Day-to-Day Medical Cover

All new members joining an EssentialMED policy must be younger than 65 years (on the data of inception of the policy).

Child dependants must be unmarried and younger than 21 years. However, if your child is still a registered full-time student, then this age limit is increased to 26 years.

Essential Med Health Plan policies from Episodic can include

• you
• your spouse/partner
• up to 6 children

That makes a total of up to 8 people per policy. To include more people, you can simply take out a second policy.

The Network page has all the information you need to find a provider on the EssentialMED network. There is an online search tool available to look up providers in your region.

Health Insurance, unlike Medical Aid, has no general Waiting Period. Each benefit has it's own waiting period.

Waiting periods can range from

• Immediate cover for accident events
• 1-3 months for frequently used low-risk benefits like doctors and medication
• 6-12 months for benefits that are not used that often or that have a higher risk factor like Critical Illnesses.

Pre-existing medical conditions may result in endorsements on the policy that add a 12-24 month waiting period for that claims related to that specific condition.

When a health insurance benefit is "unlimited" it means that the benefit can be used as many times as you need without any specific annual limits.

The only conditions are that the claim or consultation is medically necessary and fits within the defined formulary or protocols.

Unlimited benefits are usually managed. This means that pre-authorisation may be needed after a certain number of times that the benefit is used. This helps to ensure that it is you utilising the benefit and that you are getting the proper care that you deserve. You can find more details on the Network page.