Accident & Hospital Medical Cover
Access private hospitals for accidents, illnesses & maternity from only R175 pm. Choose your own benefits & save on your premiums.
Flexible Cover for Your Hospital Expenses
- Rich set of accident & hospital benefits
- Choose your benefits to suit your budget & save on your premiums
- Works with all major hospital networks
- Claims paid directly to providers or reimbursed to you
- An affordable alternative to a Medical Aid
Benefits
Your Choice of Hospital Benefits from R175 pm
Episodic's Hospital Plan has flexible benefit choices for accident and hospital events. Build the hospital cover you need and control your budget. Follow the steps below to see how.
Step 1
All Hospital Plans start with a base set of Accident and Casualty benefits. These are required on all hospital plans.
Accident Hospitalisation
Hospital cover for accidents
- Up to R800,000 per year
- Includes rehabilitation cover
- 24/7 emergency services
- Choose from 3 Levels of cover
Accident Casualty
Casualty room cover for accidents
- R15,000 cover per member per year
- For accident events that don't require hospital admission
Casualty
Visit a casualty ward in emergencies
- Up to R12,000 per year
- Covers casualty events not related to accidents
- Choose from 3 Levels of cover
Step 2
You can choose to add hospital cover for illnesses and planned procedures (that are not related to an accident)
Step 3
You can upgrade your Illness Hospitalisation cover with extra benefits that offer additional amounts for maternity or more serious events. Each of these benefits is optional.
ICU
Extra cover for Intensive Care Units
- Up to R100,000 per event
- Covers amounts per day in ICU
- Choose from 2 Levels of cover
Dread Disease
Extra cover for critical illnesses
- Up to R350,000 per member
- Covers 8 most common critical illnesses
- Choose from 3 Levels of cover
Maternity
Cover the birth of your child
- Up to R30,000 per event
- For natural birth of C-section
Step 4
Lastly, you can add on disability cover to any hospital plan combination you have chosen
What Health Plan are you going to build?
Get a quote and find out. Talk to us or build your own.
Network
A Network You Can Depend On
Access private healthcare when you need to see a doctor, visit a dentist, get medication or go to hospital.
Claims
Simple & Efficient Claims
Find out how the claims process works for rapid and pain-free claims handling.
Comprehensive
Add Day-to-Day Cover
Build a more comprehensive plan when you add primary health benefits to your hospital cover. Access private doctors, dentists, medication and much more.
Medical Aid
Alternative to a Medical Aid
A Health Insurance Hospital Plan is an affordable alternative when you can't afford a Medical Aid. Get covered for hospital expenses with stated amounts for defined events.
FAQ
You have Questions, We have Answers
Find answers to the most common questions about Hospital cover below. You can also browse our Help pages and Blog posts for more information.
Are there age limits for health insurance?
All new members joining a 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.
How many people can be on one policy?
Episodic health insurance 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.
Which hospitals can I use?
Episodic health insurance has no hospital network. We work with all major hospital groups.
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.
The Network page has more information on our networks and how to find a provider.
What are the waiting periods?
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.
How are claims paid?
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.
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