Nationwide Network of Doctors & Hospitals
Get access to private healthcare across South Africa with an Episodic Health Insurance plan.
Providers
Private Healthcare Providers Near You
You get access to a network top private healthcare providers across the country with Episodic Health Insurance. Here's what you need to know.
Hospitals
You can use any private hospital in South Africa for hospital related benefits. There is no hospital network.
We advise making use of NetCare, Busamed and Life hospital groups as well as Cure Day Clinics for the most seamless experience with the product.
Doctors
The Day-to-Day plan has a nationwide network of private doctors (GPs)
Search for doctors in your area using the online search portal from EssentialMED
Medication
You can get formulary medication on your Day-to-Day benefits from a pharmacy or a dispensing network doctor.
All major pharmacies support our product including Clicks, Medirite and Dischem. You just need a script from a network doctor.
Dentists
The Day-to-Day plan has a nationwide network of private dentists
Search for dentists in your area using the online search portal from EssentialMED
Specialists
Episodic Day-to-Day benefits do not have a network of specialist physicians. You can use any supported Specialist anywhere in South Africa.
See the FAQ item below for a list of specialties supported under Episodic Health Insurance,
Radiology
X-rays and scans on your Day-to-Day or Hospital benefits can be done at any major radiology provider. Your hospital or network doctor will refer you.
Prenatal scans can be done either by your network doctor or referred to any major radiology provider.
Optometry
Optometry benefits on the Day-to-Day plan are available through any SpecSavers or Execuspecs nationwide.
Find a Doctor or Dentist on our Day-to-Day Network
Use the network search tool provided by EssentialMED to find a network doctor or dentist in your area.
Claims
Simple & Efficient Claims
Find out how the claims process works for rapid and pain-free claims handling.
FAQ
You have Questions, We have Answers
Find answers to the most common questions about our Network below. You can also browse our Help pages and Blog posts for more information.
What if my doctor or dentist is not on the network?
The doctor and dentist network is constantly growing as more providers agree to join.
You can nominate your family doctor or dentist to join the network by filling in a request. Simply email info@essentialmed.co.za with the following information:
- Doctor/Dentist name and Practice Number
- Their contact details: phone & email
- Their address
It is ultimately the decision of the doctor and the product administrator when a provider is nominated to the network. We cannot make a guarantee that they will join as it is their choice.
How are Episodic and EssentialMED related to each other?
Episodic offers a retail health insurance product for individuals that is provided and administered by EssentialMED. The Episodic Health Insurance product is an EssentialMED product.
EssentialMED is the product administrator for our health insurance product and they are responsible for managing the network, processing claims and enhancing the product.
What are "managed visits"?
The GP benefit is unlimited in that you can visit a network doctor as often as is medically necessary. This needs to be managed to make sure that it is you or your family using the benefit and not someone else.
Preauthorisation is required from:
- the 5th consecutive visit for Single policies
- the 12th consecutive visit for Family policies
by calling Africa Assist on 0861 911 011
This protects you and us from fraud on your policy as well as helping us make sure you are getting real value from the network of providers.
What happens if I visit a doctor that is not on the network?
The Day-to-Day benefits cover consultations with network doctors. You are allowed 3 visits to out-of-network doctors a year. These visits will be reimbursed up to a maximum of R450 per visit.
Where can I find a list of network hospitals?
Episodic Health Insurance can be used at any hospital. There is no hospital network. We advise making use of NetCare, Busamed and Life hospital groups for the most seamless experience with the product.
This is because Episodic Health Insurance is not a Medical Aid. It offers stated limits for defined events which can be pre-authorised with the hospitals as a Guarantee of Payment.
What is a dispensing doctor?
A dispensing doctor is a doctor on our network that also has an in-house pharmacy. They are able to supply medication (on our formulary) directly to you.
What is a dispensing doctor?
A scripting doctor is a doctor that does not have an in-house pharmacy and will issue a script for medication that can be fulfilled at a pharmacy.
Which Specialists are covered?
The type of specialist you can visit is extensive and includes:
- Dermatology
- Obstetrics & Gynaecology
- Pulmonology
- Specialist Physician
- Gastroenterology
- Neurology
- Cardiology
- Psychiatry
- Oncology
- Opthalmology
- Orthopaedics
- Otorhinolaryngology
- Rheumatology
- Paediatrics
- Physical Medicine
- Neurosurgery
- Plastic & Reconstructive Surgery
- General & Cardio Thoracic Surgery
- Urology
What Health Plan are you going to build?
Get a quote and find out. Talk to us or build your own.
PARTNERS
We Work With the Best
