You are required to select a CareCross GP from the CareCross provider network list (obtainable on the Essential Med website, under “Medical Practitioner Network”). Alternatively, call us on 0861 632 123 to find out where your nearest CareCross doctor is located. The CareCross network is countrywide – and yes, the amount of consultation visits/GP procedures you are allowed is unlimited.
FAQ's
Can I go to any doctor I choose, and is the amount of visits unlimited?
When I see a CareCross GP/dentist, do I have to pay cash for the consultation?
No. By paying your premium in advance each month, you have already paid for your consultation.
What happens if I become ill while out of town?
Your Pre-Paid Preventative Healthcare Plan caters for three (3) out-of-area visits per year, provided they are within South Africa. This means you may go to a GP of your choice, provided that you pay for the consultation and reclaim the amount from us afterwards. Simply send us a copy of your consultation receipt and you will be reimbursed.
What happens if I don't get on with the CareCross doctor I have chosen? Can I select another doctor?
If you wish to switch doctors you may do so, but try not to do this more than once per year.
What happens if there isn't a CareCross doctor in my area? Can I nominate my own GP?
You may nominate a doctor of your choice, provided that you email the proposed doctor details (name, address, practice number and contact numbers) to info@essentialmed.co.za. You will then be notified of the outcome of your application. Please bear in mind that the process could take a few weeks.
Are specialist visits covered?
No, specialist visits are not covered. If a GP or dentist refers you to a specialist, you are responsible for settling the account.
Can I buy my medication over the counter?
No, your CareCross GP or dentist has to prescribe medication from the CareCross medication formulary. However, should your Care Cross doctor be a non-dispensing practitioner (a doctor who writes out scripts), only in these circumstances may you take a script to a Dischem or Clicks pharmacy – provided that the pharmacy is linked to the Medi-Kredit system. Most Pharmacies are linked to the Medi-Kredit system.
How do I know if the cost of my medication is covered?
Visit the “Formularies” section. Click on the “Acute” or “Chronic” sections.
Do I have to select a dentist from the CareCross list?
Yes, you are required to select a dentist from the CareCross network list. However, unlike visiting a GP, you can see a different dentist each time (although this practice is not advised). Please remember that only basic dentistry is covered i.e. preventative treatment (cleaning), pain control, fillings and normal extractions in the chair only.
How long do I have to wait before I can use these services?
Normally you have to wait one month before you can use the Pre-Paid Preventative Health Service. The Value-add benefits are available after 30 days from date of policy inception. If in doubt, please contact us on 0861 632 123.
Can I see a GP if I am outside South Africa?
No. You are only covered in South Africa.
Is physiotherapy covered under the Pre-Paid Preventative Service?
No. Physiotherapy is not covered. It will only be covered under the Hospital Plan following a hospital admission due to an accident.
Is psychology covered under the Pre-Paid Preventative Service?
No. Psychology is not covered.
Does medical insurance offer any tax benefits?
Unfortunately medical insurance offers no tax benefits for policyholders.
Hospital Plan
Do I have to go only to CareCross hospitals?
Carecross is a Private Practitioner Network, not a hospital group. With the Hospital Plan you can go to most hospitals. The Stated Benefits will be paid to you, and you will be responsible for settling your full account with the relevant hospital.
Will I still be covered if I am admitted to hospital following an accident, but am required to be in hospital for a few hours only?
Yes. For accident events there is no time restriction. Your benefits will apply, even if you are admitted for one (1) hour.
What happens if I am ill and am admitted to hospital for less than 24 hours?
Your Hospital Plan Illness Benefit will only pay out after 24 hours. The Top Up Illness Benefits of R6 500 and R4 500 will only apply once you have been on the Plan for longer than 90 days.
What happens if I become ill or have an accident outside South Africa?
You are only covered in South Africa. However if you have an accident or fall ill in one of the immediate neighbouring countries (being Swaziland, Lesotho, Botswana, Namibia, Mozambique or Zimbabwe) you will have to travel to the nearest South African border post and request assistance from ER24 (if critical).
How do I get admitted to hospital?
You call the 24hr Pre-Authorisation Number (0861-144-144) displayed on your Membership Card. Quote your policy number and/or the reason for your admission (in all likelihood you will have a doctor’s note, which you can relay to the authorisation clerk).
Should you be unconscious and have a paramedic come to your assistance, they will know what to do, provided you have your hospital card or MDB identification bracelet on your person. If you have a motor vehicle, remember to put your MDB and ER24 sticker on your windscreen.
How do I claim my hospital benefits?
Following your discharge from hospital (i.e. after your pre-authorised admission), you can either download a claim form from this website or you can call us on 0861 632 123 and request that a claim form be faxed or e-mailed to you.
Once the claim form is completed, please fax it to:0865 327 661
or post it to:PO Box 1058
Cape Gate
7562
