Our service delivery operation

Designing and pricing a simple set of primary healthcare benefits is an uncomplicated task. Delivering a real service is far more demanding.

In order to make our product as affordable as possible we have established networks of general practitioners, dentists, pharmacies, pathologists, radiologists and optometrists. Managing and expanding our provider networks is an ongoing purpose and we have dedicated significant resources to ensure accessibility of services. Our current providers consist of approximately:

0
+
Network General Practitioners
0
+
Open Dentist Network
0
+
Network Optometrists
0
+
Network Hospitals

To maximise our administration efficiency we have teamed up with MIP to provide us with state of the art medical administration systems. MIP is well known in the medical scheme environment and provide system solutions and support to numerous medical schemes. We receive claims daily from various providers via switching companies and thereafter claims are assessed and processed for weekly claim payments.

We have an agreement in place with Mediscor to manage our pharmacy benefit. Mediscor sets out and manages the formulary for both acute and chronic medicines. The pharmacy benefit programme allows us to reduce the cost of medicines and avoid co-payments for our members. The chronic programme ensures that the most appropriate medicine is provided based on the individual’s specific condition and circumstance.

Our optometry network is managed by Preferred Provider Network (PPN), one of the leading optometry networks in the country. Optometry benefits are available through Execuspecs and Specsavers.

 

For emergency transport services we have partnered with ER24, undoubtedly one of South Africa’s top providers of emergency evacuation services. ER24  operates from 59 base locations throughout South Africa and provides quality emergency response and pre-hospital care service, supporting both public and private hospitals. Members have access to a 24 hour call centre for emergencies. The 24 hour call centre includes referrals to a medical hotline and trauma counselling.

Unity Health products have been designed to ensure that when members visit their network provider, they simply present their digital or cut-out card and ID, and the provider in turn submits the bill through to Unity Health for processing and payment.

In the event of an emergency, private ambulance services will recognise the ER24 logo – an indicator that the member has private health insurance. Accordingly, the member will be taken to the nearest private facility as opposed to a state facility (subject to policy conditions and nature of the case).