Our Claims Process
Hospital
For accident, casualty, hospitalisation, maternity, dread disease and permanent
disability claims.
1. Prior to admissiont
Present your membership number or card to the hospital. Your EssentialMED policy may be
known to the hospitals under the name Africa Assist
2. Pre-Authorisation
The hospital, or you, phones 0861 911
011 to get authorisation.
3. Acknowledgement
You may be asked to sign acknowledgement of the authorisation and cover provided under your
benefits
4. Admission
You will be treated at the hospital or casualty ward
5. Claim Submission
The hospital will submit the claims to EssentialMED
6. Settlement
EssentialMED will pay the providers directly according to the acknowledged benefits
Day-to-Day
Network Provider
For network GPs, dentists, medication. radiology, pathology and optometry.
1. Prior to treatment
Present your membership number or card to the provider
2. Get treatment or medication
3. Claim submission
The provider will submit the claim to EssentialMED
4. Settlement
4. Settlement
Day-to-Day
Reimbursement
For non-network GPs and specialists.
1. Prior to admissiont
Present your membership number or card to the provider
2. Get treatment or medication
3. Claim submission
Submit your claim by filling in the
claim form and attaching a detailed
account
as well as proof of payment. Send to claims@essentialmed.co.za
4. Settlement
EssentialMED will reimburse you according to your benefits