EssentialMED Hospital Plan
Overall, the EssentialMED Hospital Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and financial protection to up to 3 Family Members. The EssentialMED Hospital Plan starts from R699 ZAR. EssentialMED has a trust rating of 4.2.
| 🔎 Medical Health Plan | 🥇 EssentialMED Hospital |
| 🌎 International Cover | None |
| 👤 Main Member Contribution | R699.00 |
| 👥 Adult Dependent Contribution | R699.00 – R751.00 |
| 👶 Child Dependent Contribution | R272.50 |
| 🔁 Gap Cover | None |
| 💶 Prescribed Minimum Benefits (PMB) | ✅ Yes |
| 😷 Screening and Prevention | ✅ Yes |
| 💙 Medical Savings Account | None |
| 🍼 Maternity Benefits | ✅ Yes |
EssentialMED Hospital Plan – 7 Key Point Quick Overview
- ✅ EssentialMED Hospital Plan Overview
- ✅ EssentialMED Hospital Plan Premiums 2023
- ✅ EssentialMED Hospital Plan Benefits and Cover Comprehensive Breakdown
- ✅ EssentialMED Hospital Plan Exclusions and Waiting Periods
- ✅ EssentialMED Hospital Plan vs Other Providers or Medical Aid Schemes
- ✅ Our Verdict on the EssentialMED Hospital Plan
- ✅ EssentialMED Hospital Plan Frequently Asked Questions
EssentialMED Hospital Plan Overview
The EssentialMED Hospital Plan is one of 3, starting from R699. EssentialMED Hospital Plan is a medical insurance plan offered by EssentialMED, a South African health insurance provider. The plan is designed to provide financial protection to individuals and families in case of hospitalization.
Gap Cover is not available on the EssentialMED Hospital 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
Health Insurance EssentialMED Hospital Plan Premiums 2023
Private Medical Insurance that is affordable :
| 🅰️ Family Dynamic | 🅱️ Average Monthly Premium 2024 |
| 👤 Single Members/Individuals | R699 |
| 👥 Families | R751 |
You might consider adding GAP Cover. Read more about the 5 Best Gap Cover Options for Under R200
EssentialMED Hospital Plan Benefits and Cover Comprehensive Breakdown
| 🟥 Hospitalization Cover | Limited to 21 days in the hospital.
Prior authorization is required at least 48 hours before admission, and the member must be admitted for at least 24 consecutive hours for the benefit to apply.
Level 3 stated conditions have a 12-month waiting period, and hysterectomy has a 24-month waiting period.
Procedures must be medically indicated and necessary.
Offers three levels, including the following:
Level 1
Up to R6,890 for the first day.
Up to R4,770 for the second and third days each.
Up to R1,590 for every day after that, up to 18 days.
Level 2
Up to R10,600 for the first day.
Up to R6,890 for the second and third days each.
Up to R5,300 for every day after that, up to 18 days.
Level 3
Up to R10,600 for the first day.
Up to R6,890 for the second and third days each.
Up to R5,300 for every day after that, up to 18 days.
Up to R21,200 for hernia repairs.
Up to R37,100 for Gallbladder/Kidney Stones.
Up to R10,600 for Miscarriages.
Up to R47,700 for Hysterectomies. |
| 🟧 Dread Diseases Cover | Paid according to the SCIDEP staging, as follows:
Most Severe – 100% of the benefit.
75% of the available benefit.
50% of the available benefit.
Least Severe – 25% of the benefit.
Covers up to 8 specified conditions on the critical illness list, including heart attack, chronic coronary heart disease, stroke, cancer, kidney failure, major organ transplant (kidney, heart, lung, liver, pancreas, bone marrow), paraplegia, and blindness.
There are three levels of cover to choose from as follows:
Level 1 – up to R196,100.
Level 2 – up to R265,000.
Level 3 – up to R371,000.
|
| 🟨 Intensive Care Unit Cover | Covers up to 5 consecutive days in an ICU per member per event.
The optional benefit with two cover levels.
The benefit is in addition to the daily Hospitalisation Benefit.
ICU costs are initially claimed under the ICU benefit, and any additional costs can be claimed under the Hospitalisation benefit.
The Accident Hospitalisation benefit applies to ICU expenses incurred due to an Accident Event.
The following levels are available under this benefit:
Level 1 – up to R13,250 per member per day.
Level 2 – up to R21,200 per member per day. |
| 🟩 Maternity Cover | Natural delivery or C-section are covered.
Limited to R31,800 per delivery.
Covers one event every 12 months.
Pre-approval is required from 32 weeks of pregnancy. |
EssentialMED Hospital Plan Exclusions and Waiting Periods
EssentialMED Hospital 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 Hospital 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 Hospital Plan Waiting Periods
- ✅ Hospitalization – 3 months for admission day benefits.
- ✅ Hernia, Appendectomy, Gallbladder/Kidney Stones, and Miscarriages have a 12-month waiting period.
- ✅ Hysterectomies have a 2-year waiting period.
- ✅ Dread Diseases have a 12-month waiting period.
- ✅ ICU Benefits – 3-month waiting period.
- ✅ Maternity Benefits – 12-month waiting period.
Waiting periods with EssentialMED depend on the benefit.
EssentialMED Hospital Plan vs Other Providers or Medical Aid Schemes
| 🔎 Medical Health Plan | 🥇 EssentialMED Hospital | 🥈 Affinity Health Hospital | 🥉 Oneplan Health Blue |
| 🌎 International Cover | None | None | None |
| 👤 Main Member Contribution | R699 | R1,258 | R955 |
| 👥 Adult Dependent Contribution | R699 | R1,168 | R880 |
| 👶 Child Dependent Contribution | R272.50 | R378 | R545 |
| 🔁 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: 10 Leading Hospital Plans in South Africa
Our Verdict on the EssentialMED Hospital Plan
EssentialMED is a comprehensive hospital plan that covers hospitalization costs, such as accommodation, theatre fees, and medication. The plan also covers dread diseases, ICU stays, and maternity. One of the plan’s drawbacks is its limited range of benefits. For example, it does not cover certain medical expenses, such as GP consultations, dental treatment, and chronic medication.
Additionally, there are waiting for periods and exclusions that apply, which means that policyholders may not be able to claim for certain medical conditions or treatments immediately.
Therefore, overall, the EssentialMED Hospital Plan may be a good option for individuals who are looking for basic hospital coverage at an affordable price.
EssentialMED Hospital Plan Frequently Asked Questions
What is the EssentialMED Hospital plan?
EssentialMED Hospital plan is a medical insurance product that covers in-hospital expenses such as accommodation, doctor’s fees, and medication.
What are the benefits of the EssentialMED Hospital plan?
The benefits of the EssentialMED Hospital plan include cover for in-hospital expenses, maternity, and dread diseases.
How much does the EssentialMED Hospital plan cost?
EssentialMED Hospital plan costs an additional R68 for single members and R82 for families, starting from R699 per month.
Is dental and vision coverage included in the EssentialMED Hospital plan?
No, the EssentialMED Hospital Plan does not cover dental or vision.
Is there a waiting period for the EssentialMED Hospital plan?
Yes, certain waiting periods will apply to the EssentialMED Hospital Plan.
Does the EssentialMED Hospital plan cover pre-existing conditions?
Yes, the EssentialMED Hospital plan covers pre-existing conditions after a 12-month waiting period.
Can seniors enroll in the EssentialMED Hospital plan?
Yes, the EssentialMED Hospital plan is available to individuals of all ages, including seniors.
Can I choose my doctor or hospital with the EssentialMED Hospital plan?
Yes, you can choose your own doctor and hospital with the EssentialMED Hospital plan as long as they are registered with the South African Medical and Dental Council.
