Overall, the EssentialMED Accident and Emergency Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and affordable cover for accidental injuries to up to 3 Family Members. The EssentialMED Accident and Emergency Plans start from R185.50 ZAR. EssentialMED has a trust rating of 4.2.
| 🔎 Medical Health Plan | 🥇 EssentialMED Accident and Emergency |
| 👤 Main Member Contribution | R185.50 |
| 👥 Adult Dependent Contribution | R220.50 single +1 (Family) |
| 👶 Child Dependent Contribution | – |
| 😷 Screening and Prevention | None |
| 🍼 Maternity Benefits | None |
| 🌎 International Cover | None |
| 🔁 Gap Cover | None |
| 💙 Medical Savings Account | None |
| ➡️ Pre- and Postnatal Care | None |
The EssentialMED Accident and Emergency Plan is one of three, starting from R185.50. It is a good option for individuals seeking affordable cover for accidental injuries and emergencies.
Gap Cover is not available on the EssentialMED Accident and Emergency Plan. However, EssentialMED offers 24/7 medical emergency assistance. According to the Trust Index, EssentialMED has a trust rating of 4.2.
EssentialMED Health Insurance has the following plans to choose from:
✅ EssentialMED Accident and Emergency Plan
✅ EssentialMED Day-to-Day Plan
✅ EssentialMED Hospital Plan
| 🔍 Family Dynamic | 💶 Average Monthly Premium |
| 👤 Single Members/Individuals | R185.50 |
| 👥 Families (single +1 Family) | R220.50 |
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| 🅰️ Emergency Casualty Visits Cover | There is no hospital network, allowing members to visit any hospital in South Africa. After-hour access is available for emergencies. There are three levels of cover to choose from, including the following: Level 1 – cover is limited to R2,205 per member yearly, with an overall limit of R4,410 per policy. Level 2 – cover is limited to R4,410 per member yearly, with an overall limit of R8,810 per policy. Level 3 – cover is limited to R6,610 per member yearly, with an overall limit of R13,220 per policy. |
| 🅱️ Accident Hospitalisation Cover | There is no hospital network, allowing members to visit any hospital in South Africa. Access to 24/7 emergency services. The cover is available immediately, with no waiting period. There are three levels of cover to choose from, including the following: Level 1 – Single policies are limited to R82,680 per event with an annual limit of R165,360. Family policies are limited to R165,360 per event with an OAL of R330,720.R15 900 limit per member per annum for emergency room treatment only due to an accident and not admitted to hospital. Level 2 – Single policies are limited to R137,800 per event with an annual limit of R275,600. Family policies are limited to R275,600 per event with an OAL of R551,200.R15 900 limit per member per annum for emergency room treatment only due to an accident and not admitted to hospital. Level 3 – Single policies are limited to R220,480 per event with an annual limit of R440,960. Family policies are limited to R440,960 per event with an Annual Overall Limit of R832,000.R15 900 limit per member per annum for emergency room treatment only due to an accident and not admitted to hospital. |
Health insurance typically excludes certain medical expenses and treatments from coverage. Here are some common exclusions that you may find in your EssentialMED Accident and Emergency insurance policy:
Some health insurance policies may exclude coverage for medical treatments received outside South Africa.
Waiting periods with EssentialMED depend on the benefit and are as follows:
A detailed list of exclusions and waiting periods can be requested from EssentialMED customer support.
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| 🔎 Medical Health Plan | 🥇 EssentialMED Accident and Emergency | 🥈 Dis-Chem Health Accident Cover | 🥉 Oneplan Health Blue |
| 🌎 International Cover | None | None | None |
| 👤 Main Member Contribution | R185.50 | R145 | R1,080 |
| 👥 Family Contribution | R220.50 single +1 (Family) | R169 | R2,140 for a couple |
| 👶 Child Dependent Contribution | – | R99 | R1,755 (Single adult + 1 Child) – R2,775 (Couple + 1 child) |
| 🔁 Gap Cover | None | ✅ Separate plan – Dischem Gap Cover | None |
| 😷 Screening and Prevention | None | ✅ Yes | None |
| 💙 Medical Savings Account | None | None | None |
| 🍼 Maternity Benefits | None | None | ✅ Yes |
| ➡️ Pre- and Postnatal Care | None | None | ✅ Yes |
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The EssentialMED Accident and Emergency Plan is a health cover product that provides benefits for accidental injuries and emergencies.
The plan covers various expenses, including emergency medical treatment, hospitalization, and certain procedures. Some of the plan’s features include no overall limit on benefits, a guaranteed acceptance policy, and a 24-hour emergency helpline.
However, some drawbacks of the plan include a waiting period of three months for all benefits except for accidental injuries, which are covered immediately, and the plan does not cover any pre-existing medical conditions.
The EssentialMED Accident and Emergency plan covers emergency medical services, hospitalization, and related expenses resulting from an accident.
The cost of the EssentialMED Accident and Emergency plan depends on whether you are a single member or part of a family. Accident and Emergency is an add-on that starts from R185.50 for single members.
Yes, you can enroll in the EssentialMED Accident and Emergency plan anytime.
Yes, the EssentialMED Accident and Emergency plan has a network of providers you can visit for covered services.
Out-of-pocket expenses with the EssentialMED Accident and Emergency plan may include your deductible, copayments, and coinsurance for covered services.
The EssentialMED Accident and Emergency plan does not cover pre-existing conditions. However, it does cover emergency medical services related to a pre-existing condition.
Exclusions with the EssentialMED Accident and Emergency plan may include expenses related to non-emergency services, pre-existing conditions, and certain medical procedures.
Customer service options with the EssentialMED Accident and Emergency plan may include phone support, email support, and online chat.
You must provide proof of your accident and medical expenses to file a claim with the EssentialMED Accident and Emergency plan. Contact our customer service team for assistance with filing a claim.
Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.
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