What are prescribed minimum benefits (PMBs), and how do they relate to EssentialMED Day-to-Day Plan?

Prescribed minimum benefits (PMBs) are defined benefits that all medical aid schemes and health cover products must cover by law. For example, EssentialMED Day-to-Day Plan covers PMBs, including certain chronic conditions, emergency medical treatment, and procedures.

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EssentialMED Day-to-Day Plan ( 🇿🇦2025)

Overall, the EssentialMED Day-to-Day Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and Prescribed Minimum Benefits to up to 3 Family Members. The Medihelp MedAdd Medical Aid Plan starts from R445.50 ZAR. EssentialMED has a trust rating of 4.2.

🔎 Medical Plan	🥇 EssentialMED Day-to-Day
🌎 International Cover	None
👤 Main Member Contribution	R445.50
👥 Adult Dependent Contribution	R445.50
👶 Child Dependent Contribution	R223.50
🔁 Gap Cover	None
💵 Prescribed Minimum Benefits (PMB)	✅ Yes
😷 Screening and Prevention	✅ Yes
💙 Medical Savings Account	None
🍼 Maternity Benefits	✅ Yes

EssentialMED Day-to-Day Plan – 7 Key Point Quick Overview

✅ EssentialMED Day-to-Day Plan Overview
✅ EssentialMED Day-to-Day Plan Premiums 2025
✅ EssentialMED Day-to-Day Plan Benefits and Cover Comprehensive Breakdown
✅ EssentialMED Day-to-Day Plan Exclusions and Waiting Periods
✅ EssentialMED Day-to-Day Plan vs Other Providers or Medical Aid Schemes
✅ Our Verdict on the EssentialMED Day-to-Day Plan
✅ EssentialMED Day-to-Day Plan Frequently Asked Questions

EssentialMED Day-to-Day Plan Overview

The EssentialMED Day-to-Day Plan is one of 3, starting from R445,50. It includes cover for GP Visits, In-Room Procedures, HIV, Pathology, Radiology, Dentistry, Optometry, and more. EssentialMED Day-to-Day is a good choice for individuals or families who want affordable coverage for routine medical expenses.

Gap Cover is not available on the EssentialMED Day-to-Day 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

EssentialMED Day-to-Day Plan Premiums 2025

🅰️ Family Dynamic	🅱️ Average Monthly Premium 2025
👤 Single Members/Individuals	R445,50
👥 Families	R669,00

💙Consider adding GAP cover? Read more about the 5 Best Gap Cover Options for Under R300

EssentialMED Day-to-Day Plan Benefits and Cover Comprehensive Breakdown

🟥 GP Visits	Unlimited managed visits to an EssentialMED network doctor. Includes consultation costs, minor procedures, and medication. If the doctor you visit is not part of the EssentialMED network, you may be reimbursed up to R450 per consultation, up to three times per policy per year. Managed visits only require authorization after the fifth consecutive consultation for individuals or the twelfth for families per year.
🟧 Acute and Chronic Medication	Unlimited access to acute medication. EssentialMED covers 24 specified chronic conditions. There is a limited Over-the-Counter medicine benefit available. The benefit is available through a network of pharmacists or a dispensing network doctor. Medication is available according to the comprehensive formulary. Chronic patients need only apply for the chronic benefit with the assistance of their network physician.
🟨 Dentistry	Unlimited consultations, pain control, cleaning, fillings, and extractions from a nationwide network of dentists. Three levels of cover to choose from as follows: Level 1 – Pain control, normal extractions, amalgam fillings, and cleaning. Level 2 – Pain control, normal extractions, resin fillings, and cleaning. Limited to 1 root canal per member every 12 months to a maximum of R2,200. Limited to 1 crown per member every 2 years up to R4,950. Level 3 – Pain control, normal extractions, resin fillings, and cleaning. Limited to 2 root canals per member every 12 months to a maximum of R2,200. Limited to 2 crowns per member every 2 years up to R4,950. Dentures up to R2,000 per policy yearly.
🟩 Pathology and Radiology	Unlimited black and white, single, or double-sided X-Rays from a radiologist. Unlimited basic pathology. No network specialist is needed, but members need a referral. Pregnant members get one ultrasound for the first trimester. Protocols and formularies apply to pathology and radiology.
🟦 Optometry	Includes eye tests, glasses, and frames. Members can go anywhere in the country but must use Spec-Savers. There are three levels of cover to choose from, including: Level 1 – Free eye exam and single-vision lenses and frames per member every 2 years. Level 2 – Free eye exam and single-vision or bifocal lenses and frames per member every 2 years. Level 3 – Free eye test and single-vision or bifocal lenses and frames per member every 2 years. Alternatively, the member can choose 4 packs of contact lenses valued at R370 every 2 years.
🟪 Specialist Cover	Members can see any practicing physician. There are three levels of cover to choose from, including: Level 1 – Limited to R1,100 per policy yearly. Level 2 – Limited to R1,650 per policy yearly. Level 3 – Limited to R2,200 per policy yearly.

💙Discover the 5 Best Hospital Plans for Pensioners and Receivers of SASSA

EssentialMED Day-to-Day Plan Exclusions and Waiting Periods

EssentialMED Day-to-Day Plan Exclusions

💙Health insurance typically excludes certain medical expenses and treatments from coverage. Here are some common exclusions that you may find in your EssentialMED day-to-day insurance policy:

✅ Cosmetic treatments: Health insurance usually does not cover cosmetic procedures like plastic surgery or non-essential cosmetic treatments.
✅ Alternative therapies: Some health insurance policies may not cover alternative therapies, such as acupuncture, herbal remedies, or massage therapy.
✅ Pre-existing conditions: Some health insurance policies may exclude coverage for pre-existing conditions or have a waiting period before coverage for pre-existing conditions kicks in.
✅ Experimental treatments: Health insurance may not cover experimental treatments that have not been proven effective or approved by regulatory authorities.
✅ Self-inflicted injuries: Health insurance may not cover injuries or illnesses that are self-inflicted or a result of illegal activities.
✅ Intentional harm: Health insurance may not cover injuries or illnesses resulting from intentional harm or injury inflicted by the policyholder.

Some health insurance policies may exclude coverage for medical treatments received outside South Africa.

EssentialMED Day-to-Day Plan Waiting Periods

✅ Acute Medication – 1 month
✅ GP Visits – 1 month
✅ Pathology and Radiology – 1 month
✅ Specialists – 3 months
✅ Chronic Medication – 6 months
✅ Dentistry – 6 months
✅ Optometry – 12 months

Waiting periods with EssentialMED depend on the benefit.

EssentialMED Day-to-Day Plan vs Other Providers or Medical Aid Schemes

🔎 Medical Plan	🥇 EssentialMED Day-to-Day	🥈 Dis-Chem Health MyHealth Core	🥉 Oneplan Health Core
🌎 International Cover	None	None	None
👤 Main Member Contribution	R445.50	R509	R500
👥 Adult Dependent Contribution	R445.50	R509	R1000 (Couple)
👶 Child Dependent Contribution	R223.50	R357	R875 (Single Insured + 1 Child) R1,350 (Couple + 1 Child)
🔁 Gap Cover	None	None	None
💵 Prescribed Minimum Benefits (PMB)	✅ Yes	✅ Yes	✅ Yes
😷 Screening and Prevention	✅ Yes	✅ Yes	None
💙 Medical Savings Account	None	None	None
🍼 Maternity Benefits	✅ Yes	✅ Yes	✅ Yes

💙POLL: 5 Best Medical Aids under R500

Our Verdict on the EssentialMED Day-to-Day Plan

EssentialMED Day-to-Day is a health insurance plan that covers day-to-day medical expenses, such as doctor consultations, prescription medication, pathology and radiology tests, and basic dentistry. Some of the features of this plan include low premiums, no co-payments, and a choice of deductibles.

However, there are also some drawbacks, such as waiting periods for certain benefits, exclusions for pre-existing conditions, and limited cover for hospitalization and major medical expenses.

💙You might also like: EssentialMED Accident and Emergency Plan
💙You might also like: EssentialMED Hospital Plan
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EssentialMED Day-to-Day Plan Frequently Asked Questions

What is the EssentialMED Day-to-Day Plan?

EssentialMED Day-to-Day Plan is a health cover product that benefits out-of-hospital medical expenses such as doctor consultations, specialist visits, and chronic medication.

What are the benefits of the EssentialMED Day-to-Day Plan?

EssentialMED Day-to-Day Plan covers a range of medical expenses not covered by medical aid schemes, including consultations with doctors and specialists, chronic medication, and some procedures.

What medical expenses are covered by the EssentialMED Day-to-Day Plan?

EssentialMED Day-to-Day Plan covers a range of out-of-hospital medical expenses, including doctor consultations, specialist visits, chronic medication, and some procedures. However, it does not cover hospitalization or major medical expenses.

What is the difference between an EssentialMED Day-to-Day Plan and a medical aid scheme?

EssentialMED Day-to-Day Plan is not a medical aid scheme but a health cover product that benefits out-of-hospital medical expenses. Unlike medical aid schemes, it does not cover hospitalization or major medical expenses.

Are there any waiting periods for the EssentialMED Day-to-Day Plan?

Yes, there are waiting periods from 1 to 12 months on the Day-to-Day plan, depending on the benefit.

What are prescribed minimum benefits (PMBs), and how do they relate to the EssentialMED Day-to-Day Plan?

Prescribed minimum benefits (PMBs) are defined benefits that all medical aid schemes and health cover products must cover by law. For example, the EssentialMED Day-to-Day Plan covers PMBs, including certain chronic conditions, emergency medical treatment, and procedures.

Can I choose my doctor or specialist with the EssentialMED Day-to-Day Plan?

Yes, you can choose any registered healthcare provider with EssentialMED Day-to-Day Plan, including doctors and specialists. However, the benefits you receive may vary depending on the healthcare provider’s rates and the benefit limits of your plan.

Adriaan Schoeman

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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