Claims

Pre-authorisation: 0861 911 011
Client Services: 0861 71 71 71
Email: claims@episodic.co.za

Hospital Claims

For accident, casualty, hospitalisation, maternity, dread disease and permanent disability claims

Prior to admission

Present your membership number or card to the hospital. Note that your Episodic policy may be known to the hospitals under the name "Africa Assist".

Pre-Authorisation

The hospital, or you, contacts the Essential Med call center on 0861 911 011 to get authorisation.

Acknowledgement

You may be asked to sign acknowledgement of the authorisation and cover provided under your benefits.

Admission

You will be treated at the hospital or casualty ward.

Claim Submission

The hospital will submit the claims to Essential Med (the administrator).

Settlement

The providers will be paid directly according to the acknowledged benefits

Day-to-Day Claims at a Network Provider

For network GPs, dentists, medication, radiology, pathology and optometry

Prior to treatment

Present your membership number or card to the provider

Get treatment or Medication

Claim Submission

The provider will submit the claim to Episodic Health or Essential Med

Settlement

The providers will be paid directly according to your benefits

Day-to-Day Claims Reimbursement

For non-network GPs and specialists

Prior to treatment

Present your membership number or card to the provider

Get treatment or Medication

Claim Submission

Submit your claim by filling in the claim form and attaching a detailed account as well as proof of payment to claims@episodic.co.za

Settlement

You will be reimbursed according to your benefits

Episodic Health (Pty) Ltd, is a Financial Services Provider (FSP 49319). Health product is provided and administered by Essential Med (Pty) Ltd (FSP 42980), the Underwriting Management Agent on behalf of the insurer African Unity Life (FSP 8447). Episodic Health and Essential Med are a health insurance provider, not a medical aid scheme.