Healthcare benefits
Your Lion Health
insurance benefits
Private healthcare benefits designed around your everyday needs - private doctor consultations, medication, dental, optometry, and hospital benefits for qualifying hospital admissions.
Health insurance, not a medical scheme. Benefits are paid as stated amounts.
How your benefits are paid
Lion Health is a health insurance product — not a registered medical scheme.1 Everyday benefits — private-doctor visits, the 24/7 nurse line, and acute or over-the-counter medication (up to R1,340 a year from the medicine list) — are delivered through our national PAMC network of HPCSA-registered practitioners.2 Hospital and ICU benefits are stated amounts — R10,000 for your first day in hospital and R15,000 a day in ICU (up to five days) — not a reimbursement of your hospital bill. These benefits require authorisation and may be paid directly to the hospital under the Guarantee of Payment issued on approval, or to you after discharge on a valid claim. Specialist cover of up to R4,120 per policy a year is available on your doctor's referral and subject to authorisation. Waiting periods apply to several benefits.3 LionLife is a licensed insurer and authorised FSP (FSP# 15283).4
How to read your benefits
Lion Health is health insurance, not a medical scheme. Everyday benefits (doctor visits, the nurse line, medication) are delivered through the PAMC network. Hospital and ICU benefits are stated amounts, not a settlement of your hospital account. Admissions require authorisation, and on approval the benefit may be paid directly to the hospital under the Guarantee of Payment issued, or to you after discharge on a valid claim. Limits, waiting periods and terms & conditions apply; check the benefit schedule for the detail.
| Benefit | What you get | Key limit / condition |
|---|---|---|
| Private-doctor consultations | Network GP visits as often as your family needs | Pre-authorisation after the 3rd visit; no waiting period |
| 24/7 nurse line | Virtual nurse consultations, any hour | No waiting period |
| Acute & OTC medication | From the approved medicine list | R155 per event, up to R1,340 / year; no waiting period |
| Chronic medication (CDL) | For listed chronic conditions, from the medicine list | 90-day waiting period |
| Specialist cover | On network-GP referral & authorisation | R2,060 / member, up to R4,120 / policy per year; 90-day wait |
| Pathology & radiology | Blood tests and basic scans on referral | Per formulary; no waiting period |
| Dental | 2 check-ups a year (scaling, polishing, extractions, fillings) | Network tariff; 90-day wait |
| Optometry | 1 eye test and 1 set of glasses per 24 months | Network tariff; 90-day wait |
| Hospital benefit (illness) | Stated benefit, payable to the hospital under the GOP, or to you post-discharge | R10k day 1, R7.5k day 2, R5k days 3–4, R1.5k/day after; up to R53k / 21 days; 90-day wait |
| ICU benefit | Stated benefit, payable to the hospital under the GOP, or to you post-discharge | R15,000 / day, max 5 days; 90-day wait |
| Accident | Paid per incident | R300,000 / person, R450,000 / family; no waiting period |
| Dread disease | Graded compensation, authorisation required | Up to R250,000; 6-month wait |
| Maternity | Hospital benefit for birth + antenatal day-to-day | R30k natural / R45k caesarean; 2 growth scans + R120/mo × 9; 10-month wait |
| Emergency transport | Ambulance to hospital | Pre-authorised via Africa Assist; no waiting period |
Know your options
Medical insurance compared with other cover
| Medical aid | Hospital plan | Gap cover | Medical insurance (Lion) | |
|---|---|---|---|---|
| What it is | Registered medical scheme | Scheme cover for in-hospital costs | Short-term top-up for in-hospital shortfalls | Health insurance — not a scheme |
| Everyday care | Often via a savings account (MSA) that can run out | Little or none | None (companion product) | Defined everyday care that doesn't run out mid-year |
| Hospital | Pays a share of your actual bill | In-hospital costs | Tops up specialist shortfalls | Stated benefit, payable to hospital or you |
| Regulated under | Medical Schemes Act | Medical Schemes Act | Short-term insurance / FSCA | FAIS / FSCA (health insurance) |
Generic category positioning. Not a named-competitor comparison.
Everyday healthcare support
Everyday care we provide
Quality care when you need access to a private doctor, with support for everyday healthcare costs your current cover often leaves you paying for.
Private-doctor cover across a national network
Unlimited in-person consultations with private doctors in our national PAMC network, plus a 24/7 nurse line. Pre-authorisation required after your third visit.
R1,340 a year towards acute & over-the-counter medication
Over-the-counter and acute script medication, limited to R155 per script or OTC event, up to an overall annual limit of R1,340 per annum.
A 24/7 nurse line on WhatsApp
Access to a 24/7 nurse line for clinical guidance and support. WhatsApp nurse line: 060 550 4337
Specialist cover on referral
Up to R2 060 per member (maximum R4 120 per policy per year). Referral from your network doctor required. Where a specialist submits claims directly, there’s nothing for you to do. Otherwise, simply pay the account and claim reimbursement.
What's included
Everyday care and hospital benefits, together.
A comprehensive range of healthcare benefits designed around you and your family.
Hospital and emergency support
Hospital benefits when you're admitted
Stated benefits for qualifying admissions. Authorisation required. Payable to the hospital under the Guarantee of Payment issued on approval, or to you post-discharge on a valid claim.
Hospital benefits
Hospital benefits for qualifying hospital admissions — up to R53 000 over 21 days. Authorisation required. Payable to the hospital under the Guarantee of Payment issued on approval, or to you post-discharge on a valid claim.
Emergency care
Emergency healthcare assistance and hospital transportation support when urgent care is needed.
ICU support
Up to R15 000 per day in ICU for a maximum of five days. Subject to pre-authorisation and policy terms.
Accident benefits
Up to R300 000 per person per incident, facilitated via a Guarantee of Payment to the hospital by Africa Assist.
Health insurance, not a medical scheme. Benefits are stated amounts for qualifying events; limits, waiting periods and terms and conditions apply.
Serious illness support
Support through major health challenges
Additional support for qualifying serious illnesses and major medical conditions when you need it most.
Cancer
Stroke
Heart attack
Kidney failure
Major organ transplant
Blindness
Paraplegia
Chronic coronary heart disease
Health insurance, not a medical scheme. Benefits are stated amounts for qualifying events; limits, waiting periods and terms and conditions apply.
Maternity and family support
Healthcare support for life's bigger moments
Support for life's bigger moments, including maternity and qualifying surgical procedures.
Maternity benefits
Support for qualifying maternity-related healthcare needs and childbirth benefits.
Surgery benefits
Financial support for qualifying surgical procedures and related medical events.
Family-focused cover
Considered cover designed around individuals, couples and families.
Why Lion Health
A more personal approach to healthcare support
Premium healthcare built on clinical quality and trust — private doctors for your family, and the everyday care your current cover often leaves you paying for.
Quality care
Quality care designed around you and your family.
Nationwide network
Access private doctors and approved providers through the PAMC network.
Flexible plan options
Choose between Day-to-Day, Hospital and Combined healthcare cover options.
Digital member access
Manage your cover, find providers and access your membership card through the Pan-African Managed Care member app.
Key numbers
Key benefit fact cards
| Benefit | Amount | Limit | How it works | Paid when |
|---|---|---|---|---|
| Hospital benefit | R10,000 day 1 | Up to R53,000 / 21 days | Stated benefit, not a bill settlement | To hospital on approval, or to you after discharge |
| ICU benefit | R15,000 / day | Max 5 days | Stated benefit, not a bill settlement | To hospital on approval, or to you after discharge |
| Medication | R155 / event | R1,340 / year | From the approved medicine list | At point of care (network) |
| Specialist | R2,060 / member | R4,120 / policy / year | On referral & authorisation | At network tariff |
Compare your options
Choose the cover that suits your needs
Day-to-day plan
Unlimited in-person private doctor consultations and a 24/7 nurse line, plus up to R1 340 per year towards acute and over-the-counter medication, access to specialists.
From
Hospital plan
Hospital benefits for qualifying admissions — up to R10 000 on day one and up to R15 000 per day in ICU. Authorisation required. Stated benefits are payable to the hospital under the Guarantee of Payment issued on approval, or to you post-discharge on a valid claim.
From
Combined plan
Everyday care and hospital benefits in one considered plan — designed around individuals, couples and families.
From
Find the cover that fits your life
Because confidence looks different when quality care is always within reach.
Trusted healthcare Cover
Supporting South African families with modern healthcare solutions.
Licensed & authorised insurer
Healthcare cover backed by a licensed insurer and authorised FSP.
Trusted member support
Dedicated support when you need it most.
Built around people
Healthcare cover focused on real life and everyday wellbeing.
Health insurance, not a medical scheme. Hospital benefits are stated amounts and do not reimburse your hospital bill. Limits, waiting periods and terms and conditions apply.
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References
- Council for Medical Schemes — Medical Schemes Act 131 of 1998 (defines a registered medical scheme; Lion Health is not one).
- Health Professions Council of South Africa (HPCSA) — registration of the practitioners in the PAMC network. (Link pending verification — see note below.)
- National Treasury — Demarcation Regulations (2017), distinguishing health insurance policies from medical schemes.
- Financial Sector Conduct Authority (FSCA) — regulates LionLife under the FAIS Act (FSP# 15283).
The Council for Medical Schemes, National Treasury and FSCA links above were verified live. The HPCSA link could not be verified (certificate error at time of writing) — confirm that domain resolves correctly before publishing. This page supports Lion Health's own compliance review and is not legal or financial advice — obtain FSCA / compliance sign-off before publishing, and verify all premiums and benefit figures against the current PAMC schedule.