Day-to-Day cover

Stay healthy by seeing a doctor as often as you need to with comprehensive cover for everyday out-of-hospital expenses.

GP Visits

Unlimited managed visits to a network doctor for you and your family.

Prevention is better than cure. We want you to be able to see a doctor as often as you need to. You and your family.

The benefit covers consultations, minor procedures and dispensed medication. Enjoy a nationwide network of doctors.

1 month waiting period applies.

FAQ

You may be reimbursed up to R250 to cover the consultation cost for visits to a doctor outside of our network. This can be claimed a maximum of 3 times a year per policy.
It means that pre-authorisation is required from your 5th consecutive consultation for individuals. For families on a policy, pre-authorisation is required from the 12th visit.‍ Managed visits simply allows us to try and ensure that you are getting the right level of care that you deserve and to provide clinical assistance should you need it.

Dentistry

Unlimited managed visits to a network dentist.

Keep your winning smile by seeing a dentist as often as you need to.

The benefit covers unlimited consultations, pain control, cleaning, fillings and extractions at a nationwide network of dentists.

There are 3 levels of cover for you to choose from:

  • Level 1
    • Pain control, normal extractions, amalgam fillings and cleaning
  • Level 2
    • Level 1 benefits plus:
    • Includes resin fillings
    • 1 root canal per member every 12 months to the value of R2000
    • 1 crown per member every 12 months to the value of R4500
  • Level 3
    • Level 2 benefits plus:
    • Extends cover to 2 root canals per member every 12 months to the value of R2000 each
    • 2 crowns per member every 24 months to the value of R4500 each
    • Annual R2000 per policy to cover any shortfalls

6 month waiting period applies.

Medication

Unlimited access to Acute and Chronic medication.

Anything on our extensive formulary is covered when you need it with no limits.

Chronic medication is available for 24 specified conditions, you only need to apply with the help of a network GP to access the benefit.

The benefit is accessed through pharmacies nationwide or a dispensing network doctor. There is also limited over-the-counter medication included to take the edge off thise low schedule drugs that you need to prevent illness, simply inquire at the pharmacy’s self-service counter.

1 month waiting period applies for acute medication. 6 month waiting period applies for chronic medication.

FAQ

Medication formularies are extensive, with tens of thousands of items so it is not practical to publish the lists. However, your network doctor does know what is covered and will advise you accordingly so that you can maximise the use of your benefits.

Pathology and Radiology

Unlimited access to basic blood tests and x-rays.

With unlimited GP visits as a benefit, we also offer unlimited basic blood tests and black & white single or double sided X-rays to make sure your doctor has the tools and information they need to treat you.

The basic blood tests cover all of the most commonly conducted tests required by a GP. A network doctor will know what is specifically excluded.

For pregnant women, your first 2 trimesters each have 1 ultrasound scan covered by the benefit.

There is no network limitation, you only need a referral from a network doctor to access the benefit.

1 month waiting period applies.

Optometry

See more for less with our flexible optometry cover for you and your family.

The benefit includes eye tests, glasses and frames and provided through Spec-Savers nationwide.

There are 3 levels of cover for you to choose from:

  • Level 1
    • Every member gets a free eye test as well as a frame with single vision lenses every 24 months.
  • Level 2
    • Extends level 1 to include bi-focal lenses
  • Level 3
    • Extends level 2 with the option of 4 packages of contact lenses to the value of R350 per package every 24 months. A package should last 6 months.

12 month waiting period applies.

Specialists

When your GP needs to refer you to a specialist, medical cover is available to help cover the costs.

There is no specialist network, you simply need to be referred from a network doctor to be able to see any practicing physician.

There are 3 levels to choose from

  • Level 1
    • R1000 per policy per year
  • Level 2
    • R1500 per policy per year
  • Level 3
    • R2000 per policy per year

3 month waiting period applies

Why not explore our product online and build your own quote?

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

Medication is available from a pharmacy by prescription or dispensed from your network doctor. Optometry benefits available through any Spec-Savers.

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 the paid for things our previous medical aid never covered or paid for! A HUGE Thumbs UP for you guys!

Chantal