A private
doctor
for your family.

A waiting period is the number of months you must be a member before you can access certain benefits. Waiting periods are standard insurance practice and protect the sustainability of the plan for all members.

The following benefits are available immediately with no waiting period: private doctor consultations, acute and over-the-counter medication, pathology, radiology, and accident benefits.

The following waiting periods apply from your policy start date:

• Specialists, dental, optometry and chronic medication: 90 days
• Dread disease benefits: 180 days
• Maternity benefits: 10 months
• Pre-existing conditions: 12 months

Waiting periods are not automatically waived if you switch from another insurer. They apply to each insured person from their individual join date.

The Hospital Plan and Combined Plan include the following stated cash benefits:

• General hospital admissions: up to R53 000 over a 21-day period — paid post-discharge on submission of claims, invoices and proof of payment
• ICU admissions: up to R15 000 per day for a maximum of five days — paid post-discharge
• Accident benefits: up to R300 000 per person or R450 000 per family — facilitated via a Guarantee of Payment issued directly to the hospital by Africa Assist
• Dread disease events: up to R250 000, graded according to disease stage — 180-day waiting period applies
• Maternity: R35 000 for natural delivery, R45 000 for C-section delivery — 10-month waiting period applies
• Selected surgical procedures: up to R35 000 depending on procedure

Important:

• Lion Health does not provide upfront payment guarantees for standard illness admissions.
• Members may be required to fund hospital costs themselves and claim reimbursement post-discharge.
• Hospital benefits are stated cash amounts and do not reimburse your actual hospital bill.
• A 90-day waiting period applies to illness-related admissions.

Hospital admissions:

• Notify Pan-African Managed Care at least 48 hours before a planned admission on 087 405 2001.
• For emergencies, contact Africa Assist immediately on 060 550 4337.
• Once discharged, submit your claim together with your invoices and proof of payment to claims@pamc.co.za.
• All documentation must be submitted within 120 days of the service date.

Day-to-day benefits:

• In most cases, approved network providers will claim directly on your behalf.
• For specialist consultations, pathology and radiology — where you pay upfront — submit your claim and proof of payment to claims@pamc.co.za within 120 days of the service date.

All claims:

• Keep all invoices and proof of payment.
• Include your membership number on all correspondence.
• Submit within 120 days — claims submitted after this period may not be payable.

For claims queries, email claims@pamc.co.za or call 087 943 9627.