55 Plus Medical cover

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Essential Med has an option for over 55′s! We offer day to day benefits only as well as the Essential Assist services.

 

Day-to-day benefits

  • Unlimited GP visits: you may visit your chosen network-registered doctor (GP only) as many times as you need to. Your doctor will provide healthcare services and prescribe medication according to the list of specified generic medications on the Care Cross medicine formulary. No cash payment is required and medication and small procedures are included.
  • Partial cover for after-hour or out-of-network emergency consultations: should you need to visit a doctor (GP only) after hours or while away from your normal area of residency, you are entitled to three out-of-network GP visits per year with an annual limit of R1000 per family. You will need to pay for the treatment and services rendered and then claim the money back from Essential Med.
  • Unlimited prescribed and acute medication:all acute medication linked to the network-registered GP consultation is covered. No over the counter benefit is available. Acute medication is subject to the acute medication formulary and is usually dispensed by Care Cross network GPs. If the GP is a scripting doctor, medication may be obtained from a network pharmacy (Dischem, Clicks or Medi-Kredit pharmacy)
  • Unlimited chronic medication upon successful registration and approval: our unique chronic benefit structure includes all chronic medication liked to your network-registered GP consultation subject to the medication formulary. The Care Cross chronic medicines formulary is a list of medicines which are fully covered (if prescribed by your Care Cross doctor) for conditions on the chronic conditions list. No over the counter medication benefit is available.  Chronic medication is subject to registration and approval. If approved your medication will be couriered to the nominated address.
  • Basic dentistry, including dentist consultations and procedures (network-registered): includes healthcare cover for consultations, cleaning, pain control, fillings and extractions. These services must be obtained from a network-registered dentist.
  • Eye test per beneficiary and free lenses, contact lenses and frames every 24 months: Services must be obtained from a network-registered optometrist. There is a limit in place on prescriptions of white standard mono- or bifocal- lenses with basic frame.
  • Unlimited referred black & white X-rays and blood tests: these benefits are unlmited when referred by a network-registered GP according to a list of approved codes from the radiology and pathology formulary.

Essential Assist

Health care assistance, advice and much more

Minimise the impact of every day challenges, be they health, home, legal, auto, travel or funeral related. Essential Assist offers quick and easy access to telephonic life and healthcare advice and assistance that will keep your life uninterrupted.

Emergency Medical Evacuation:

A single call from you (or a 3rd party) to our emergency number – 0861 911 011 – results in immediate action:

  • Emergency vehicles dispatched immediately (cost covered)
  • Telephonic advice to the primary accident scene attendant to assist in stabilising the patient
  • Informing your next-of-kin about your accident

Health assist:

Personal healthcare advice and assistance from experienced professionals just a call away.

  • Emergency medical advice,
  • Symptom assessment,
  • General health information,
  • Counselling on HIV/Aids, cancer, addiction, stress & trauma.

Home assist:

This helpline offers assistance with household emergency repairs, anywhere in South Africa. It covers the callout and 1 hrs labour for 3 incidents per annum, limited to R500 per incident.

  • Electrical,
  • Plumbing,
  • Locksmith,
  • Glazier,
  • Domestic appliances.

Legal assist:

Just call to get guidance and advice on legal matters from qualified and experienced attorneys.

  • General legal advice,
  • Labour law advice,
  • Motor accident advice,
  • Road accident fund advice,
  • Attorney referral service,
  • Std legal documentation.

Auto assist:

In the event of a roadside emergency within South Africa, call this helpline for access to appropriate services.

  • Cost of towing (to an approved dealer),
  • Flat tyre (tyre change),
  • Running out of fuel (10L of fuel supplied)
  • Keys locked in car (locksmith)

In addition the following benefits apply in the case of a breakdown 100km or more from home:

  • Accommodation for 1 night (maximum R500 per night) or rental of a class B vehicle (Maximum R500 per day) for 1 day,
  • Cost of transport back to holiday or permanent residence in the event of theft or hi-jacking (maximum R500 per incident).

Travel assist:

Just call or visit www.travel.co.za for info, availability and costs of national and international accommodation, transport and special packages. Call and get directions when travelling anywhere in South Africa. Directions are given telephonically, via email or fax.

Funeral assist:

For assistance with the facilitation of a burial:

  • Advising and referral to a reputable undertaker,
  • Help with funeral arrangements,
  • Advice on death certificate and legal documentation,
  • Counselling of the bereaved.

AVAILABLE 24/7 on 0861 911 011

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