The Accident Casualty Benefit Explained

Pays for emergency casualty room expenses related to an accident

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Hospital Casualty Room Cover for Accident Events

Accidents happen and they don't always need admission in hospital. They might just need treatment in an emergency casualty room. So get the health insurance benefit that covers this.

This benefit offers up to R15,000 per member per year for treatment in a hospital casualty room as a result of an accident.

No Waiting Period
Single Benefit Level
Included in Hospital Plan
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FAQ

How Does It Work?

Find answers to the most common questions about this benefit. Browse our Help pages and Blog posts for more information.

What is the Accident Casualty cover?

R15,000 per member per year for emergency casualty treatment is available when:

  • you go to hospital as a result of an accident
  • you get treated in the emergency casualty room
  • instead of being admitted to the hospital

What if hospital admission is needed?

If the accident requires you to be admitted to hospital then the Accident Hospitalisation benefit will apply.

How is this different to the Emergency Casualty Benefit?

The difference is simply whether you visiting a casualty room for an accident event or for some other illness related reason.

If it was an accident that led you to the casualty room then the Accident Casualty Benefit applies.

If it was not accident but some other illness emergency reason then the Emergency Casualty Benefit applies.

What is the waiting period?

Accident Casualty cover has no waiting period. Your cover will be available immediately when your policy is active.

What is an Accident Event?

To quote the policy wording:

  • "A sudden, unforeseen, unusual and unexpected specific event" - an accident
  • "which is unintended" - you didn't mean it to happen and it was not self-inflicted
  • "arises from a source external to the insured" - it was something else that affected you, like a car or a spider
  • "which is independent of illness, disease or other bodily malfunction" - illnesses are not accidents
  • "occurs at an identifiable time and place" - you can pinpoint what it was and when it happened

The definition above helps because it is not only car accidents that apply but also falling, getting bitten by a dog, malaria or other accidental events. But getting cancer is not an accident, even though it was not intended.

Is authorisation required?

Accidents may require immediate hospitalisation or result in the injured person being unconscious or otherwise unable to obtain pre-authorisation.

Medical personal will always stabilise a patient before being admitted, at which point your next of kin can assist with identifying you and your available medical cover.

If you can't practically pre-authorise a hospital visit owing to an accident then you must inform EssentialMED within 48 hours about the accident event.

The authorisation procedure is described on the Claims page.

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