Guide 2024
DOCTOR CONSULTATIONS
TELEHEALTH CONSULTING
• Affinity Health members may contact us on 0861 11 00 33 to
consult an Affinity Health Nurse Practitioner, who will assess
• Affinity Health is proud to introduce the new Telehealth your symptoms and give you medical advice before issuing you
Consulting benefit, a convenient way of getting the medical with a script for medication or referring you to consult with an
assistance you need telephonically, without travelling the Affinity Health network GP.
distance or spending more money than necessary.
• Please visit https://www.affinityhealth.co.za/find-doctor/ to
• Call 0861 11 00 33 to have a telephonic consultation with an locate an Affinity Health network GP closest to you.
Affinity Health Nurse, Doctor or Mental Health Professional.
• It is important to call 0861 11 00 33 to check the status of your
• The Nurse, Doctor or Mental Health Professional will assess policy and receive pre-authorisation before visiting a GP.
your symptoms and either issue a prescription for acute
medication up to schedule 4 - provided you are out of the 1 • The Affinity Health Network includes Dispensing and Scripting
month waiting period - or refer you to your nearest primary doctors. Should you consult a dispensing GP, please note that
healthcare facility or Affinity Health network GP for further medication will be issued to you from the dispensary within the
assistance. doctor's rooms. If you consult a scripting GP, the doctor will
issue you with a script to take to the pharmacy and collect
• Please note that medication will be issued according to the medication according to the Affinity Health formulary.
Affinity Health formulary.
• When you receive a script, please collect the medication at a
pharmacy linked to the Affinity Health formulary.
• Network doctors claim directly from Affinity Health, however
additional administration fees may be charged separately by
the practice and cannot be recovered from Affinity Health.
These will be for the members` accounts.
IN-ROOM GP PROCEDURES
• Members may consult out-of-network doctors as well, however
important information applies:
• IMPORTANT – these procedures are only covered if performed • The full consultation fee will have to be paid upfront by
by an Affinity Health network GP. the member. Up to R300 may be claimed back from
Affinity Health. For assistance with reimbursement,
• Pre-authorisation is required before the procedure is please email the detailed account and a signed Affinity
performed. Health reimbursement form to
[email protected].
• These will be covered according to the Affinity Health limits that
fall under this benefit. • Out-of-network GPs are unfamiliar with cover rules, which
means that they are unaware of exactly which medication
• Call 0861 11 00 33 for assistance with obtaining pre- is covered. Using an Out-Of-Network GP may increase the
authorisation. chance of having to pay excess for medication.
NURSE-LED MEDICAL CONSULTATIONS SPECIALIST VISITS
(MEDICAL SOCIETY BENEFIT):
• Being an Affinity Health member gives you access to • IMPORTANT – these consultations are only covered if referred by
conveniently located centres with highly skilled Nurse a GP and pre-authorisation is required before the consultation.
Practitioners that strive to provide quick services in a clean
environment. • Please call 0861 11 00 33 or email [email protected] with
the GP's referral letter, the specialist's name, contact number and
• This benefit includes Nurse-led medical consultations, basic eye practice number to obtain a pre-authorisation number.
tests, child nutrition and treatment for acute illnesses.
• Please note that only certain specialists are covered, who may
• You may also use this benefit to monitor your vital signs and require an upfront payment of the consultation fee. This can be
manage your chronic symptoms with medical and lifestyle advice paid by the member and claimed back from Affinity Health
provided by the Nurse Practitioner. The Nurse Practitioner will according to the maximum benefit amounts (R1700 per single
refer you as required, should you need further medical assistance. member policy per year, R3 500 per family policy per year.)
• There are 14 Medical Society centres. The different locations • In the event that no upfront payment was required, please ensure
can be viewed on: https://www.medicalsociety.co.za/locate-tms- that the specialist's account is sent to Affinity Health to claim
facility/ benefits.
• Should you be required to pay upfront, please email the detailed
account and a signed Affinity Health reimbursement form to
[email protected].
OPTOMETRY
• Members must call Affinity Health on 0861 11 00 33 for pre-
authorisation before using this benefit.
• Only Spec-Savers may be used, unless your nearest Spec-Savers DENTISTRY
is located more than 100km from your residential or work
address.
• IMPORTANT – Affinity Health only covers in-chair dental
• Members are covered for one consultation (eye test), one set of procedures, subject to the Formulary, done by network dentists.
standard frames (the grey sticker range) and lenses (single vision Please contact 0861 11 00 33 or visit
and bifocal lenses. Multi focal lenses will be covered up to the https://www.affinityhealth.co.za/find-doctor/ to obtain the
amount for bifocal lenses). latest provider list.
• Spec-Savers will submit the bill directly to Affinity Health for • Pre-authorisation is required, call 0861 11 00 33.
payment processing according to the Affinity Health benefits.
• Note that the benefit covers 1 full mouth assessment and 1
scale and polish every 6 months. Infection control, 2 intraoral
radiographs, 3 extractions and 3 fillings per Assured Person(s)
per year.
ACUTE MEDICATION
PATHOLOGY & RADIOLOGY
• No OTC medication is covered under this benefit. Affinity Health
works with a medicine formulary. This means that the
prescribed medication that is not on our formulary will not be • Members can make use of any Radiology or Pathology
covered, and that members may be required to make a co- laboratory, as referred by a medical practitioner.
payment.
• Pre-authorisation is important for you to understand what will
• Remember to ask your Doctor to prescribe medication in be covered.
accordance with Affinity Health's formulary.
• The formulary includes basic x-rays and blood tests only,
• Should you have any problems claiming medication, contact according to Affinity Health's protocol and pricing.
Affinity Health on 0861 11 00 33 while you are at the pharmacy
for further assistance. • When a member is referred, we recommend that the member
obtain a tariff code for the referral. In this way, the member can
• Remember that if members use a dispensing doctor, the be certain whether the relevant test is covered or not.
medication must be collected from the dispensary within the
doctor's practice and that a script from a dispensing doctor will • Call 0861 11 00 33 or email [email protected] with the
not be valid at any other pharmacy. relevant tariff codes for pre-authorisation.
OVER-THE-COUNTER MEDICATION CHRONIC MEDICATION
• Members must call 0861 11 00 33 or use the Affinity Health app • Only members on the Day-to-day or Combined Plans qualify for
to obtain Pre-authorisation before using this benefit. the Chronic Essential Benefit.
• This benefit is linked to the Telehealth Consulting benefit with a • A chronic medication application form can be obtained by
Nurse Practitioner. emailing [email protected].
• This benefit is subject to the maximum benefit amounts (R500 • Both the member and the treating doctor will be required to
per single member policy per year, R1 000 per family policy per complete specific sections of the application form.
year) and the Affinity Health Formulary.
• A complete chronic medication application form, your most
recent prescription and pathology report are required to begin
the application process.
• Upon receipt, the chronic application will undergo a validation
process,and you will be notified of the outcome via email or
SMS within 48 hours.
• There is an additional monthly surcharge per condition per
member.
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MATERNITY SCANS AND BLOOD TESTS CASUALTY ROOM BENEFIT
• This benefit covers two growth sonars referred by your network • Affinity Health provides an immediate Casualty Room Treatment
GP, subject to the Affinity Health Formulary. benefit as a result of an accident, which is activated as you apply.
The benefit is an amount of up to R1 000 per policy. This benefit
• Call us on 0861 11 00 33 so we can refer you to a network GP who is only available to first time applicants.
provides this service from within their practice rooms.
• This benefit is available 24/7, to be claimed for accident or illness
• Members may also ask us for assistance via WhatsApp on emergencies.
079 479 3230 or chat to us live during office hours on
www.affinityhealth.co.za. • This benefit pays up to R4 750 per policy per year, depending on
the plan chosen.
• Pre-authorisation is required. Call 0861 11 00 33 in the event of
an emergency.
HIV CHRONIC MEDICATION MANAGEMENT PROGRAMME
• The programme caters to the medical and lifestyle needs of members living with HIV/AIDS by providing them with suitable treatment and tools to live a
healthy life.
• Members are required to email their latest prescription, updated viral load report and a complete chronic medication application form to
[email protected] for further assistance.
• Contact us on 0861 11 00 33 for more information.
HOSPITAL BENEFITS
• PRE-AUTHORISATION IS REQUIRED: Affinity Health has a 24-hour hospital pre-authorisation line. Members MUST call in for pre-authorisation before going
to the hospital to ensure that Affinity Health can contact the hospital to arrange admission prior to the members arrival.
• Pre-authorisation can also be obtained via our WhatsApp line 071 314 5862 or you may send us a please-call-me request to 071 314 5862,and one of our
pre-authorisation agents will contact you back within minutes. Call 0861 11 00 33 to speak to a pre-authorisation agent and let us know what has
happened.
• The agent will assess and define the event as either an illness or accident event, according to the Affinity Health Hospital benefits.
• Please note: illness and planned admissions generally require specific documentation – the admission letter, quotes from the treating provider and facility,
pathology and radiology reports and a signed cession form – these can be emailed to [email protected].
• An injury report is required in the event of an accident.
• For planned admissions,please contact Affinity Health at least 48 hours prior to the procedure/admission to ensure authorisation is provided timeously.
• IMPORTANT – Please remember to send us the cession form (which you will receive when the guarantee of payment is issued) before admission. Affinity
Health cannot pay any accounts without a signed cession form.
• If the Casualty Benefit was previously claimed within the year, only the remaining benefit amount will be payable.
• Continuation of cover for illness events will be considered part of the same claim event and only the maximum benefit amount will be payable. This will
be for admissions for the same or a related illness condition within a 6 month period.
• Accident continuation will also be linked to the initial accident event, as readmission for surgery or further treatment may be required. Treatment cover
period is up to 6 months.
• Members are urged to contact Affinity Health post – discharge. Friendly staff will assist the member in ensuring everything pertaining to the case is
updated to secure a smooth, hassle-free claims process.
• If there are any changes to your treatment plan during admission, please contact Affinity Health.
• All related accounts need to be emailed to [email protected] within 7 days of discharge. Please note that no accounts may be paid until
the hospital account has been received.
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Call Centre Customer Care (WhatsApp)
0861 11 00 33 079 479 3230
Casualty/Hospital Pre-Auth (WhatsApp) Email Address
