Preloader

Our Claims Process

Pre-authorisation: 0861 911 011
Client Services: 0861 70 70 70

 
Day-to-Day
Network Provider
For network GPs, dentists, medication, radiology, pathology & 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 Essential Med
4. Settlement
Essential Med will pay the provider directly according to your benefits
Reimbursement
For non-network GPs and specialists.
1. Prior to treatment
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 [email protected]
4. Settlement
Essential Med will will reimburse you according to your benefits
Hospital
For accident, casualty, hospitalisation, maternity, dread disease and permanent disability claims.
1. Prior to admission
Present your membership number or card to the hospital. Your Essential Med 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 Essential Med
6. Settlement
Essential Med will pay the providers directly according to the acknowledged benefits

Hospital

For accident, casualty, hospitalisation, maternity, dread disease and permanent disability claims.

Day-to-Day

Network Provider

For network GPs, dentists, medication. radiology, pathology and optometry.

Day-to-Day

Reimbursement

For non-network GPs and specialists.