What you are covered for

Your Benefits, At a Glance

A complete summary of all 19 benefits across the Vertex and Apex plans, organised by category so you can quickly find what matters to you.

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Benefit overview

Two Plans, Comprehensive Cover

Both the Vertex and Apex plans are designed to protect you from the most common and costly medical shortfalls faced by South Africans with private medical aid.

The Apex plan includes every Vertex benefit, plus additional day-to-day cover, trauma counselling, robotic surgery, and enhanced value-added benefits. Use this page to see exactly what is included in each plan before speaking to a broker.

19
Total Benefits
5
Categories
2
Plans
Additional 500%
Gap Benefit
R223K
Annual Limit, Per Beneficiary
R450+
From Per Month
Apex plan benefit
Vertex plan benefit
Not included
In-Hospital
7 benefits
Benefit
Apex
Vertex
Gap Cover 500% additional cover. In-hospital specialist shortfalls.
500% up to OAL
500% up to OAL
BMI-Related Procedures Additional charges for the management of overweight or underweight patients (BMI codes 0018 and 0019).
R5 000 per claim
Not included
Co-Payments Co-payments, excesses, and deductibles imposed by your scheme.
Up to OAL
Up to OAL
Penalty Fee Network penalty when using a non-network hospital. 3 claims per annum.
R15 000
R15 000
Sub-Limit Enhancer MRI, CT, cochlear implants, intraocular lenses, internal prostheses, TAVI valves. Any other sub-limit per claim.
R40 000 / R2 000
R40 000 / R2 000
Hospital Account Shortfall Shortfalls on hospital accounts. 4 claims per annum. Includes 1 private room upgrade per annum.
R2 500 per claim
R2 500 per claim
Robotic Surgery Shortfall for robotic-assisted surgical procedures where scheme does not pay the full cost.
R20 000 per claim
Not included
Appliance Shortfall Benefit Hearing aids, wheelchairs, CPAP machines, humidifiers, insulin pumps, glucometers, nebulisers, Mirena devices.
R8 000 per annum
Not included
Emergency Room
1 benefit
Benefit
Apex
Vertex
Emergency Room, Annual Sub-Limit Total annual sub-limit covering all emergency room visits, per policy. Accident and illness benefits accumulate to this sub-limit.
R25 000 per annum
R20 000 per annum
Emergency Room, Accident Costs directly related to the initial accidental event. Subject to the sub-limit.
R2 500 per claim
R2 500 per claim
Emergency Room, Illness (8 years and older) Illness-related emergency room visits for beneficiaries aged 8 and older. Subject to the sub-limit.
R2 500 per claim
R2 500 per claim
Emergency Room, Illness (younger than 8 years) Illness-related emergency room visits for beneficiaries younger than 8 years. Subject to the sub-limit.
R5 000 per claim
R5 000 per claim
Day-to-Day
4 benefits · Apex only
Benefit
Apex
Vertex
Specialist Consultations Out-of-hospital specialist consultation shortfalls. 4 claims per annum.
R1 500 per claim
Not included
Primary Care Consultations GPs, dentists, physiotherapists, chiropractors, and other scheme-covered providers. 4 claims per annum.
R500 per claim
Not included
Preventative Care Selected preventative screenings and check-ups. 2 claims per annum.
R1 500 per claim
Not included
Trauma Counselling After hijacking, violent crime, or dread disease diagnosis. Limit per policy per annum.
R10 000
Not included
Cancer
4 benefits
Benefit
Apex
Vertex
Cancer Co-Payment Cancer treatment co-payments required by your scheme throughout your treatment journey.
Up to OAL
Up to OAL
Cancer Top-Up Additional protection once your scheme's cancer benefit limit is reached.
Up to OAL
Up to OAL
Initial Diagnosis Benefit Once-off lump sum on first-time Stage 2 or higher cancer diagnosis, where the beneficiary is younger than 65 at diagnosis. 1 claim per beneficiary, lifetime limit.
R25 000 lump sum
R25 000 lump sum
Breast Reconstruction After medically necessary mastectomy: affected breast reconstruction (additional 500%), unaffected breast reconstruction (R40 000), and breast prosthesis (R4 000). 1 claim per beneficiary, lifetime limit.
500% / R40 000 / R4 000
Not included
Value-Added Benefits
3 benefits
Benefit
Apex
Vertex
Premium Waiver Gap Cover premium waived for 6 months following accidental death or total permanent disability of the principal insured.
6 months
6 months
Accidental Death Once-off cash payout providing immediate financial support to your family.
R10 000
R8 000
Medical Scheme Premium Cover, Individuals Individual medical scheme premium paid for up to 6 months following accidental death or total permanent disability of the principal member.
R3 000/month · 6 months
Not included
Medical Scheme Premium Cover, Families Family medical scheme premium paid for up to 6 months following accidental death or total permanent disability of the principal member.
R6 000/month · 6 months
Not included
Private Room Upgrade 1 private room upgrade per policy per annum, included within the Hospital Account Shortfall benefit.
R2 500
R2 500
See the full detail
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Email
info@x-underwriting.co.za
Telephone
(018) 004 0206
Address
102 Peter Mokaba Avenue, Potchefstroom, 2531
Office Hours
Monday to Friday, 08:00 to 17:00