Elixi Medical Insurance aims to make private healthcare affordable and accessible to everyone. When you join Elixi Medical Insurance you get a range of plans that have been specifically designed to ensure your most essential and basic healthcare needs are taken care of. From unlimited GP visits and accident and emergency hospital care, to a range of value added services that include trauma counselling, 24hr medical advice and the C5 HIV prevention programme.

A description of your Gold Plan benefits has been provided in this brochure and a full list of benefits can be found in your policy wording.

WELCOME TO ELIXI MEDICAL INSURANCEGOLD PLAN - PRIMARY AND HOSPITAL CARE

ACCESS TO THE HIGHEST QUALITY PRIMARY HEALTHCARE AT AFFORDABLE PRICES

Talksure: Talksure Trading (Pty) Ltd is an authorised financial services provider (FSP 42788), and offers broker and intermediary solutions with a range of insurance products, including medical insurance. Talksure takes great pride and responsibility in being an FSP and created the Elixi Medical Insurance brand to meet growing customer demand in the medical insurance space. Unity Health: Unity Health is a division of Ambledown Financial Services (Pty) Ltd (FSP 10287). Unity have partnered with Elixi Medical Insurance to help create quality healthcare at an affordable price. Unity are the underwriting managers on behalf of the insurer Constantia Insurance Company Limited (FSP 31111). Unity Health administers the policies sold under the Elixi Medical Insurance brand and manage the network of service providers offered by Elixi Medical Insurance.

ER24: Unity Health and Elixi Medical Insurance have partnered with one of South Africa’s top providers of emergency medical services. Their services to Elixi Medical Insurance members includes a 24-hour call centre to deal with emergencies, in-patient and out-patient hospital admissions, verifying membership, and issuing guarantee of payments (GOPs) to Elixi Medical Insurance members.

WHO YOU WILL BE DEALING WITH

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GP VISITSUnlimited visits at a Unity Health Network GP.Pre-authorisation required for 10 or more GP visits per person, per year.

There are over 1700 Network GP’s nationwide.To find the nearest Network GP to you, please call us on 0861 366 006.

GP Procedures Minor procedures in rooms are included in your visits to the GP. E.g. stitching of a wound, application of a cast to a broken limb etc.

ACUTE MEDICATION

Prescribed medication is limited to R3 000 per person, per year.

This is limited to medication prescribed during GP visits. All acute medication is subject to a formulary.

Dispensing GP: If your GP dispenses medication, you will get everything that you need during your visit.

Non-dispensing GP: If your GP does not dispense medication. You will receive a prescription, which you can collect from the pharmacy.

What is an acute condition? A short-term condition or illness like a chest infection, sinusitis or the flu. Your GP can give you acute medication to treat your condition/illness, or write a script for you to get the medication at a pharmacy. What is a formulary? A medicine formulary is a list of approved medicines. Only medications that are on this list will be covered. This ensures that premiums stay affordable.

CHRONIC MEDICATIONChronic Medication Programme. 8 listed “high impact” conditions including HIV/AIDS.

What is a chronic condition: A condition or disease that lasts for an extended period of time.

How does the chronic medication programme work? The Gold Plan offers the chronic medication benefit which covers medication for the following specified conditions: asthma, chronic obstructive pulmonary disorder, diabetes (type 1&2), epilepsy, HIV/AIDS, hyperlipidemia, hypertension and tuberculosis.

OPTOMETRY1 eye test per person, per year. A standard frame to the value of R254 and one pair of clear standard spectacle lenses per person, per 24 months subject to the qualifying norms as listed in the policy wording.

Available at a PPN network optometrist. For a network optometrist near you, please call us on 0861 366 006 or visit www.ppn.co.za

GOLD PLAN PRIMARY CARE

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BASIC AND EMERGENCY DENTISTRYFor pain and sepsis, including extractions. Up to R1 150 per person per incident, per 24 months at a Unity Health Network Dentist. Maximum R3 500 per family, per year at a Unity Health Network Dentist.

There are over 2 200 Network Dentists nationwide. To find the nearest Network Dentist, please call us on 0861 366 006.

Treatment includes: Full mouth assessment, intraoral radiographs, scale and polish, extractions, emergency root canal, fillings, pain and sepsis treatment. Only available at a Unity Health Network Dentist. Specialised dentistry (such as bridges or crowns) is not covered. Orthodontic treatment (such as braces or dentures) is not covered.

BASIC PATHOLOGY BLOOD TESTSUnlimited blood tests are provided if you receive a referral from your Network GP.

Basic list of blood tests subject to a list of tariff codes. During your visit, your GP will advise you if blood tests are necessary.

BASIC RADIOLOGY X-RAYSBasic X-rays (black & white) are covered. Subject to a list of tariff codes.

Your Network GP will advise you if X-rays are needed. Specialised radiology such as MRI and CT scans are not covered.

PRE-BIRTH MATERNITY2 gynaecologist visits and 2 ultrasound scans per year are covered.Maximum value of up to R2 750 per family, per year.

You may go to any gynaecologist, but upfront payment may be required, but will be reimbursed to you.

If you prefer to have an ultrasound scan at your Network GP, we will not count this as an additional GP visit.

ACCIDENTAL DEATH BENEFITA benefit equal to R10 000 is payable in the event of the death of the principal insured person and/or the spouse of the principal insured due to an accident. Limited to one spouse.

WELLNESS SCREENINGSHealth screenings include checks for: blood pressure, cholesterol, glucose levels, body mass index, waist circumference, HIV and pre and post test counselling. Available at Dischem and Clicks pharmacies. Limited to one screening per person, per year.

PAP SMEARSAvailable once every 3 years after the age of 21. Available at Clicks and Dischem pharmacies. Your Network GP may or may not offer Pap smears.

VACCINATION PROGRAMME Available at approved Dischem and Clicks pharmacies.Influenza: Available annually and needs to be administered by 31 May each year.Tetanus: Available once every 10 years.Hepatitus A & B: Available once-off.Pneumococcal: Available once every 5 years for those aged 60 or older and for those individuals with a medically proven compromised immune system.

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All Gold Plan Hospital Care and Accidental Benefits are subject to an overall limit of R2 000 000 per family, per year.

GOLD PLAN HOSPITAL CARE

MRI & CT SCANS - ACCIDENT ONLYLimited to R15 000 per insured person, per year.

The actual cost of an MRI or CT scan necessitated as a result of an injury sustained due to an accident. Pre-authorisation is required.

PHYSIO & OCCUPATIONAL THERAPISTS - ACCIDENT ONLYLimited to R2 500 per insured person, per year.

Physiotherapy & Occupational Therapy following an in-patient hospitalisation due to an accident.

Limited to a period of 3 months following the discharge from an in-patient hospitalisation incident. Pre-authorisation is required.

EMERGENCY STABILISATION - IN-PATIENT EMERGENCY OR CASUALTY UNIT ONLYLimited to R20 000 per insured person, per incident.

The actual cost of hospitalisation as an in-patient, in the event of anemergency that necessitates the stabilisation of the patient in an emergency unit before the patient is transferred to a public hospital, excluding any surgical procedures.

IN-PATIENT HOSPITALISATION - ACCIDENT ONLYLimited to R1 000 000 per insured person, per incident.

The actual cost of hospitalisation as an in-patient, including all associatedservices during the hospital admission at a private facility in the event of injuries sustained due to an accident.

Planned medical procedures are not covered; e.g. hysterectomy, hip replacement.

OUT-PATIENT CASUALTY UNIT - ACCIDENT ONLYLimited to R5 250 per person, per incident.

The benefit payable for injuries sustained in the event of an accident shall be limited to treatment received in a hospital emergency unit.

EMERGENCY SERVICES

Emergency evacuation, including:• Ambulance services (air or road)• Telephonic medical advice• Inter-hospital transfers• Repatriation of mortal remains within the borders of South Africa• Unity Health push to call emergency dialing, geo-locating and find a

provider mobile app

Hospital pre-authorisation & guarantee of payment to the treating facility in the event of an emergency/accident.

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CALL A GP OR NURSEThe 24 hour GP helpline is staffed by medical professionals. This critical serviceprovides advice and assistance to all ELIXI MEDICAL INSURANCE GOLDmembers. Members will be able to discuss a number of medical related matterswith a qualified GP and or nurse on the following: medical advice, secondopinion, confirmation and clarity of medical diagnosis, guidance on drugregime, guidance to a specialist GP, guidance and advice on the side effectsof prescribed treatment, telephonic follow up after diagnosis and treatment.

C5 HIV PREVENTION PROGRAMMEIn the event that an ELIXI MEDICAL INSURANCE GOLD policy holder is exposedto HIV through a trauma or assault, the member will have access to: 24 hourtelephonic HIV advice and counselling line, emergency evacuation to HIVtreatment facility (ER24 only), medical consultation, 3 day starter pack,25 day antiretroviral HIV treatment including, sexually transmitteddisease therapy and pathology tests.

TRAUMA COUNSELLINGIn the event that an ELIXI MEDICAL INSURANCE GOLD member is involvedin a traumatic event or is witness to a traumatic event the member will haveaccess to: unlimited telephonic counselling, referral to a qualified counsellor, andface to face counselling with a qualified counsellor limited to R3 000 per event.

HOUSEHOLD ASSISTANCEThis service will provide ELIXI MEDICAL INSURANCE GOLD members with a callout and up to one hour’s labour (initial fault only), for emergency events that relate to plumbing, electrical faults, faults with appliances, damage to external windows, and emergencies where a locksmith is required.

LEGAL ASSISTANCE AND 30 MINUTE FREE CONSULTATIONSProfessional, in-house, qualified legal advisors who provide advice to ELIXI MEDICAL INSURANCE GOLD members on any legal topic or matter ranging from debt and divorce to labour and domestic violence, 24/7. The legal service also provides for standard legal documents such as a domestic worker employment contract, maintenance kit, offer to purchase, small claims court kit, Road Accident Fund, etc.

To access any of the above benefits, please call us on 0860 333 343

VALUE ADDED SERVICES

DISCLAIMER: This is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership. The benefits are subject to waiting periods and applicable limits. These are outlined in the policy wording which you are required to read and understand. T&Cs apply. This document is not your policy wording and for the full disclaimer please go to www.elixi.co.za/disclaimer-notice

Talksure Trading (Pty) Ltd - an authorised FSP 42788. Insurer – Constantia Insurance Company Ltd - an authorised FSP 31111.

CONTACT DETAILSTALKSURE CUSTOMER SERVICES/BILLING 0860 333 343UNITY HEALTH CLAIMS/QUERIES 0861 366 006ER24 ACCIDENT & EMERGENCY 0871 351 248

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Elixi www.elixi.co.za

Principal R508Senior Principal R696Adult Dependent R363Senior Dependent R551Child Dependent R163Once-off set up fee for VAPS R60

GOLD PLAN PRICING PER MONTH

What is the procedure to follow in the event of a medicalemergency or serious accident?

• Call ER24 on 0871 351 248. The number is also on your Unity Health membership card.

• ER24 will verify the membership of the person in need of help, whether it be you or your dependant.

• ER24 will assist you with advice, and emergency transportation to your nearest in-patient hospital facility.

• ER24 will issue the hospital with a guarantee of payment and you will be admitted for treatment.

• Please ensure that you have your Unity Health membership card and ID for verification purposes. Unity Health will then settle the account directly with the provider.

I did not receive my membership card, who do I contact?

Unity Health dispatches the cards once your first premium is collected. Talksure provides the membership certificate which will be used in the interim. Should you not receive your card 45 days after your first premium, please contact Unity Health on 0861 366 006 or email membership@unityhealth.co.za, alternatively, Talksure on 0860 333 343 or email client.services@talksuresa.co.za.

What are the waiting periods?

Two (2) month waiting period for all benefits, except emergency and accidents which is covered from date of inception. Twelve (12) month waiting period for chronic medication and optometry benefits. Nine (9) month waiting period applicable to pre-birth maternity benefits.

Who can be covered under my policy?

Immediate family - spouse and children.

Elixi Medical Insurance recently launched a chronic medication benefit, how do I receive this benefit and how does it work?

The Gold Plan offers the chronic medication benefit which covers medication for the following specified conditions: Asthma, Chronic Obstructive Pulmonary Disorder, Diabetes Type 1&2, Epilepsy, HIV/AIDS, Hyperlipidemia, Hypertension, and Tuberculosis. The Black Plan offers everything listed in the Gold Plan, plus hypothyroidism and glaucoma. Should you wish to upgrade your policy to the Black or Gold Plan, please contact Talksure on 0860 333 343 or alternatively email us on client.services@talksuresa.co.za

What process do I follow to add my doctor to the GP list?

Call Talksure on 0860 333 343 or email Unity Health on Networks@unityhealth.co.za . Please ensure that you provide us with the doctors name, practice number and contact details. Unity Health will invite the doctor to join the network. The Doctor either rejects or accepts the proposal and it is entirely at the doctors discretion to join. An update will be sent via email informing of you of any actions or response.

Is Elixi Medical Insurance a medical aid scheme?

No, Elixi Medical Insurance is not a medical aid scheme and the cover is not the same as a medical aid scheme. Elixi Medical Insurance is classified as short term medical insurance.

Can I go to any doctor across South Africa?

We have a network of doctors in the 9 provinces. For more information on the location of the doctors, please contact Talksure on 0860 333 343.

What is an emergency?

An event or unexpected health condition, which if not treated immediately, would result in death or serious bodily impairment. E.g. Heart attack or stroke.

What is an accident?

An accident means bodily injury caused by violent accidental and external physical means. E.g. Motor vehicle accident, burns, injuries from a crime, snake bite or injuries from a fall.

Elixi Medical Insurance FAQ’s