Agility CoPay Cover
Frequently asked questions:
What is co-pay cover?
When it comes to costly co-payments, the Agility CoPay cover product offers relief to the family wallet by taking care of co-payments which a medical scheme may have on listed in-hospital procedures.
Are there any waiting periods?
There is a 3 month general waiting period and a minimum of 12 months on pre-existing conditions.
Will the Agility CoPay product work with any medical scheme?
Yes, your cover can be combined with any medical scheme.
What will happen if I change medical schemes?
Your Agility CoPay cover will not be affected and no changes will be made to your policy. Just remember to keep us in the loop and notify us of such a change by phoning 021 918 6210 or emailing firstname.lastname@example.org
How long do I have to submit a claim?
You will have 90 days after the payment date of your medical scheme payment to the service provider to submit the necessary documentation. We will not be liable for claims outside of this timeframe.
How do I Claim?
Step 1: Submit a completed claim form. Ensure that all sections are completed in full and that you have signed the claim form.
Step 2: All provider accounts relating to the procedure must be attached and submitted at the same time, including the hospital, surgeon and anaesthetist accounts.
Step 3: Attach a copy of the medical scheme statement indicating scheme payment towards the claim.
Step 4: Submit your claim to: email@example.com
How do I apply?
Phone us at 021 918 6210 or send an email to firstname.lastname@example.org
Does the Agility CoPay cover product have specific exclusions?
Some important exclusions you should be aware of are:
The 1st 100% of the cost as this is usually covered by the medical scheme
Costs incurred for the treatment of Prescribed Minimum Benefits (PMBs) as this must be paid by your medical scheme in terms of the Medical Schemes Act 131 of 1998
The following conditions within the first 12 months of the policy inception:
Myringotomy & grommets
Pregnancy / confinement or any related complications
Hysterectomies (except where malignancy can be proven)
Joint replacements (except in the case of an accident)
Spinal, neck and back procedures
Hospital account shortfalls
Any medical scheme exclusions
Psychiatric and psychological disorders
Any hazardous sport
Claims that occur within the first 3 months after inception of cover, except in the event of an accident.
What about dentistry and optometry care?
The Agility Value Added Product (VAP) provides extensive in-hospital cover for dental and optometry gap claim shortfalls at an affordable rate of R25 per family per month. Should you not take the VAP additional cover, these in-hospital dental and optometry Gap claim shortfalls will be excluded.