FAQ

Will my baby be covered from birth?

Your newborn baby will be covered from birth if you have been on the Policy for more than 12 months. If you have been on the Policy for less than 12 months, the relevant waiting periods will apply.

May I go to any hospital if I need medical treatment and must be admitted?

Yes, you may go to any hospital, private or state. The Daily Illness Benefit or Specific Stated conditions will be paid to you and any costs associated with an Accident up to the maximum benefit amount, will be available to cover the medical costs incurred.

What is a pre-existing condition?

If you are currently or in the last 12 months have received treatment for a condition, it will be considered as a pre-existing condition and the relevant waiting periods may be applied.

What is the waiting period applicable to Maternity benefits?

There is a 12-month waiting period before you may access the Maternity Benefits.

How do I obtain pre-authorization for a hospital admission?

Should you require admission to hospital, contact 0861 70 70 70 and we will assist you in obtaining a Guarantee for Admission.

What happens if I am ill and admitted to hospital for less than 24 hours?

All admissions must be pre authorized by our 24/7 call center. If the necessary criteria for admission is met, a Guarantee of Payment will be issued to the admitting facility.

Do I need a to be on a Medical Aid to qualify for Essential Med cover?

No, your Essential Med policy does not require you to be on a medical aid. We offer a low cost benefit option specially designed for those who cannot afford medical aid.

In the event of an accident, will I have to pay the hospital and then claim back from Essential Med?

Not at all. With your permission we will issue a guarantee of payment to the hospital you are admitted to. You will receive treatment and services from the hospital and medical specialists to a maximum amount of the cover you selected.