EssentialMED Health Insurance
Who is EssentialMED?
Founded in 2005, EssentialMED is a health insurance provider and registered credit provider. They are the underwriting managing agent of African Unity Life and a member of the AfroCentric Group of companies. Their goal is to bring affordable health insurance to all South Africans. These four benefits that make them stand out from the crowd:
You Choose. EssentialMed gives you the power to choose and customise your medical insurance to suit your needs and budget. This is a unique offer in the South African health insurance market.
Smart Service. Using research, technology, and experience, EssentialMed continues to make their offers and services more relevant, beneficial, and efficient for their clients.
Affordability. Their policies are designed to give you bang for your buck. Low rates and plans carefully crafted for you ensure that you will get pure value from EssentialMed.
Credibility. With strong backing from AfroCentric, EssentialMED has access to resources no other company has and can deliver on their commitments to those insured with them.
EssentialMED promises to treat all their customers with respect and dignity. They are committed to holding their service providers and staff to high standards and to go the extra mile for all their clients’ requests. Finally, they promise to be honest and open about the benefits you are paying for.
How Does EssentialMED Work?
Choose from their health insurance products based on what your budget is and what your medical needs are. Anyone insured with EssentialMed gets benefits specified in their policy document in exchange for a monthly premium. They are a medical insurance provider and not a medical aid. This means cover won’t necessarily work like it would with a medical aid.
A network of doctors and medical specialists is available through them. They also allow their customers to choose from any hospital in the country. Their hospital cover is not limited to specific hospitals within a network.
What Does EssentialMED Cover?
The cover you get depends on the options you choose. Some options will offer more, while others will allow you to save more money but give you fewer benefits. It all depends on what you and your family need. You can choose from four categories of benefits and then customise your options so that you get the cover you need.
For example, you can choose level 3 cover for specialists, level 2 cover for emergency rooms, and day-to-day cover. Explore your options below.
EssentialMED Day-to-Day Cover
Visit unlimited doctors and dentists within the network through managed appointments. This means that after the fifth appointment per individual or twelfth appointment per family, you will need to get authorisation. This cover includes medicine your general practitioner prescribes to you, basic pathology, minor procedures, dentistry, and radiology. There is a one month waiting period before you can claim.
You can choose from three levels of dentistry cover based on your needs. First, you can opt for cover for normal extractions, amalgam fillings, cleaning, and pain control only. Second, you can choose to get cover for extras like root canals, crowns, and resin fillings. The third option is most comprehensive, and it also includes dentures.
You can also choose from three options for cover for specialists. The cover will be limited to an amount per year, and you will need to be referred by a GP. For this benefit, there is a three-month waiting period.
Accident and Emergency Cover Options at EssentialMED
With EssentialMED, you can go to any hospital in the country, and you will have cover for emergency and accidental medical needs! You can choose from three levels of cover for access to emergency rooms. The plan will then give you cover for access to after-hour emergency medical care such as the emergency unit at hospital. Each option will give you a limited amount of cover per year overall and per family member. You also get access to 24/7 emergency response.
They offer three levels of cover for accidental hospitalisation. Unlike a medical aid, they do not base their cover on which procedures you get. Instead, each option gives you a limited amount of cover for accidental hospitalisation costs. You must inform EssentialMED within 48 hours of the accident and hospitalisation.
If your hospital costs are more than the cover from the option you chose, you will need to pay the rest. This insurer’s cover stays within the limit of the option you choose. This benefit also only applies if you are in hospital for 24 hours or more.
Cover for Planned Hospitalisation with EssentialMED
If you need to be hospitalised for planned procedures or for illnesses, you can choose from three cover options on offer from EssentialMED. Each level has a financial limit for the first day, first two or three days, and so on. The third option gives you the most cover and includes additional cover that does not affect your day-by-day hospital cover for things such as hernia, kidney stones, miscarriage, and more.
All plans allow you to go to any hospital in the country, so you can enjoy private hospitalisation. Waiting periods may apply, and you may need pre-authorisation. Procedures should further be diagnosed and considered medically necessary. That means elective surgery and hospital admissions for diagnostic purposes are not covered.
You can further choose your cover level for intensive care from two available options. Each option gives you an amount per day for an ICU stay for u to 5 days. There is a three-month waiting period. This benefit is in addition to any other hospital cover, so it doesn’t influence your hospital cover.
With EssentialMED, you can get maternity cover for natural delivery or c-section up to a certain amount. One pregnancy is covered per year every 12 months, and pre-authorisation is required. Finally, Dread Disease Cover is available from EssentialMED.
The benefit pays out as per SCIDEP staging. Dread diseases that they will cover include heart attack, chronic coronary heart disease, cancer, kidney failure, stroke, major organ transplant, blindness, and paraplegia. You can only access this benefit for one such event per policy. There are three levels of cover to choose from, and pre-authorisation is required.
DISCLAIMER: The information provided in this article is meant for informational purposes only and should not be construed as legal, medical, or financial advice. Facts stated in this article are correct at the time it was published.