Universal Healthcare Essential Plan
Overall, the Universal Healthcare Essential Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and maternity benefits to up to 3 Family Members. Universal Healthcare Health Insurance Plans are available to employees who earn less than R20,000 per month. Universal Healthcare has a trust score of 2.4.
| 🔎 Medical Health Plans | 🥇 Universal Healthcare Essential |
| 🌎 International Cover | None |
| 👤 Main Member Contribution | Variable |
| 👥 Adult Dependent Contribution | Variable |
| 😊 Child Dependent Contribution | Variable |
| 🔁 Gap Cover | ✅ Yes |
| 📉 Annual Limit | ✅ Yes |
| 😷 Screening and Prevention | None |
| 💶 Medical Savings Account | None |
| 🍼 Maternity Benefits | ✅ Yes |
Universal Healthcare Essential Plan – 7 Key Point Quick Overview
- ✅ Universal Healthcare Essential Plan Overview
- ✅ Universal Healthcare Essential Plan Premiums 2023
- ✅ Universal Healthcare Essential Plan Benefits and Cover Comprehensive Breakdown
- ✅ Universal Healthcare Essential Plan Exclusions and Waiting Periods
- ✅ Universal Healthcare Essential Plan vs Plans Offered by Other Providers
- ✅ Our Verdict on the Universal Healthcare Essential Plan
- ✅ Universal Healthcare Essential Plan Frequently Asked Questions
Universal Healthcare Essential Plan Overview
The Universal Healthcare Essential Plan is one of 4. The Essential plan offers unlimited GP visits, coverage for 26 chronic conditions, maternity benefits, and several emergency and accident benefits.
Gap Cover is available on Universal Healthcare Essential Plan, along with 24/7 medical emergency assistance. According to the Trust Index, Universal Healthcare has a trust rating of 2.7.
Universal Healthcare Health Insurance has the following four plans to choose from:
1. Universal Healthcare Essential Advance Plan
2. Universal Healthcare Essential Plan
3. Universal Healthcare Standard Advance Plan
4. Universal Healthcare Standard Plan
Universal Healthcare Essential Plan Premiums 2023
The Universal Health & Accident Plan offered by Universal Healthcare is based on the principle of cross-subsidization. This means that all policyholders pay the same contribution rate, regardless of age or health status, and anyone may join the plan at any time. To ensure that policyholders are covered as they age or become ill, they are encouraged to contribute to the plan when they are young and healthy.
Depending on when they join the plan, a three-month general waiting period or a 12-month condition-specific waiting period may be imposed on their policy.
Depending on the selected option, premiums for the Universal Health & Accident Plan are calculated on a per-person, per-month basis. The employer or the employee can pay the full premiums associated with the selected plan option and the number of covered lives. The employer pays for the premiums in advance.
Universal Healthcare Essential Plan Benefits and Cover Comprehensive Breakdown
Essential Plan Primary Healthcare Cover
| 🟥 General Practitioners (GPs) | Unlimited cover for GP visits if they are part of the Universal Healthcare Provider Network.
Includes acute medication.
Includes small in-room procedures such as wound care. |
| 🟧 Chronic Medication | The benefit covers 26 conditions.
Chronic condition registration is required.
Chronic medication must be obtained from a UHPN dispensing doctor or pharmacy.
Stated Benefits are paid monthly per registered condition per insured person. |
| 🟨 Basic Radiology | Specified X-rays, as requested as part of a General Practitioner event.
Member must use a radiologist on the Universal Healthcare Provider Network.
For X-rays, a Stated Benefit amount is payable. |
| 🟩 Basic Pathology | Specified Pathology, as requested as part of a General Practitioner event.
Members must use a radiologist on the Universal Healthcare Provider Network.
For Pathology, a Stated Benefit amount is payable. |
| 🟦 Optometry | Limited to one eye test event and one pair of specified single or bifocal lenses and frames at a Universal Healthcare Provider Network optometrist.
Limited to one exam and glasses per insured person every 24 months. |
| 🟪 Dentistry | A stated benefit amount is dedicated to emergency dental procedures.
Must use a dentist that is part of the Universal Healthcare Provider Network.
Covered once per insured person every 12 months. |
| 🟥 Maternity | A stated benefit amount is payable for 2 ultrasound scans during pregnancy.
The ultrasound must be performed or requested by a Universal Network General practitioner.
The benefit includes certain pathology tests per insured female per twelve months. |
Essential Plan Emergency Benefit
1️⃣ Emergency Accidental Injuries
Hospital Casualty/Emergency Room Benefit
Hospitalization because of an Accidental Emergency Injury | Hospital casualty/ER benefit or Hospitalisation for Accidental Emergency Injury is limited to R100,000 per insured person per 12-month period.
Pre-authorized treatment will pay severity-based amounts up to the benefit limit.
Accident-related hospitalization is covered only if clinically necessary. |
2️⃣ Emergency Medical Illness
Hospital Casualty/Emergency Room Benefit
Hospitalization because of an Emergency Medical Illness | Includes hospital casualty/ER benefit or emergency medical illness hospitalization.
Limited to R25,000 per insured per year.
Pre-authorized treatment will pay severity-based amounts up to the benefit limit.
This benefit only covers emergency medical illnesses and does not cover hospital casualty/ER doctor consultations.
Only emergency medical illness stabilization requires hospitalization. |
3️⃣ Emergency Medical Services
Response to an accident scene or medical emergency and transportation (via road) to the nearest private or public hospital within South Africa | Limited to R25,000 annually. |
POLL : 5 Best Medical Aids under R1000
Universal Healthcare Essential Plan Exclusions and Waiting Periods
Universal Healthcare Essential Plan Exclusions
The Essential from Universal Healthcare offers comprehensive healthcare coverage. However, some exclusions are common in South African health insurance policies. Among these exclusions are the following:
- ✅ The Essential does not cover pre-existing medical conditions before the policy’s inception.
- ✅ Cosmetic treatments, such as plastic surgery or Botox injections, are generally not covered by the Essential unless deemed medically necessary.
- ✅ The Essential typically does not cover alternative therapies, such as acupuncture or homeopathy.
- ✅ Fertility treatments, such as in-vitro fertilization (IVF), may be excluded from the Essential or covered only under certain conditions.
- ✅ The Essential may exclude or limit coverage for substance abuse treatment under certain conditions.
Typically, experimental treatments or procedures that have not been proven effective are excluded from the Essential.
Universal Healthcare Essential Plan Waiting Periods
Universal Healthcare’s Essential offers a range of benefits and coverage options. However, like other health insurance policies in South Africa, the plan has waiting periods for certain services. The waiting periods for the Universal Healthcare Essential Plan are typical for health insurance policies in South Africa, and they include the following:
- ✅ General waiting period: A general waiting period of three months must pass before a policyholder can claim on their health insurance policy. This waiting period applies to all benefits provided by Essential.
- ✅ Condition-specific waiting period: A condition-specific waiting period of 12 months must pass before a policyholder can claim treatment related to a pre-existing medical condition. This waiting period applies to any pre-existing medical conditions the policyholder had before the start of their cover.
- ✅ Maternity waiting period: A maternity waiting period of 10 months must pass before a policyholder can claim maternity-related services, such as prenatal care, childbirth, and postnatal care.
It is important to note that the waiting periods for the Universal Healthcare Essential Plan may vary depending on the specific plan and cover options selected by the policyholder. Therefore, we urge prospective members to review the terms and conditions of the policy to understand the coverage and waiting periods before enrolling.
Universal Healthcare Essential Plan vs Plans Offered by Other Providers
| 🔎 Medical Health Plans | 🥇 Universal Healthcare Essential | 🥈 Affinity Health Hospital | 🥉 Makoti Medical Scheme Primary Option |
| 🌎 International Cover | None | None | None |
| 👤 Main Member Contribution | Variable | R1,728 | R332 – R966 |
| 👥 Adult Dependent Contribution | Variable | R1,578 | R332 – R752 |
| 😊 Child Dependent Contribution | Variable | R598 | R215 – R346 |
| 🔁 Gap Cover | ✅ Yes | None | None |
| 📉 Annual Limit | ✅ Yes | Up to R175,000 per policyholder, R275,000 per family | Unlimited hospital cover |
| 😷 Screening and Prevention | None | ✅ Yes | ✅ Yes |
| 💶 Medical Savings Account | None | None | None |
| 🍼 Maternity Benefits | ✅ Yes | ✅ Yes | ✅ Yes |
Discover the 5 Best Hospital Plans under R2000 in South Africa
Our Verdict on the Universal Healthcare Essential Plan
According to the Universal Healthcare brochure, the Essential Plan offers a range of benefits, including unlimited doctor consultations, emergency services, and access to a network of private hospitals and healthcare providers. The plan also covers chronic medication and provides maternity benefits to pregnant members.
According to our evaluation, the Essential Plan offers good value for money, with a comprehensive range of benefits catering to most individuals’ healthcare needs.
You might like to learn more about:
Universal Healthcare Essential Plan Frequently Asked Questions
How many doctor consultations can I have under the Universal Healthcare Essential Plan?
TheUniversal Healthcare Essential Plan offers unlimited doctor consultations.
Can I choose which private hospitals and healthcare providers I go to?
Yes, under the Universal Healthcare Essential Plan you can access a network of private hospitals and healthcare providers through the plan.
Is chronic medication covered under the Universal Healthcare Essential Plan?
Yes, the plan offers chronic medication coverage for 26 conditions.
Are there any waiting periods for using the Universal Healthcare Essential Plan’s benefits?
Yes, there are waiting periods for certain benefits, such as a 3-month general waiting period and a 12-month waiting period for pre-existing conditions.
Does the Universal Healthcare Essential Plan cover maternity benefits?
Yes, maternity benefits are included in the plan.
What treatments or procedures are excluded from the Universal Healthcare Essential Plan?
Some treatments and procedures, such as cosmetic and fertility treatments, are excluded from the plan.
How much does the Universal Healthcare Essential Plan cost?
The plan’s cost may vary depending on factors and is offered member-to-member.
Can I upgrade to a more comprehensive plan if I need more coverage?
No, you cannot upgrade from the Universal Healthcare Essential plan to a higher-level plan if you need more coverage. Universal Healthcare offers the plans to employer groups, and all employees in a group must be on the same option. Therefore, you cannot upgrade or downgrade.
