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 as "Africa Assist". The hospital contacts the Essential Med call center on 0861 911 011 to get pre-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) and 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

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

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