brochure essential med nov 2016

Essential Med Version 1 2016. Dated November 2016.

...life uninterrupted

Brochure 2016 0861 70 70 70

www.essentialmed.co.za

Essential Med is a registered Financial Services Provider. FSP No: 42980.

AS YOU CHOOSE TO HEALTH INSURANCE

With our unique quoting engine you build your own plan – around your individual needs

Scheduled and emergency

doctors visits

Cover options for acute and chronic

medication

Visits to a network of specialists

Access to dentistry and optometry

benefits

Radiology and pathology cover

options

Illness and maternity cover

Accidents ICU Permanent disability

Dread disease

Hospital Cover Benefits Include:

Primary Health Cover Benefits Include:


Casualty

Please note this is a Health Insurance Product and not a Medical Aid.

SPECIALIST VISITS


Included As Standard Benefit Should your doctor require you to have blood tests or X-rays done, an extensive list of covered items is available. 30 day

waiting period applies.

RADIOLOGY & PATHOLOGY

ACUTE & CHRONIC MEDICATION

PRIMARY HEALTH COVER

Unlimited Acc To Formulary Including Over The Counter Meds.

Acute Medication: Formulary - an extensive list of acute medication is

available to you. The Essential Med Acute Medication

Formulary is applicable. 30 day waiting period applies to acute & 6 month waiting

period applies to chronic.

DENTISTRY Managed unlimited dentist consultations and procedures as per formulary, including cleaning, pain control, amalgam fillings and normal extractions. These services are obtained from an Essential Med network registered provider. 6 month waiting period applies.

Managed unlimited dentist consultations and procedures as per formulary, including cleaning, pain control, amalgam fillings and normal extractions. These services are obtained from an Essential Med network registered provider.

1 Root Canal Treatment to the value of R2000 per event per beneficiary within a 12 month period. 1 Crown per beneficiary to the value of R4500 per event within a 24 month period. Resin Fillings included. These services are obtained from an Essential Med network registered provider.

2 Root Canal Treatments to the value of R2000 per event per beneficiary within a 12 month period. 2 Crowns per beneficiary to the value of R4500 per event within a 24 month period. Resin Fillings included. These services are obtained from an Essential Med network registered provider. Includes a R2000 annual overall limit to be applied in event of shortfall.

Benefit Level 1 Benefit Level 2 Benefit Level 3

If your doctor requires you to be seen by a Specialist, an annual benefit amount is available to help cover these costs. 90 day waiting period applies.

R1500 Benefit Per Poli-cy Per Annum

R2000 Benefit Per Policy Per Annum

R1000 Benefit Per Policy Per Annum


UNLIMITED GP CONSULTATIONS When making use of one of our many GP Network Providers, you will have access to unlimited primary healthcare benefits. In the event of making use of a Non Network Provider, you will be reimbursed up to R250 for the consultation.

FUNERAL BENEFITS

VALUE ADDED BENEFITS - ESSENCE

OPTOMETRY Your Optometry benefit includes an eye test per beneficiary. 12 month waiting period applies.

Can be added to any combination plan. A Funeral Benefit will be paid out within 48 hours upon receipt of all required documentation. A 3 month waiting period is applicable to death due to natural causes. No waiting period in the event of death due to accident. Rules for dependents.

Be part of our Essence Reward Program and you'll get rewarded for all kinds of "good behaviour" like paying your premium on time, responsible use of benefits, introducing your friends and much more! Essence is super simple to understand and manage - no Ph.D. required!



Free single vision lenses and frames every 24 months.

Free single or bi-focal vision lenses and frames every 24 months.

Free single or bi-focal vision lenses and frames every 24 months. This option also includes contact lenses - 4 packages in a 24-month cycle to the value of R350.


Funeral Benefit of R10 000 Funeral Benefit of R20 000 Funeral Benefit of R30 000

HOSPITAL COVER

ACCIDENT HOSPITALISATION

ILLNESS HOSPITALISATION

Accidents happen and we understand that. No waiting periods are applicable to events that are related to accidents. Emergency Medical Services are automatically included. AOL = Annual Overall Limit.

No one plans to get ill and have to be admitted to hospital. In the event of you or your family members requiring admission, the below amounts are available for hospitalisation:

Included in Benefit Level 3: Stated Conditions amounts paid regardless of admission days, but not in addition to the Daily Illness Benefit. Certain procedures no longer require extended periods of admission, for this reason we have cover for specific events.

Hernia - R20 000

Appendectomy - R35 000

Gall / Kidney - R35 000

Miscarriage - R10 000 A 12 month waiting period is applicable to the stated condition benefits.

Hysterectomy - R45 000 A 24 month waiting period is applicable.



1st 24 hrs: Up to R6 500 Day 2: Up to R4 500 Day 3: Up to R4 500 Day 4 onwards: Up to R1 500. Maximum 21 days’ total admission. Subject to a 3 month waiting period.



This benefit is available in addition to Illness benefit. MATERNITY HOSPITALISATION In the event your Doctor advising that a C-Section is necessary in order to

deliver your baby, there is a R35 000 benefit available for this admission. Should you have a normal delivery, R25 000 is available for this event. Subject to a 12 month waiting period. 1 event per 12 months.

Please note this is a Health Insurance Product and not a Medical Aid.

Benefit Level 1

Benefit Level 2

Up to R250 000 per incident per family with an AOL of R500 000.



Up to R600 000 per incident per family with an AOL of R1 200 000.

Up to R1 000 000 per incident per family with an AOL of R2 000 000.

Benefit Level 3

Benefit Level 4

Benefit Level 5

DREAD DISEASE

PERMANENT DISABILITY

In the event of your Illness or accident requiring you to be admitted to ICU or High Care, a Daily Benefit amount will be available to cover these costs. 3 month waiting period if due to illness. Maximum 5 days allowed.

Heart Attacks, Coronary Heart Disease, Stroke, Cancer and Kidney Failure are a few of the conditions that are covered in this Benefit. 6 month waiting period applies.

Should an accident occur that results in permanent disability, for example a loss of a limb, a Permanent Disability Benefit amount will be paid out less costs already paid.

For those after hour emergencies that are never planned for and don’t require admission, we offer generous cover to help pay for costs at Casualty. 30 day waiting period if due to illness.

CASUALTY WARD BENEFIT

ICU CARE


Benefit Level 1 Benefit Level 2

ICU or High Care, a Daily Benefit amount of R12 500 will be available to cover these costs.

ICU or High Care, a Daily Benefit amount of R20 000 will be available to cover these costs.


R9 000 a day while admitted for a confirmed Dread Disease and up to the maximum benefit limit of R185 000 will be paid out according to the staging of the disease.




Up to R200 000 will be paid out less costs already paid. Main member only. No waiting periods applied.

Up to R250 000 will be paid out less costs already paid. Main member only. No waiting periods applied.

Up to R250 000 will be paid out less costs already paid. This applies to both main member and spouse. No waiting periods applied to princi-pal member - 6 months applied to spouse.


Up to R2000 in total per annum.



ESS MED MEDICAL COVER (Pty) Ltd Trading as Essential Med

Registration number: 2011/116999/07 Essential Med is a registered financial services provider. FSP 42980.

Hospital cover underwritten by African Unity Life. FSP 8447. Reg No: 2003/016142/06. Essential Group Building, Olive Grove Estate, Ou Paardevlei Road, Somerset West, 7130

PO Box 653, Somerset Mall, 7137, Tel: 0861 70 70 70, Fax: 0865 327 661, Email: [email protected],

Website: www.essentialmed.co.za

/essentialmed /essentialmedSA


brochure essential med nov 2016

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