The Emergency Casualty Benefit Explained

Casualty - hybrid
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Visit a hospital casualty ward in emergencies

1 month waiting period
3 Benefit Levels
Nationwide Network
Mandatory Benefit

When you need to see a doctor urgently after hours, get the benefit that helps pay for visits to a private hospital casualty room.

Episodic's Hospital Plan has flexible cover for all of this and more.

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Choose Your Level of Cover

Flexible levels of cover mean you get to choose your benefit limits to suit your needs and budget.

Level 1

  • R2,000 per member & R4,000 per policy per year

Level 2

  • R4,000 per member & R8,000 per policy per year

Level 3

  • R6,000 per member & R12,000 per policy per year

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What is Covered?

Emergency casualty cover pays stated amounts (according to your chosen benefit level) per year for treatment in a hospital's casualty ward. Hospital admission is not required. This benefit is for events that are:

  • Life threatening emergencies
  • Not accident related

Note that if the event is accident related, then the casualty cover included in the Accident Hospitalisation benefit will apply.

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Is Pre-Authorisation Required?

In general, all Hospital claims for planned procedures need to be pre-authorised at least 48 hours before you can use the benefit. This is a simple procedure where we determine whether the procedure you need is covered under your benefits and whether you still have available amounts left over after previous claims.

If you can't practically pre-authorise a visit to a casualty ward due to a serious emergency then the hospital admission desk can inform EssentialMED and confirm the benefits for you.

The pre-authorisation procedure is described on the Claims page.

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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.

Nationwide Network of Doctors & Dentists
Private hospitals across South Africa

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Simple & Efficient Claims

Find out how the claims process works for rapid and pain-free claims handling.

No upfront payments
Claims paid directly to providers
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Answers to Your Questions

What is the waiting period for the Casualty benefit?

A 1 month waiting period applies to the Emergency Casualty benefit.

Where I can find the network hospitals?

The benefit doesn't have a specific hospital network and is designed to work with all major hospital groups. The Network page has all the information needed.

How are claims paid?

Claims are paid directly to the medical providers. You can find all the details on our claims page.

What are the age limits?

All new members joining a policy must be younger than 65 years on date of application.

Child dependants must be younger than 21 years before they will need to start their own policy.

However, if your child is still a registered full-time student and unmarried, then they may stay on the policy as a child dependant until they turn 26.

How many people can be on a policy?

Episodic health insurance policies can include:

  • you
  • your spouse/partner
  • up to 6 children