Essential Med aims to offer comprehensive health care that is flexible and affordable, with options available for both day-to-day cover and a hospital plan. So here we will have a look at health insurance from Essential Med.
You can build your own plan from the benefits available to match both your lifestyle and your pocket. There is also the ability to add a funeral cover to your policy.
Hospital cover
Key features:
- Ability to make use of any South African private hospital
- Cover available with no waiting period for accidents or emergency services
- Five benefit levels to choose from
- Cover available for specialist procedures
Day-to-Day Cover – Health Insurance from Essential Med
Key features:
- Visits to network-registered GPs as often as needed
- Ability to visit a GP outside of the registered network (certain amount reimbursed)
- Medication included in GP visits
- Chronic medication covered (linked to a consultation)
- Unlimited basic radiology and pathology
- Dentistry, specialist cover & optometry cover available at various benefit levels
Funeral Cover
Members can also add funeral benefits to their policy, with three levels available.
- R10,000 – R30,000 per member (depending on the level selected)
- Payout received within 48 hours of member’s death
- Also, no waiting period for accidental death, the 3-month waiting period for death by natural causes, 24 months for suicide
- So 100% for the main member, 75% for spouse and children over 14 years, 50% for children over 6
Build your own Plan – Health Insurance from Essential Med
So with Essential Med, you can build your own plan and tailor-make it to suit your requirements. Certain basic benefits are compulsory, but most can be selected and the level of cover for each one can also be chosen.
For example, if you choose a day-to-day plan, the following benefits are mandatory:
- GP visits
- Acute & chronic medication
- Also, Pathology & radiation
The following can be selected or removed from your policy:
- Dentistry
- Specialist visits
- Also, Optometry
If you choose a hospital plan, the following benefits are mandatory:
- Accident hospitalisation
- Emergency casualty visits
The following can be selected or removed from your policy:
- Illness hospitalisation
- Maternity (in conjunction with illness hospitalisation)
- Also, dread disease (in conjunction with illness hospitalisation)
- Permanent disability cover
- ICU care
An Example – Health Insurance from Essential Med
For example, a couple with two children and a dependent grandparent (under the age of 65) could select the following day-to-day cover:
- GP visits
- Unlimited visits to a network doctor
- R250 reimbursed for visits to non-network GP
- Also, 1 month waiting period
- Acute & chronic medication
- Unlimited medication
- R100 per month towards over-the-counter medication
- Also, 1 month waiting period for acute and over-the-counter; 6 month waiting period for chronic medication
- Pathology & Radiation
- Basic blood tests & x-rays covered when required by a doctor
- 1 month waiting period
- Dentistry (Level 1 selected)
- Unlimited visits to network dentist for basic treatment which includes cleaning, filling (amalgam), extractions & pain control.
- 6 month waiting period
- Specialist visits (Level 1 selected)
- R1000 per year towards specialist consultations
- 3 month waiting period
- Optometry (Level 1 selected)
- Free eye test per member in a 24-month period
- Single vision lenses & frames within a 24-month period
- Also, a 12 month waiting period
So the monthly premium for this policy would be R865.04.