Get access to private doctors, dentists, medication and more on a nationwide network. Choose your own cover and save on your premiums.
Day-to-Day cover is a collection of primary health insurance benefits that gives you access to quality medical care for your basic everyday needs. Flexible levels of cover allow you to control your budget and save on your premium.
You can take it on its own or combine it with Hospital Cover or a Medical Aid hospital plan.
Access private healthcare when you need to see a doctor, visit a dentist, get medication or go to hospital.
When you build a plan, your premium depends on the number of family members on the plan and your choice of benefits with their level of cover
Decide how many people will be covered. You can add your spouse and up to 6 children on one policy.
Hospital cover also offers flexible benefit choices. Add what you want and leave out what you don't need.
Most benefits have a choice of up to 3 levels of cover. Each level has different cover limits.
Day-to-Day Benefits cover events that do not require hospital admission. Our Hospital Cover is designed for in-hospital expenses.
Claims are paid directly to the providers and settled within defined service levels.
Some Day-to-Day benefits use a nationwide network. Other benefits can be used with any provider.
Day-to-Day benefits work with a Medical Aid. They can be used with your existing hospital plan to boost your out-of-hospital cover.
Each benefit has it's own waiting period. Frequently used benefits have shorter waiting periods.
You have a choice of the level of cover for the Dentistry, Optometry and Specialist benefits. This affects your final premium.
Episodic's unique flexibility of benefit choices gives you greater control over your budget.
You are not locked in to your policy choice for the year. Make amendments when you need to as your budgets and needs change.
Underwriting rules require that all new members joining a policy be younger than 65 years.
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.
Unlimited benefits are usually managed. This means that pre-authorisation is needed after a certain number of times that the benefit is used 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.
Health Insurance, unlike Medical Aid, has no general Waiting Period. Each benefit has it's own waiting period.
Waiting periods can range from
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.
All new members joining a policy must be younger than 65 years on the date of inception of the policy.
Child dependants must be unmarried and younger than 21 years before they will need to start their own policy.
However, if your child is still a registered full-time student, then they may stay on the policy as a child dependant until they turn 26.
Episodic health insurance policies can include:
To include more people, you can simply take out a second policy.