Benefits

Episodic Health offers medical insurance benefits, in addition to Accident & Emergency cover, that give you a more comprehensive suite of hospital benefits. Flexible and optional, you choose what you need at the level you want.

Illness Hospitalisation

Get access to private hospitals.

Planned procedures or illnesses may need hospitalisation so choose the benefits that offer stated amounts per admission day for up to 21 days in hospital.

There is no hospital network, the benefit is effective anywhere.

There are 3 levels of cover to choose from:

  • Level 1
    • Up to R6,500 for 1st day
    • Up to R4,500 for 2nd & 3rd days each
    • Up to R1,500 per day afterwards
  • Level 2
    • Up to R10,000 for 1st day
    • Up to R6,500 for 2nd day
    • Up to R5,000 for 3rd day
    • Up to R1,500 per day afterwards
  • Level 3
    • Level 2 benefits as well as cover for stated conditions:
      • Hernia: R20,000
      • Appendectomy: R35,000
      • Gallbladder/Kidney stones: R35,000
      • Miscarriage: R10,000
      • Hysterectomy: R45,000

3 month waiting period applies for admission day benefits. 12 month waiting period for level 3 stated conditions and 24 months for hysterectomy.

FAQ

Each level of cover offers stated amounts for the listed admission days. The benefit works on consecutive hospitalisation days up to a maximum of 21 days. For example, on level one, up to R1,500 is available per day from the 4th day for a maximum of 18 days. 3 days plus 18 days is 21 days.

You need to be admitted for a minimum of 24 consecutive hours for the benefit to come into effect.

On level 3, the stated conditions are covered regardless of the admission days. They are not in addition to the daily amounts.
The admission day benefits have a 3 month waiting period. The stated conditions in Level 3 are 12 months (24 months for hysterectomy).
Only procedures that are diagnosed and medically necessary are covered under this benefit. Elective surgery is not covered, nor is admission for the purposes of establishing a diagnosis.
Hospital costs incurred as a result of an accident event are claimed under the Accident Hospitalisation benefit, which is a required benefit to be eligible for choosing this benefit.
Yes, pre-authorisation is required to access this benefit. Simply contact the Essential Med call center on 0861 911 011.

Intensive Care Units

Higher cover for higher ICU costs.

ICU costs are higher than normal hospital admissions. The Illness Hospitalisation benefit alone might not be enough to cover a stay in high care. The ICU benefit provides additional cover for the extra costs incurred,

There is no hospital network and the benefit pays out for up to a maximum of 5 consecutive days in ICU.

This is an optional benefit with two levels of cover:

  • Level 1
    • Up to R12,500 per member per day
  • Level 2
    • Up to R20,000 per member per day

3 month waiting period applies.

FAQ

This benefit can be taken in addition to the Illness Hospitalisation benefit. ICU costs are claimed under the ICU benefit first and additional costs may then apply to the Illness Hospitalisation benefit.
ICU costs incurred as a result of an accident event are claimed under the Accident Hospitalisation benefit which is a required benefit to be eligible for choosing this benefit.
Yes, pre-authorisation is required to access this benefit. Simply contact the Essential Med call center on 0861 911 011.

Dread Disease Cover

Get cover for in and out of hospital expenses related to a critical illness.

Dread diseases, like heart attacks and cancer, are serious and require major treatment. The Illness Hospitalisation benefit alone will not be enough to cover these events. Choose the dread disease benefit to provide additional cover.

The benefit covers 8 specified conditions and pays according to SCIDEP staging. There is no hospital network applied.

This is an optional benefit with 3 levels of cover

  • Level 1
    • Up to R185,000
  • Level 2
    • Up to R250,000
  • Level 3
    • Up to R350,000

12 month waiting period applies.

FAQ

The stated amounts are available once per policy for any dread disease occurrence and can't be reinstated. This means that you can't claim twice for the same dread disease.
Dread disease treatment usually incurs a much higher cost than ordinary hospital admission. As a result, the Illness Hospitalisation benefit alone is probably not enough to cover these events. The Dread Disease benefit is available as an optional addition to your Illness Hospitalisation benefit to cover these additional costs.The benefit does not cover claims in addition to any other hospital benefits.

The list includes:

  • Heart attack
  • Chronic Coronary Heart Disease
  • Stroke
  • Cancer
  • Kidney Failure
  • Paraplegia
  • Blindness
  • Major organ transplant

The major organ transplants include:

  • Kidney
  • Heart
  • Lung
  • Liver
  • Pancreas
  • Bone marrow

The Standardised Critical Illness Definitions Project (SCIDEP) grid is used to indicate the ratio of the available benefit paid out according to the severity of the condition.

  • A (most severe): 100% of the available benefit
  • B: 75%
  • C: 50%
  • D (least severe): 25%
Yes, pre-authorisation is required to access this benefit. Simply contact the Essential Med call center on 0861 911 011.

Maternity Cover

Select hospital cover is available for your new arrival

Maternity is an optional benefit that offers a stated amount of R30,000 towards the hospital costs for your delivery, regardless of the delivery method. Natural delivery or C-Section are both covered.

The benefit requires hospitalisation to come into effect and can be claimed once every 12 months. It does not relate to the Illness Hospitalisation benefit in that you cannot claim under both benefits

There is no hospital network. Pre-authorisation is required.

12 month waiting period applies.

No waiting period for the newborn child.

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

Chantal