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Essence Option

Essence is the ideal ‘just-in-case’ medical cover 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. It’s what you absolutely need when you need it most.

Our essential emergency cover for every pocket.

Essence
2022 Monthly Contributions

Principal Member: R1 697
Adult Dependant: R1 360
Child Dependant: R612

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 Netcare, Life Healthcare hospitals (countrywide) and Mediclinic (Western Cape, Polokwane, Bloemfontein) – hospitals that are part of our Designated Service Provider (DSP) network – will be paid in full. A list of hospitals in areas where DSP hospitals are not present is available on request. There is no restriction on the number of hospital admissions, but all in-hospital procedures must be pre-authorised prior to admission.
*If a non-DSP hospital is voluntarily used, a 30% co-payment will be applicable on the hospital account.

Benefit value Unlimited
Injuries suffered as result of an accident

Treatment for almost all accidents is regarded as a Prescribed Minimum Benefit (PMB). Treatment of such injuries, including hospitalisation, is therefore covered in full by the Scheme, subject to Scheme rules and clinical protocols.

Benefit value: Unlimited

Specialist services in-hospital

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

Any service falling within the Scheme rules and rendered by the Scheme’s Specialist Network (DSP) or preferred provider for PMB conditions will be covered in full.

Benefit value: Unlimited*
*Conditions apply*Conditions apply

Oncology

The diagnosis and treatment of cancer-related conditions.

Benefit value: R169 000 per family per annum

MRI & CT scans

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

Benefit value: R17 800 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 PMB CDL conditions
Benefit value: Unlimited

Supplementary services cover

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

Benefit value: R21 500 per family per annum

Prosthetics/ Prosthesis

(Internal, external, fixation devices and implanted devices)

  • PMB entitlement only.
  • Pre-authorisation compulsory.
  • Subject to case Management, reference pricing, preferred provider, and Scheme protocols.

Benefit value
*Conditions apply

Emergency transport by ambulance

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

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: R7 900 per family per annum*
*Conditions apply

Endoscopic procedures (scopes)

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

Benefit 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

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Not Included on Essence - click here
  • Hospitalisation benefits for the following procedures:
    • Varicose vein and reflux surgery
    • Facet joint injections
    • Rhizotomy
    • Back surgery (including spinal fusion)
    • Joint replacements (e.g. hip and knee)
  • Day-to-day benefits
  • Basic and specialised dentistry
  • Prosthesis benefits