The Accident Disability Benefit Explained

HI Permanent Disability - hybrid
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Permanent Disability Cover for Accidents

Immediate Cover
3 Benefit Levels
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Optional Benefit
Nationwide Network

Get up to R250,000 cover for accidents that result in permanent disability, even up to 24 months after the event. The benefit is available once per policy.

Accident Disability benefit is purely optional with flexible levels of cover to choose from.

The 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

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

Level 2

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

Level 3

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

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What is Covered?

The Accident Disability cover offers up to R250,000 cover for specific permanent disabilities incurred as a result of an accident. It pays out cash less medical expenses incurred.

The benefit is available once per policy lifetime. This means that the total amount available on your chosen benefit level can be used once and, when used up, does not reinstate.

Claims are usually paid from the Accident Hospitalisation benefit first, which makes sense as the events must be accident related. If the accident results in a permanent disability then the costs already covered are transferred to the Disability benefit. This is what is meant by "less medical expenses incurred".

You have up to 24 months after an accident event to claim for a disability that occurs as a result of that accident.

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Which Disabilities are covered?

The benefit includes cover for the permanent and total loss of :

  • speech
  • hearing in both ears
  • sight in one or both eyes
  • an arm at or above the wrist
  • a leg at or above the ankle

as a result of an accident.

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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.

Accidents may require immediate hospitalisation or result in the person affected being unconscious or otherwise unable to obtain pre-authorisation. In these events, medical personal will always stabilise a patient before being generally 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 due to an accident then you must inform EssentialMED within 48 hours about the accident event.

You can find more detail about the process on the Claims page.

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What is the Waiting Period?

Cover is immediate for the main member of the policy.

On Level 3, the benefit is extended to include the spouse or partner of the main member, however, the spouse will have a 6 month waiting period before they can claim.

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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

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

Is there a waiting period for the Disability benefit?

There is no waiting period for the main member, the benefit is available immediately.

On Level 3, there is a six month waiting period before the spouse of the main member on the policy may claim under this 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