Essential Lite Brochure

7/26/2019 Essential Lite Brochure

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...life uninterrupted

Essential Lite Brochure

Essential Lite Version 2 2015. Dated November 2015.


2/10

Colds and flu, tummy

bugs, allergies, routine

health checks and more,

these out-of-hospital

medical needs are taken

care of with access to a

network of more than 3000health practitioners

nationwide.

All that is needed for freeconsultation and medication from

any of these Essential Doctor healthcare

professionals is your Essential Med cardand policy number.

Great benefits include:

GP visits (network-registered),

Partial cover for after hour or out-of-network emergency

consultations,

Routine maternity check-ups, medication and tests with a network

registered GP are included,

2 referred growth sonars by a network registered GP,

Included prescribed and acute medication according to the Essential Doctor formulary,

Chronic medication upon successful registration and approval,

Basic dentistry, including consultations and procedures (network registered),

Annual eye test per beneficiary includes lenses and frames every 24 months,

Included referred X-rays and blood tests according to the Essential Doctor formulary.

terms and conditions apply

visit www.essentialdoctor.co.za

Please note: Essential Med offers health

insurance and not medical aid.

Day-to-day benefits



3/10

Emergency GP Visits: If you are out

of town and you cannot see your

network GP , the Prepaid

Preventative Health Plan will allow 3

out of area visits to a GP of your

choice. You will have to pay for

these consultations. Simply send

Essential Group a copy of the re-

ceipt and the agreed tariff will be

reimbursed to you.

Waiting Period: 30 days

Growth Sonars: Essential Med also

makes provision for two growth

sonars if requested by a network-

registered doctor (GP) during

each pregnancy which will be

done by radiology.


Dentistry: 2 Visits per member per

annum. Basic dentistry, including

dentist consultations and

procedures. Includes cover for

consultations, cleaning, pain control,

fillings and normal extractions. Theseservices must be obtained from a

network-registered dentist.

Waiting Period: 6 months

Day to Day Benefits & Waiting Periods

GP Visits: 3 Visits for a single member

per annum & 6 Visits per family per

annum. Your doctor will provide

services and prescribe medication

according to the list of specified

generic medications on the Essential

Doctor medicine formulary. No cash

payment is required and medication

and small procedures are included.


Maternity Benefits: 3 Visits for a single member

per annum. Routine maternity GP check ups,

medication and tests. Maternity benefits include

prenatal care

which covers all GP visits. Pathol-ogy blood tests for Monoclonal Immunological,

Alpha-feto Protein are also included. Our post-

natal benefit is not specifically defined, but is in-

stead included in the GPs general scope of

services, with blood tests subject to the

pathology and radiology lists (for example: Pap

smears are included as part of postnatal and

general benefits) - giving you flexibility and

choice in making your own healthcare decisions.


*terms and conditions applyvisit www.essentialdoctor.co.za



4/10

Acute Medication: R2400 per annum for a

single member and R4800 per family per

annum. Prescribed and acute medica-

tion linked to the network-registered GP

consultation is covered. No over the

counter benefit is available. Acute medi-

cation is subject to the acute medicationformulary and is usually dispensed by Es-

sential Doctor network GPs. If the GP is a

scripting doctor, medication may be ob-

tained from a network pharmacy

(Dischem, Clicks or Medi-Rite pharmacy).


Chronic Medication: Our unique chronic benefit

structure includes chronic medication linked to

your network-registered GP consultation subject

to the medication formulary.

The Essential Doctor chronic medicines formulary

is a list of medicines which are fully covered (if

prescribed by your Essential Doctor ) forconditions on the chronic conditions list. No over

the counter benefit is available. Chronic

medication is subject to registration and

approval. If approved your medication will be

couriered to the nominated address or the

member may collect it from the nearest patient

choice pharmacy.


Radiology: 3 Visits for a single member


annum. Includes black and white X-rays

and these benefits are included when

referred by a network-registered GP

according to a list of approved codes

from the radiology formulary.


Pathology: 3 Visits for a single member


annum. These benefits are included

when referred by a network-

registered GP according to a list of

approved codes from the pathology

formulary.


Optometry: R800 every 24 months for a

single member and R1600 every 24 months

per family. Services must be obtained from

a network-registered optometrist. There is a

limit in place on prescriptions of white

standard and bifocal lenses with a basic

frame. (PPN 1 rates applicable).



Option to upgrade your policy every 6

months!


5/10

Essential Med facilitates admission to most private hospitals and government hospitals.

* terms and conditions applyvisit www.essentialmed.co.za

Underwritten by:In association with:

Description Waitingperiods

Essential Lite planbenefits

AccidentHospitalisation In-hospital expenses paid inincrements of R200 for everyR190 of expenses.

Inception. Up to R50 000 per incident(max 2 events per annum).

PermanentDisabilityBenefit

Accidentpermanent disability.

Inception. R100 000 Principal policyholder only.

EmergencyRooms orCasualty

Accidents -Inception.

Normalcasualty - 30

days

R2000 per family perannum.

DeathBenefit -PrincipalHolder

Accident

Inception.Naturalcauses6 months

R1 500 principal/R1 500spouse/partner.

African Unity Insurance Limited.

An authorised financial services provider.


Hospital cover

You would need your Essential Med

card & policy number to obtain

hospital pre-authorisation (this can

be done by yourself, emergency

services or the hospital) and the

payment of a stated benefit to

cover in-hospital expenses of

procedure, consultation or service.


6/10

Minimise the impact of

every day challenges, bethey health, home, legal,auto, travel or funeral

related.

Essence offers quick and

easy access to

Telephonic advice and

Assistance that will keepyour life uninterrupted.

Emergency services

Emergency medical advice and information,

Emergency medical response by road or air,

Transfer to the most appropriate medical facility,

Transfer to a specialist diagnostic and therapeutic medical care centre,

Transfer of life-saving medications and emergency blood as required,

Comprehensive pre-hospital services,

Companionship and / or care of stranded minor.

Available 24/7 on 0861 911 011.

* terms and conditions applyvisit www.essentialmed.co.za

Essence offers the following valuable emergency medical services:



7/10

Available 24/7 on 0861 911 011* terms and conditions applyvisit www.essentialmed.co.za

Health assist:

Personal health advice from experienced

professionals just a call away.

Emergency medical advice,

Symptom assessment,

General health information,

Counseling on HIV/Aids, cancer,

addiction, stress and trauma.

Home assist:

This helpline offers assistance with

household emergency repairs, anywhere

in South Africa. It covers the cost of 3

incidents per annum, limited to R500 per

incident.

Electrical, Plumbing, Locksmith,

Glazier, Domestic appliances.

Legal assist:

Just call to get guidance and advice on

legal matters from qualified and

experienced attorneys.

General legal advice,

Labour law advice,

Motor accident advice, Road accident fund advice,

Attorney referral service,

Std legal documentation.Auto assist:

In the event of a roadside emergency within South

Africa, call this helpline for access to appropriate

services.

Cost of towing (to an approved dealer),

Flat battery (jump start),

Flat tyre (tyre change),

Running out of fuel (10L of fuel supplied), Keys locked in car (locksmith) and

In case of a breakdown 100km or more from

home, accommodation or rental of a vehicle

(maximum R500 per day).

Emergency Medical Evacuation:

A single call from you (or a 3rd party) to our

emergency number

0861 911 011

results inimmediate action.

Emergency vehicles dispatched immediately

(cost covered),

Telephonic advice to the primary accident

scene attendant to assist in stabilising the

patient,

Informing your next-of-kin about your

accident. Funeral assist:

For assistance with the facilitation of a

burial.

Advising and referral to a reputable

undertaker,

Help with funeral arrangements,

Advice on death certificate and

legal documentation,

Counseling of the bereaved.

Travel assist:

Just call for info, availability and costs of national and

international accommodation, transport and special

packages. Call and get directions when travelling

anywhere is South Africa. Directions are given

telephonically, via email or fax.

7Essential Lite Version 2 2015. Dated November 2015.


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Essential Lite

Benefits

Accident hospitalisation Up to R50 000 perincident (max 2 events per annum)

Permanent DisabilityBenefit

R100 000 Principal only

Emergency rooms or

casualty

R2000 annually

Death Benefit -Principal Holder

R1 500 Principal/R1 500 spouse/partner

GeneralPractitioners

3 Visits for a single member perannum & 6 Visits per family per

annum

Emergency/Out ofnetwork visits

3 out of area visits per annum perpolicy

Maternity Benefits 3 Visits for a single member perannum

AcuteMedication

R2400 per annum for a single mem-ber and R4800 per family per annum

Chronic Medication Included

Basic Dentistry 2 Visits per annum (Basicdentistry only) per member

Optometry R800 every 24 months for a singlemember and R1600 every 24 months

per family

Radiology 3 Visits for a single member perannum & 6 Visits per family per

annum

Pathology 3 Visits for a single member perannum & 6 Visits per family per

annum

Premiums Essential LitePrice List

Single R360

Including 1 child R410

Including 2 children R460



Couple R560

Including 1 child R610






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Why Essential Med?

Professional service,

Affordable cover for you and your family,

Extensive network of registered healthcare professionals

Partnerships with leading financial and healthcare services brands Emergency medical services

Personal health advice

Legal, auto, home emergency, travel & map and funeral assistance

Prompt and efficient claim payment

NB: Please confirm any endorsements that may be placed on your policy before commencement

/EssentialMed

/EssentialMedSA

Essential Med is a registered

Financial Services Provider. FSP No: 42980

Underwritten by:

African Unity Insurance Limited.

An authorised financial services provider.

FSP: 8447

t 0861 70 70 70

f 0865 327 661

Essential Group Building

Olive Grove Estate

Ou Paardevlei Road

Somerset West

7140

[email protected]

www.essentialmed.co.za



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ESS MED MEDICAL COVER (Pty) Ltd

Trading as Essential MedRegistration number: 2011/116999/07

Essential Med is a registered financial services provider. FSP 42980.

Hospital cover underwritten by African Unity Insurance Limited. 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

1E ti l Lit V i 2 2015 D t d N b 2015

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Essential Lite Brochure