Hospital Cover

Accidents happen and even the healthiest can become victim to disease and illness. These and other eventualities are taken care of with Essential Med’s hospital cover. All that is needed for hospital pre-authorisation and the payment of a stated benefit to cover in-hospital expenses irrespective of procedure, consultation or service is your Essential Med card and policy number.

Cover includes:

• Illness hospitalisation: the policy will pay a daily contribution per illness, per person per overnight stay in hospital, up to 21 days per illness event. An insured client may have many illness events in a year, however, benefits are only payable if the insured client is hospitalised. Please note that if the hospital/procedure costs exceed these limits, the insured client is responsible for paying the difference. No benefit is payable should a person be hospitalised for less than 24 hours.
• Dread disease hospitalisation: the policy pays a lump sum in daily instalments of R9 000 (upon diagnosis), up to R250 000 depending on the policy option. It covers heart attacks, coronary heart disease, cancer, strokes, brain tumours, kidney failure, organ transplants, paraplegia and blindness.
• Maternity hospitalisation: will pay a daily contribution based on the number of days spent in hospital for the delivery – irrespective of the procedures performed.
• Accident hospitalisation: the policy pays in-hospital medical expenses of from R75 000 up to R400 000 per incident depending on the policy option. An insured person may have multiple accident events in a single year – for each event, the policy will pay out up to the stated sum of money specified in the policy document (subject to an excess of R500 per event). For accident expenses, the policy pays out in units of R200 for every R190 of medical expenses incurred by the insured person. This means that the policy will always pay out slightly more than the actual expense, provided the expense does not exceed the accident limit stated in the policy. This benefit is available immediately (i.e. on inception of your policy).
• Emergency and casualty visits.
• Permanent disability benefit: A stated benefit of up to R250 000 is payable in respect of the permanent disability of the principal client and or spouse or partner depending on the policy option.
• Death benefit:  is payable to the named beneficiary/s following the death of the principal insured client.
• HIV / Aids benefit: each client covered under the policy will receive assistance in the event of accidental exposure to HIV/Aids. The incident resulting in possible exposure to HIV must be reported to our helpline within 72 hours. An insured client can use this benefit twice a year, subject to a maximum of two visits per family, per year.

View our policy options now. For hospital pre-authorisation call 0102 053 080 Essential Med facilitates admission to most private hospitals and government hospitals. Terms & conditions apply

Important Facts

• Please note that this is not a Medical Scheme; this is a Stated Benefit Insurance Hospital Plan.
• You and your spouse / partner must be younger than 55 years of age when you join.
• If you have a medical insurance policy and/or medical aid with another financial service provider, and that policy/scheme covers you and your family (i.e. the insured person/s) for the defined events that give rise to a medical expense claim under this policy, that this policy shall be liable to make good only the difference of the amount payable by you/to you/on your behalf in respect of such an insured event.The daily in-hospital benefit will be limited to actual medical expenses up to the maximum of the daily in-hospital benefit. The actual medical expenses to be applied will be those not paid by any other insurer and or medical aid scheme.
•  You may choose to use most private or state-run hospitals.
• The accident benefits are subject to an excess of R500 for each claim.
• The illness and dread disease benefits are subject to a 90-day waiting period.
• You will enjoy cover while you pay your monthly premium, or until you reach 65 years of age.
• All stated benefits are paid to the insured member.
• For further details please refer to your policy wording.
• A 12-month exclusion period is applicable in respect of pregnancy i.e. a person has to be on the plan for 12 consecutive months before benefits become applicable in respect of childbirth.
•  Exclusions and waiting periods may apply for known pre-existing conditions.
• This product is powered by Day1Health Pty Ltd and the benefits are underwritten by Sanlam Developing Markets.

Call us now to discuss the best policy option for you and your family: 0860 900 900 or apply online.