Accident & Hospital 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 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 Essential Med Health Plan has no hospital network. Theywork with all major hospital groups and day clinics.

This is because health insurance issues a Guarantee of Payment based off your stated benefit limits so it doesn't need specific contracts with hospitals. Medical Aids, on the other hand, negotiate tariff rates with providers.

You can read more about how this works in our helpful blog article. The Network page also has more information on the networks and how to find providers.

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 you need to go to hospital, the insurer will issue a Guarantee of Payment to the provider based on the event and your available limits on the specific benefit. This happens at the pre-authorisation stage.

Claims will generally be paid directly to the provider. See the Claims page for more detail.