How to get the most out of your cover

XHealth gives members two types of benefits: Day-to-Day Benefits (for routine medical costs) and Health Platform Benefits (for preventative care and screenings). Knowing the difference helps you get the most out of your cover.

Day-to-Day Benefits

These benefits pay for everyday medical costs that happen outside of hospital, like doctor visits, medication, and basic dentistry.

How They’re Funded (Depends on Your Product)

• Savings Component: A portion of your contribution is set aside (MotiveX = 10%, GearX = 25%).
• Voluntary Savings (XSaver): For NormX and GrowX, you use your XSaver account.
• Threshold & Extended Cover: On GearX, once your savings run out, you self-fund until you reach a set Threshold — then the Scheme pays again.
• Annual Limit: PinnacleX gives up to R33,000 per beneficiary per year.
• Network Cover: On OneX, you must use network providers for day-to-day costs.

What’s Typically Covered

• GP and specialist visits
• Basic & specialised dentistry
• Eye tests, frames, and lenses
• Prescribed medication
• Blood tests & X-rays
• Physiotherapy, biokinetics, allied health services

Health Platform Benefits

These are paid directly by XHealth to help with prevention and early detection — available to all members, regardless of your product.

Key Rules

• Paid by Scheme: Doesn’t come from your savings.
• Pre-notification required: For dental check-ups, pap smears, HPV screenings, general physicals, and HIV tests. If you don’t notify first, costs may come from your day-to-day benefits.
• Provider rules apply: On some products, using a non-Aligned GP could mean a 30% co-payment. OneX members must use their chosen network.

What’s Typically Covered

• Preventative care: Baby immunisations, flu vaccines, pneumococcal vaccines for high-risk members.
• Early detection tests: Dental check-ups, pap smears, mammograms, PSA tests, health assessments.
• Maternity programme: Antenatal consultations, two pregnancy scans, pathology tests, and baby’s first-year paediatric visits.

The Bottom Line

• Day-to-Day = Everyday medical costs.
• Health Platform = Preventative care and screenings.

Knowing which benefit applies helps you avoid unexpected costs and make full use of what’s available on your plan.

Want help understanding which benefits apply to your plan?

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