Benefits

Episodic Health offers medical insurance benefits, in addition to Day-to-Day cover, that is designed to provide relief for accident and emergency events. Be prepared and get access to private hospitals and healthcare.

Accident Hospitalisation

Stated amounts to cover any costs associated with an accident event that results in hospitalisation.

This means that the amounts available are there to cover any in-hospital costs incurred that are directly related to the accident event, as long as at least 24 hours of hospitalisation was required.

Also, the benefit will still cover any recurring events related to that accident up to the stated amounts chosen for 12 months after the event.

Emergency services are included 24/7 and there is no hospital network applied.

There are 3 levels of cover to choose from

  • Level 1
    • Singles policies: up to R75,000 per event. R150,000 annual limit.
    • Family policies: up to R150,000 per event. R300,000 annual limit
  • Level 2
    • Singles policies: up to R125,000 per event. R250,000 annual limit.
    • Family policies: up to R250,000 per event. R500,000 annual limit
  • Level 3
    • Singles policies: up to R200,000 per event. R400,000 annual limit.
    • Family policies: up to R400,000 per event. R800,000 annual limit

No waiting period, cover is immediately available.

FAQ

The benefit covers the chosen stated amounts, irrespective of the medical procedures performed. This means that the amounts available are there to cover any in-hospital costs incurred directly related to the accident event. You will need to be hospitalised for at least 24 hours for the benefit to come into effect.
Contact the Essential Med call center on 0861 911 011 for any emergencies.
Most serious accident events result in immediate hospitalisation so pre-authorisation is not practical, however, you will need to inform us within 24 hours of being admitted for the benefit to apply.Sometimes the effects of the accident are delayed and you are not admitted to hospital immediately. In these cases you will need to inform us of the incident within 48 hours of the accident occurring, otherwise we won't know to apply the benefit later should you need it. Then, to be admitted under this benefit, you will need to get pre-authorisation at least 24 hours prior to being admitted.
For 12 months after the event and after you have been discharged from hospital, the benefit will still cover any recurring events related to that accident, whether they are in or out of hospital needs, up to the stated amounts chosen.

Emergency Casualty Visits

Access to after-hours emergency casualty rooms at a hospital

For those emergencies when your network GP is not available, you can access the hospital casualty rooms to get treated. Weekend, after-work, whenever you need it most you still have access to private healthcare.

There is no hospital network but pre-authorisation is required.

3 levels of cover to choose from

  • Level 1
    • Up to R2,000 per member per year limited to an annual overall limit of R4,000 per policy
  • Level 2
    • Up to R4,000 per member per year limited to an annual overall limit of R8,000 per policy
  • Level 3
    • Up to R6,000 per member per year limited to an annual overall limit of R12,000 per policy

1 month waiting period applies

Permanent Disability

Cover for permanent disability as a result of an accident.

The benefit is purely optional. It builds on top of the Accident Hospitalisaiton benefit to provide additional cover for permanent disability and pays out the stated amounts less any medical costs incurred.

There is no hospital network and pre-authorisation is required.

There are 3 levels of cover to choose from

  • Level 1
    • Up to R200,000 per disability reason for the main member
  • Level 2
    • Up to R250,000 per disability reason for the main member
  • Level 3
    • Up to R250,000 per disability reason for the main member and spouse

Cover is immediately available for the main member. 6 month waiting period for the spouse (on level 3)

FAQ

Permanent Disability, for this benefit, means the permanent and total loss of or use of:

  • Speech
  • Hearing in both ears
  • Sight in one or both eyes
  • Loss of one or both eyes
  • Any limb by physical separation at or above the wrist or ankle

The disability must have been incurred as a result of an accident event.

The benefit is available once for any of the reasons above for any one accident, it is not an annual or renewable amount. However, separate accident events resulting in a new disability will enjoy the full stated benefit.You must submit your claim within 24 months of the accident.
Yes, authorisation is required to access this benefit. We still need to be informed of the accident within 48 hours of it occurring. Simply contact the Essential Med call center on 0861 911 011.

Episodic Health has one of the largest networks of doctors and dentists across South Africa.

Best of all, there is no hospital network. You can make use of any private or public hospital in the country.

What our customers say

“

Very satisfied. We have our 2 daughters on their insurance, and it has been blissful so far. Took my youngest to a network doctor without any hassles, and they paid for things our previous medical aid never covered or paid for! A HUGE Thumbs UP for you guys!

Chantal

”