Day to day Benefits
Essential Med’s Day to Day Benefits option provides out-of-hospital benefits for routine medical needs. Clients have access to a national network of medical practitioners through CareCross Health, a leader in the primary healthcare market. CareCross represents more than 3 000 medical professionals in South Africa (you may find your current GP is already registered with CareCross). No cash payment is required when visiting a CareCross practitioner, and your policy ensures access to:
GP Visits
You benefit from unlimited visits to a chosen doctor (GPs only) in your area as often as you require - medication is included. No cash payment is required. Your doctor will provide consultations and prescribe medication according to the list of specified generic medications on the CareCross medicine formulary.
After-Hours Emergency Providers
Should you find yourself needing care while away from your normal area of residence (away from home), you are entitled to three (3) out-of-centre visits per year – provided you use another listed CareCross provider. Clients are also entitled to up to three (3) out-of-network visits per year. Simply send us a copy of your payment receipt and we will be reimburse you R180 per consultation.
Acute Medication Benefit
Our unique Acute Medication Benefit structure covers the cost of all acute medication linked to the network doctor consultation. Acute medication is subject to medication formulary and is usually dispensed by CareCross network GPs. If the GP is a scripting doctor, medication may be obtained from a network pharmacy (Dischem, Clicks or Medi-kredit pharmacy).
The CareCross Acute Medicine Formulary is a list of medicines covered by CareCross (if prescribed by your CareCross doctor).
The Acute Medication Benefit gives you value for money, choice and convenience.
Chronic Conditions and Medication Benefit
Chronic conditions are those serious ailments that require ongoing intervention and care. Our unique Chronic Benefit structure includes all chronic medication linked to your doctor consultation.
Chronic medication is subject to medication formulary. The CareCross Chronic Medicines Formulary is a list of medicines which are fully covered (if prescribed by your CareCross doctor) for conditions named on the Chronic Condition List.
Chronic medication is subject to registration and approval. No over the counter medication benefit is available. Medication will be couriered to the nominated address. To make sure everything flows smoothly, we need to approve your application before covering your condition under the Chronic Illness Benefit. To apply, get your application form on the link below. Complete it with your doctor and return it to us.
View Chronic Conditions Covered 2011
Maternity Benefit
The Maternity Benefit includes prenatal care - which covers all GP visits. Pathology blood tests for Monoclonal Immunological, Down Syndrome screening (second trimester) and Alpha-feto Protein are also included. The plan also makes provision for two growth sonars (with network providers) during each pregnancy.
Our Postnatal Benefit is not specifically defined, but is instead included in the GP’s general scope of services, with blood tests subject to the pathology and radiology lists (for example, Pap smears are included as part of postnatal and general benefits) – giving you flexibility and choice in making your own healthcare decisions.
Dentistry Benefit
The Dentistry Benefit offers access to basic dentistry and includes cover for consultations, cleaning, pain control, fillings and extractions. These services are obtained at a CareCross Health-contracted dentist.
View Dentist Network Providers
Optometry Benefit
The Optometry Benefit includes spectacle frames, lenses, contact lenses and eye examinations at 100% of the agreed tariff. The Optometry Benefit is available at any CareCross-contracted optometrists: one benefit per each named beneficiary every two years. To ensure ongoing value and reduced costs in your healthcare plan, there is a limit in place of one eye test per beneficiary every 24 months, as well as a prescription of white standard mono- or bifocal lenses, with a basic frame.
View Optician Network Providers
Radiology Benefit
The Radiology Benefit is unlimited, according to a list of approved codes. It covers all black-and-white x-rays linked to your doctor visit (as referred by the CareCross provider) from the radiology formulary.
Pathology Benefit
The Pathology Benefit is unlimited according to a list of approved codes. These tests may only be requested from the Pathology Formulary by your Network GP.
Other Important Facts
- Please note: this is not a Medical Scheme; it is a pre-paid Preventative Health Care Service.
- Persons already on a Medical Aid Scheme with access to a savings plan or day-to-day benefits may not also have access to this benefit and may only apply for our Hospital Insurance Plan.
- Benefits are effective 30 days after inception of your policy.
- Optometry Benefits are available 12 months after your policy inception date.
