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Essence2 1

Essence Option

It’s what you absolutely need when you need it most.

Essence is the ideal ‘just-in-case’ medical benefit for individuals starting out and for those who only need that crucial cover for emergencies and unexpected medical expenses.

With a low cost and unbeatable value for money, this option includes an unlimited private hospital plan and covers the basic 26 chronic medical conditions.

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Essence 2024 Monthly Contributions

  • Principal Member: R1 990
  • Adult Dependant: R1 595
  • Child Dependant: R717

Medical Benefits

  • Hospital

  • Accidents

  • Specialists

  • Oncology

  • MRI & ICT Scans

  • Medical Appliances

  • Chronic Medication

  • Ambulance

  • Scopes

  • PMB's

Click on the tabs below to see the full description of the option benefits.

Major medical expenses cover

All costs related to treatment at any Life Healthcare and Netcare hospitals nationally and selected Mediclinic hospitals in the Western Cape, Bloemfontein, and Polokwane and other selected hospitals (DSP hospital network), will be paid in full. There is no restriction on the number of admissions to the hospital, but all in-hospital procedures should be pre-authorised prior to admission.

*30% co-payment applicable on the hospital account if a non-DSP hospital is voluntarily used.

Benefits value: Unlimited

Injuries suffered as result of an accident

Almost all accidents are regarded as a PMB (Prescribed Minimum Benefit) and the treatment of such injuries, including the hospitalisation, will therefore be covered in full by the Scheme, as per the rules and clinical protocols.

Benefit value: Unlimited

Specialist services in-hospital

The services provided by any Specialist whilst the member is in hospital are covered by the Scheme.

Benefit value: Unlimited

*Conditions apply


The diagnosis and treatment of cancer related conditions.

Benefit value: R189 000 Per family per annum

MRI & CT scans

Includes scans done for diagnostic reasons both in and out of hospital.

Benefit value: R20 000 Per family per annum

*Conditions apply

Chronic medication

Chronic medication for CDL conditions

Prescribed medication used continuously for 3 months or more for one of the 26 CDL (Chronic Disease List) illness conditions

Benefit value: Unlimited

Supplementary services cover

Psychiatric Treatment
  • Per family per annum.
  • In-hospital benefit only.
  • Pre-authorisation compulsory.
  • Case Management applies.
  • Out-of-hospital: PMB entitlement.

Benefit value: R24 000 

Prosthesis / Prosthetics
  • PMB entitlement only.
  • Pre-authorisation compulsory.
  • Subject to case Management, reference pricing, preferred provider, and Scheme protocols.
Emergency transport by ambulance

Netcare 911 (DSP provider) provides members with emergency transport from an accident scene by road or air ambulance and medically justified inter-hospital transfers. For emergencies members may also be transferred from their homes to the hospital.

Benefit value: Unlimited.

Medical appliances

The provision of medical equipment used for the treatment and cure of medical conditions or procedures, including equipment such as wheelchairs, crutches and contraceptive devices.

Benefit value: R8 800 Per family per annum
*Conditions apply

Endoscopic procedures (scopes)

All scopes are covered in full if done at a DSP hospital – any Life Healthcare and Netcare hospitals nationally and selected Mediclinic hospitals in the Western Cape, Bloemfontein, and Polokwane and other selected hospitals (DSP hospital network) or if done in the doctor’s rooms, subject to the use of a KeyHealth Specialist.

Benefits value: Unlimited

Prescribed Minimum Benefits (PMB)

Prescribed Minimum Benefits

Prescribed Minimum Benefits (PMBs) are a set of legislated, defined benefits to ensure that all medical scheme members are entitled to certain minimum health services, regardless of the benefit option they have selected on their scheme.

Benefit value: Unlimited

Additional Benefits


Smart Baby

Not Included on Essence - Click here
  • Hospitalisation benefits for the following procedures:
    • Varicose vein
    • Facet joint injections
    • Rhizotomy
    • Back surgery (including spinal fusion)
    • Joint replacements (e.g. hip and knee)
    • Hernia procedures requiring a prosthesis / internal fixation device
  • Specialised dentistry
  • Prosthesis benefits