry	Basic dental treatments like extractions and fillings can be received from any dentist without restrictions. Pre-authorization is required for dental fillings. Emergency dental treatments like draining an abscess, root canal treatment, or tooth loss due to an accident are covered. Dental procedures are covered according to an approved list of codes and agreed-on rates up to R1,375 per consultation, with a limit of R4,100 per family per year.
🟨 Optometry	Unity Health has an exclusive network arrangement with Specsavers and Execuspecs. The nearest network optometrist can provide 1 eye test per person every 2 years, 1 standard frame up to R499 per person every 2 years, and 1 pair of clear, standard spectacle lenses every 2 years.
🟩 Wellness Benefits	–
🟦 Wellness Assessment	Alpha Pharm, Clicks, Dis-Chem, Local Choice, and Medicare pharmacy clinics are approved network providers for wellness assessment, preventative tests, and vaccinations. You are covered for 1 wellness assessment per person per year, which includes basic health checks like blood pressure, body mass index, cholesterol, glucose levels, waist circumference, and HIV/AIDS testing, including counseling before and after testing.
🟪 Preventative Care	Vaccinations covered include the following: One flu vaccination per person per year before May 31. One pneumococcal vaccination every five years for individuals 60 or older or those with a medically proven compromised immune system (pre-authorization required). One hepatitis A and B vaccination once-off per person, One tetanus vaccination per person once every ten years. Tests and screenings covered include the following: One pap smear every three years for females aged 21 years or older (can be done in the rooms during one of your visits to the network GP), One rapid prostate-specific antigen screening every two years for males aged 50 years or older.
🟥 Testing and Screening	–
🟧 Essential Assistance Program (EAP)	Reality Wellness Group provides unlimited 24/7 telephonic advice and counseling services for financial advice, legal advice, HIV/AIDS counseling, and trauma counseling.
🟨 Lifestyle Benefit	–
🟩 Extra High School Learning Support	High school learners from Grades 8 to 12 can access e-learning solutions through Boston Online Home Education. These solutions offer online CAPS and Cambridge International Curriculum content, educational webinars, career guidance, short learning programs, and more. To access the platform, learners must register online, and a coupon with a unique voucher number will be issued.

 

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Stratum Benefits Essential Primary Plus Day-to-Day Plan Exclusions and Waiting Periods

 

Stratum Benefits Essential Primary Plus Day-to-Day Plan Exclusions

 

The insurance policy does not cover the following events:

 

• ✅ Events that occurred before becoming an insured person.
• ✅ Events that occur during the policy waiting period, except for accidental events or medical emergencies, where applicable.
• ✅ Events where policy benefit limits have been reached.
• ✅ Events not covered by the policy.
• ✅ Events without pre-authorization or referral from an appropriate healthcare provider.
• ✅ More than one consultation on the same day for the same insured person.
• ✅ Healthcare services, procedures, or medication are not included in the approved tariff codes or formularies.
• ✅ Out-patient consultations related to allied healthcare providers, such as physiotherapists and speech therapists, under the Specialist Consultation Benefit.
• ✅ Eye care, except for eye tests, frames, or spectacle lenses covered under the Eye Care Benefit.
• ✅ Reconstructive cosmetic or maxillo-facial surgery, including related medical conditions or procedures.
• ✅ Obesity or its sequel, cosmetic surgery, or surgery directly or indirectly caused by, related to, or in consequence of cosmetic surgery.
• ✅ External prosthetic devices or medical equipment, such as artificial limbs and wheelchairs.
• ✅ Artificial insemination, infertility treatment, or contraceptives.

 

and many more. A full list of exclusions will be made available by Stratum Benefits.

 

Stratum Benefits Essential Primary Plus Day-to-Day Plan Waiting Periods

 

The following waiting periods apply to the Essential Primary Plus Day-to-Day Plan:

 

• ✅ 2-month general waiting period where there is no cover for Day-to-Day Wellness Assessment and Preventative Care Benefits.
• ✅ 9-month waiting period for pre-birth consultation.
• ✅ 12-month waiting period for chronic medication.

 

Finally, a 12-month waiting period will apply for eye care.

 

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Stratum Benefits Essential Primary Plus Day-to-Day Plan vs Plans Offered by Other Providers or Medical Aid Schemes

 

🔎 Medical Health Plan	🥇 Stratum Benefits Essential Primary Plus Day-to-Day	🥈 Bonitas BonEssential Select Plan	🥉 Makoti Medical Scheme Primary Option
🌎 International Cover	None	R10 million	None
👤 Main Member Contribution	R410	R1,998	R355 – R1,034
👥 Adult Dependent Contribution	R329	R1,464	R355 – R805
🍼 Child Dependent Contribution	R130	R659	R230 – R370
🔁 Gap Cover	✅ Yes	✅ Yes	None
📉 Annual Limit	✅ Yes	Unlimited	Unlimited hospital cover
💙 Hospital Cover	None	Unlimited	Unlimited
😷 Screening and Prevention	✅ Yes	✅ Yes	✅ Yes
💶 Medical Savings Account	None	None	None

 

Learn more about Hospital Plans

 

 

Our Verdict on the Stratum Benefits Essential Primary Plus Day-to-Day Plan

 

According to our analysis, the Essential Primary Plus Day-to-Day Plan from Stratum Benefits is a comprehensive medical insurance plan that offers cover for day-to-day medical expenses, preventative care, and wellness assessments.

 

The plan offers a range of features that make it a popular option for individuals and families seeking affordable medical aid coverage. Members can access various medical services and treatments, including GP and specialist consultations, medication, and blood tests.

 

We found the plan also offers unlimited access to a network of pharmacies and dentists, certain vaccinations, and telephonic advice and counseling services.

 

However, the plan has certain drawbacks, including waiting periods and benefit limits.

 

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Stratum Benefits Essential Primary Plus Day-to-Day Plan Frequently Asked Questions

 

What is the Essential Primary Plus Day-to-Day Plan from Stratum Benefits?

The Essential Primary Plus Day-to-Day Plan is a health insurance plan that covers basic healthcare needs, including regular check-ups and minor medical expenses.

 

What are the key benefits of the Essential Primary Plus Day-to-Day Plan?

The plan includes unlimited visits to your network GP, nurse consultations for minor ailments, medication, basic dentistry, optometry, and wellness assessments.

 

How much does the Essential Primary Plus Day-to-Day Plan cost?

The cost of the plan varies depending on your age and family size. Contact Stratum Benefits for a personalized quote.

 

Can I choose my own healthcare provider with the Essential Primary Plus Day-to-Day Plan?

Yes, you can choose any healthcare provider within the Stratum Benefits network.

 

Is pre-authorization required for medical procedures with the Essential Primary Plus Day-to-Day Plan?

Yes, pre-authorization is required for certain procedures, such as dental fillings and pneumococcal vaccination. Contact Stratum Benefits for more information.

 

Are pre-existing conditions covered under the Essential Primary Plus Day-to-Day Plan?

Pre-existing conditions might be covered under the plan. However, there is a 12-month waiting period for chronic medication for pre-existing conditions.

 

How do I claim on the Essential Primary Plus Day-to-Day Plan?

You can submit a claim online through the Stratum Benefits portal or by submitting a claim form and supporting documents via email or fax.

 

What is the cover limit for medical expenses with the Essential Primary Plus Day-to-Day Plan?

The cover limit varies depending on the specific benefit, but most benefits have a limit of R4,000 per family per year. Contact Stratum Benefits for more information on specific benefits.