Frequently Asked Questions

Company name, location, and employees’ ID numbers or age and gender.

A minimum of 20 principal insured members. All members of the group must join. No waiting periods apply.

A small group is defined as a group of 2-19 principal insured members. A voluntary group is where not all members of the group join. The following waiting periods apply:

• 1-month general waiting period: GP pre-auth waiver
• No general waiting period: No GP pre-auth waiver
• 12-month waiting period in respect of chronic medication & optometry benefits
• 9-month waiting period in respect of maternity benefits

• 2-month general waiting period: GP pre-auth waiver
• 1-month general waiting period: No GP pre-auth waiver
• 12-month waiting period in respect of chronic medication & optometry benefits
• 9-month waiting period in respect of maternity benefits

Hospital care members have emergency and accident cover at any private hospital.

There is no chronic medicine application. Book an appointment with your Unity Health GP. Your Unity Health GP will register you to collect chronic medication from our network pharmacies.

Press the “please call me” button on your app and a case manager, based on your symptoms, will direct you to a network nurse or GP.

There is no network of specialists. Members can consult with their Unity Health GP and get authorisation to see a specialist.

Requests should be emailed to membership@unityhealth.co.za.

Requests should be emailed to membership@unityhealth.co.za.

Unity Health has gone digital — digital welcome packs and cards are available on the app. Contact 0861 366 006 for assistance.

31 days’ written notice must be provided to Unity Health via e-mail to membership@unityhealth.co.za. Cover is cancelled when premiums are not paid for two consecutive months.

You must complete an accidental death beneficiary form and send it to membership@unityhealth.co.za.

Forms are included in your welcome pack or accessible via web portal registration, or contact 0861 366 006.

Please inform your broker of any contact or address changes. You can also contact Unity Health’s call centre on 0861 366 006, e-mail membership@unityhealth.co.za, or update this information on your Unity Health App.

General Waiting Period

Applies from the date cover commences.

9 Month Pre-Birth Consultation Waiting Period

Applies to maternity-related consultations.

12 Month Chronic Illness Waiting Period

Applies to chronic medication and chronic illness benefits.

12 Month Optometry Waiting Period

Applies to optometry benefits. Assistance and emergency care are excluded from waiting periods.

Unity Health is rated annually with adjustments taking effect on 1 January of every year, however we do reserve the right to adjust the premium with 31 days’ written notice.

Benefit coverage will be suspended, and any claims submitted during the time of suspension will only be paid once premium payments are up to date.

If you have missed up to 2 premiums, then an EFT payment can be made to activate your policy.

You can choose any of the following dates for our monthly debit order: 1st, 15th, 25th or 31st of the month.

Submit claims via email (claims@unityhealth.co.za), the app, or post — with required documentation including ID, a bank confirmation letter, and proof of payment.

In most cases, you simply present your Unity Health membership card or digital card and ID to the provider, and the provider will submit the claim directly to Unity Health.

Access via web portal registration at https://live.unitywellness.co.za/unitylogin/perslogin.html or call 0861 366 006.

Make representation to Unity Health or the Insurer indicated in the Disclosure Notice attached to the policy wording, within 90 days of receipt of the benefit/rejection letter.

1. You need to take your Unity Health membership card and either your ID, passport or driving license with you. This will allow your GP to ensure that you are active and do have benefits available.
2. Always visit a Unity Health Network GP – to check if your provider is on the Unity Health network go to www.unityhealth.co.za or contact the Unity Health call centre at 0861 366 006.
3. Check with your GP that your treatment or medicine is on our list of covered services.
4. Ensure your premiums are paid up to date.
5. Members without the GP pre-authorisation waiver must contact the nurse call centre to obtain pre-authorisation to visit the Network GP prior to making an appointment with the GP.

Contact the Unity Health call centre on 0861 366 006 for a list of providers close to where you live or work, or search via the app/portal.

A dispensing provider will provide your medication during the consultation and you will not receive a script to go to the pharmacy. A non-dispensing provider will give you a script during the consultation.

Call the Unity Health call centre on 0861 366 006 and ask for a provider request form.

Use the website portal’s geo mapping tool, or contact 0861 366 006 for a provider list.

A dispensing provider may issue a script if he/she recommends a medication which is not kept in their rooms.

As per legislation, a consultation is confidential and between a doctor and patient.

Members without a GP pre-auth waiver must obtain pre-authorisation; those with the waiver may visit directly.

You can consult with a nurse at approved pharmacy clinics. In many practices, nurses can provide scripts for minor ailments for up to schedule 2 medications.

No, there is no limit to nurses’ consultations.

Virtual GP consultations are available through approved pharmacies that have a nurse clinic.

Virtual counselling services are provided by registered counsellors via Reality Wellness at 080 11 22 55 0 or eppengage@realitywellness.co.za.

Any Alpha Pharm, Clicks, Dis-Chem and The Local Choice are approved on the Unity Health Network.

Unity Health has an open network of dentists, which means you may consult with any dentist of your choice.

If you have visited your Unity Health Network GP and he/she believes that you require the treatment of a specialist, he/she must write a referral letter.

Members are required to provide the Unity Health Case Manager with the following information when requesting authorisation:

• Name and surname of the member requiring the authorisation
• Name and practice number of the specialist your Network GP has referred you to
• Membership number
• ICD10 code or diagnosis
• Name and practice number of the referring GP

You may only visit a specialist if the treatment provided by your GP failed and your GP is of the opinion that you require a

specialist’s intervention.

Pathology is covered from the specified tests on the pathology form / those listed in your policy document.

Yes — please make sure that only the Unity Health pathology/radiology form for tests/referrals is completed.

An “emergency” is an event of a sudden, and at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment.

“Accident” means bodily injury caused by violent, accidental and external physical means.

Call the Unity Health call centre on 0861 366 006 and press 1 for an emergency, or make use of the push-to-call function.

An emergency department, also known as an accident and emergency department, emergency room (ER) or casualty department, is a medical treatment facility specialising in emergency treatment.

Immediate treatment to stabilise patients in emergencies — for example, stabilisation for appendicitis is covered, but admission for surgery is not.

Yes, you can contact ER24, the designated provider, via the Unity Health call centre on 0861 366 006.

No, international cover is not provided.

You should contact the Unity Health call centre on 0861 366 006 and select the option for pre-authorisations.

Yes. Once the member has selected their network GP or gynaecologist, the member or provider should contact the Unity Health call centre.

This is a disease that lasts 3 months or more and generally cannot be prevented by vaccines or cured by medication.

Contact 0861 366 006 and self-quarantine; case managers will provide guidance and support.

You have access to a COVID-19 PCR pathology test should you test positive for COVID-19.

Members on primary healthcare options have access to COVID-19 benefits.

If a test shows you have contracted COVID-19 and you visit a Unity Health Network GP, our benefits include the following:

• Consultation with a Unity Health Network GP
• Consultation with a Unity Health Network Nurse
• The test that shows you have COVID-19 (diagnostic testing – only if the test is positive)
• Basic chest X-rays
• Acute medication available on the formulary

We have experienced Case Managers available 24/7 to assist with:

• GP consultations
• Nurse consultations
• Testing guidelines
• COVID-19 information and guidelines

Our partners at Reality Wellness are available to assist at any point in the process to help you cope with uncertainty, changes and challenges. Sessions are available for counselling.

Toll free number : 080 112 2550

Refers to the list of services, conditions or events which are always excluded from cover:

1. Nuclear weapons or nuclear material or by ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the purpose of this exception combustion shall include any self-sustaining process of nuclear fission.
2. Investigations, treatment or surgery for obesity or its sequel or cosmetic surgery, or surgery directly or indirectly caused by or related to or in consequence of cosmetic surgery, other than as a result of an Insured Incident.
3. Suicide, attempted suicide or self-inflicted injuries unless such injuries are sustained to preserve another human life.
4. Routine physical or any other procedure of a purely diagnostic nature, or any other examination where there are no objective indications of impairment in normal health, and laboratory diagnostic or x-ray examinations, except in the course of a medical condition or disability established by prior call or attendance of a Medical Practitioner.
5. All costs which are, in the opinion of the Underwriting Manager’s clinical review team, not medically necessary or clinically appropriate or do not meet the healthcare needs of the Insured Person, or not consistent in type, frequency and duration of treatment.
6. Procedures performed in doctors’ rooms that are not listed in the list of tariff code descriptions.
7. Any accident where the initial accident event occurred prior to the Insured Person’s commencement date with this policy.
8. The taking of any drug or narcotic unless prescribed by and taken in accordance with the instructions of a registered Medical Practitioner (other than the Insured Person), or any illness caused by the use of alcohol.
9. Any medical transportation service for non-emergency purposes.
10. Drug addiction.
11. The supply of medication that is not listed on the Underwriting Manager’s formulary list.
12. An event directly attributable to the Insured Person having an alcohol content exceeding zero point zero five (0.05) grams per one hundred (100) millilitres of blood, or the Insured Person suffering from alcoholism.
13. Artificial insemination, infertility treatment or contraceptives.
14. Robotic surgery, specialised mechanical or computerised appliances, equipment or all related Service Providers.
15. Contact lenses.
16. Participation in active military duty, police duty or police reservist duty; aviation other than as a passenger; any Competitive or Professional Sport or Activity; or any form of race or speed test (other than on foot or involving any non-mechanically propelled vehicle, vessel, craft or aircraft).
17. External prosthesis or appliances such as artificial limbs.
18. Any activity prohibited by law.
19. Any benefit requiring pre-authorisation where no authorisation was requested or approved.
20. More than one General Practitioner, nurse or virtual General Practitioner consultation on the same day for the same Insured Person.

Acute medication is used for diseases or conditions that have a rapid onset and severe symptoms, and that require a short course of medicinal treatment.

It is medicine prescribed by a medical practitioner for an uninterrupted period longer than three (3) months.

A formulary is an approved list of medication that has been approved by Unity Health.

No, you can only get medication from a pharmacy with a script from a non-dispensing Unity Health network GP.

We will cover the specialist consultation up to the benefit limit.

Consult your network GP, who will prescribe it. The GP contacts Chroniline (0860 119 553), faxes to 0866 151 509, or emails preauth@mediscor.co.za.

Once your chronic medication has been approved, you may collect it from any approved pharmacy including Alpha Pharm, Clicks, Dis-Chem, Local Choice or Medicare.

Once you are registered to get chronic medication, you have an option for your medications to be delivered by our courier pharmacy (MediLogistics).

Deliveries are usually free of charge.

UNIbot is very helpful and can assist with most general queries, FAQs and form requests from new clients, Unity Health members, providers, brokers and companies.

Queries:

• Request a call back
• General queries
• Claims queries (new or existing)
• Finding a network provider
• Authorisation
• FAQ’s

Forms:

• Pathology form
• Radiology form

• An emergency button for easy emergency assistance
• Tracking your GP visits, medication, and other claims
• Finding your closest GP, dentists or optometrist
• Your digital membership card with your membership details
• A useful summary of your plan details, benefits and limits
• Your personal details
• All contact details for any enquiries
• FAQ’s
• Access to the intercare benefit