How Often Can You See Your GP with XHealth?

When it comes to GP and specialist visits, what’s covered depends on the XHealth product you choose. Here’s a quick breakdown so you know what to expect on your plan.

MotiveX

• GP visits are covered from your Day-to-day Benefits (Savings).
• 10% of your monthly contribution goes into Savings.
• No fixed number of visits - it depends on your available balance.

NormX

• GP consultations come from XSaver if you’ve opted in.
• If you selected “Aligned” as your chronic provider, using a non-Aligned GP means a 30% co-payment.

GearX

• Unlimited GP visits within the General Rule for Day-to-day Benefits.
• 25% of your contribution goes into Savings.
• After Savings run out, you move into a self-funding gap until you hit your Threshold. Then Extended Cover kicks in.
• Coverage depends on your chronic provider choice:
  • Any or State: 100% of Scheme Rate.
  • Aligned: 100% at Aligned GP, 70% at non-Aligned GP (plus 30% co-payment for Health Platform visits).

PinnacleX

• GP visits are included in your annual day-to-day limit of R33 000 per beneficiary.
• Paid at 100% of the Scheme Rate.
• Freedom to choose any GP.

GrowX

• 2 virtual GP consultations per beneficiary per year through the GP Virtual Consultation Network (including HeyDoc).
• Covers scripting of medication (up to schedule 4).
• Extra GP visits come from XSaver, if available.

OneX

• Network GPs: Unlimited visits, but from your 11th visit you’ll need pre-authorisation.
• Virtual consultations: 3 per beneficiary per year via HeyDoc (24/7).
• Out-of-network/casualty visits: 1 per beneficiary per year (max 2 per family), with pre-authorisation.
  • R110 co-payment applies.
  • If you’ve chosen Connect Network hospitals, you must use State facilities for these visits.

Quick Help

No matter your plan, you can get authorisation or check benefits easily via the:

• XHealth App
• Web chat
• Email: assist@xhealth.co.za
• Call: 0860 55 55 55