Accident &Emergencies

Get access to private healthcare in event of an accident or an emergency. Starting at R159 per month. Episodic Health offers medical insurance benefits that are designed to provide cover for accident and emergency events. Be prepared and get access to private hospitals and healthcare.

Accident & Emergency benefits:
Browse through our accident & emergency benefits and then Build a Quote to find out what your monthly premium could be.

Stated amounts to cover any costs associated with an accident event that results in hospitalisation.

It covers any in-hospital costs incurred that are directly related to the accident event, as long as at least 24 hours of hospitalisation was required.

The benefit will also cover any recurring events related to that accident for 12 months after the event, up to the stated amounts chosen.

Emergency services are included 24/7 and there is no hospital network applied. You can use any private or public hospital.

There are 3 levels of cover to choose from

Level 1

  • Singles policies: up to R75,000 per event. R150,000 annual limit.
  • Family policies: up to R150,000 per event. R300,000 annual limit.

Level 2

  • Singles policies: up to R125,000 per event. R250,000 annual limit.
  • Family policies: up to R250,000 per event. R500,000 annual limit.

Level 3

  • Singles policies: up to R200,000 per event. R400,000 annual limit.
  • Family policies: up to R400,000 per event. R800,000 annual limit.

No waiting period, cover is immediately available.

Access to after-hours emergency casualty rooms at a hospital

For those emergencies when your network GP is not available, you can access the hospital casualty rooms to get treated. Weekend, after-work, whenever you need it most you still have access to private healthcare.

There is no hospital network but pre-authorisation is required.

3 levels of cover to choose from

Level 1

  • Up to R2,000 per member per year limited to an annual overall limit of R4,000 per policy.

Level 2

  • Up to R4,000 per member per year limited to an annual overall limit of R8,000 per policy.

Level 3

  • Up to R6,000 per member per year limited to an annual overall limit of R12,000 per policy.

1 month waiting period applies.

Cover for permanent disability as a result of an accident.

The benefit is purely optional. It builds on top of the Accident Hospitalisaiton benefit to provide additional cover for permanent disability and pays out the stated amounts less any medical costs incurred.

There is no hospital network and pre-authorisation is required.

There are 3 levels of cover to choose from

Level 1

  • Up to R200,000 per disability reason for the main member.

Level 2

  • Up to R250,000 per disability reason for the main member.

Level 3

  • Up to R250,000 per disability reason for the main member and spouse.

Cover is immediately available for the main member. 6 month waiting period for the spouse (on level 3).

Stated amounts to cover any costs associated with an accident event that results in hospitalisation.

It covers any in-hospital costs incurred that are directly related to the accident event, as long as at least 24 hours of hospitalisation was required.

The benefit will also cover any recurring events related to that accident for 12 months after the event, up to the stated amounts chosen.

Emergency services are included 24/7 and there is no hospital network applied. You can use any private or public hospital.

There are 3 levels of cover to choose from

Level 1

  • Singles policies: up to R75,000 per event. R150,000 annual limit.
  • Family policies: up to R150,000 per event. R300,000 annual limit.

Level 2

  • Singles policies: up to R125,000 per event. R250,000 annual limit.
  • Family policies: up to R250,000 per event. R500,000 annual limit.

Level 3

  • Singles policies: up to R200,000 per event. R400,000 annual limit.
  • Family policies: up to R400,000 per event. R800,000 annual limit.

No waiting period, cover is immediately available.

Access to after-hours emergency casualty rooms at a hospital

For those emergencies when your network GP is not available, you can access the hospital casualty rooms to get treated. Weekend, after-work, whenever you need it most you still have access to private healthcare.

There is no hospital network but pre-authorisation is required.

3 levels of cover to choose from

Level 1

  • Up to R2,000 per member per year limited to an annual overall limit of R4,000 per policy.

Level 2

  • Up to R4,000 per member per year limited to an annual overall limit of R8,000 per policy.

Level 3

  • Up to R6,000 per member per year limited to an annual overall limit of R12,000 per policy.

1 month waiting period applies.

Cover for permanent disability as a result of an accident.

The benefit is purely optional. It builds on top of the Accident Hospitalisaiton benefit to provide additional cover for permanent disability and pays out the stated amounts less any medical costs incurred.

There is no hospital network and pre-authorisation is required.

There are 3 levels of cover to choose from

Level 1

  • Up to R200,000 per disability reason for the main member.

Level 2

  • Up to R250,000 per disability reason for the main member.

Level 3

  • Up to R250,000 per disability reason for the main member and spouse.

Cover is immediately available for the main member. 6 month waiting period for the spouse (on level 3).

Frequently asked questions

The Accident Hospitalisation benefit covers the chosen stated amounts, irrespective of the medical procedures performed. This means that the amounts available are there to cover any in-hospital costs incurred directly related to the accident event.

You will need to be hospitalised for at least 24 hours for the benefit to come into effect.

For 12 months after the accident and after you’ve been discharged from hospital, the benefit will still continue to cover any recurring events related to that accident, whether they are in or out of hospital needs, up to the stated amounts chosen on the level of cover.

Contact the Africa Assist / EssentialMED call center on 0861 911 011 for any emergencies.

Most serious accident events result in immediate hospitalisation so pre-authorisation is not practical, however, you will need to inform us within 24 hours of being admitted for the benefit to apply. This is usually handled by a family member or first-responder if you are unable to communicate.

Sometimes the effects of the accident are delayed and you are not admitted to hospital immediately. In these cases we still need to be informed of the incident within 48 hours of the accident occurring, otherwise we won’t know to apply the benefit later should you need it. Then, to be admitted under this benefit, you will need to get pre-authorisation at least 24 hours prior.

The Permanent Disability benefit cover is for the permanent or total loss or use of:

  • Speech
  • Hearing in both ears
  • Sight in one or both eyes
  • Loss of one or both eyes
  • Any limb by physical separation at or above the wrist or ankle

The disability must have been incurred as a result of an accident event and pre-authorisation is required.

The benefit is available once for any of the reasons above for any one accident, it is not an annual or renewable amount. However, separate accident events resulting in a new disability will enjoy the full stated benefit. You must submit your claim within 24 months of the accident.

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