SA's No 1 Insurance Blog

Don’t you wish you could choose what you need on your medical insurance instead of paying for benefits you may not actually need like any other medical aid on the market? If so then Essential Med is definitely the product for you!

Think about it…

  • You’re a single guy who’s never going to use the maternity benefits; so why pay for them?
  • You don’t wear spectacles. Why pay the same as someone who claims for a new pair every year?

Of course, that’s not how medical schemes work, and we should be thankful we pay for things we don’t need because one day we might need them, but you get what I mean – it’s still irritating paying for things you never use.

So, before we continue, Essential Med is not a medical aid.

They don’t imply they’re a medical aid, and they don’t encourage you to discontinue your medical aid. Nor for that matter, do we.

Essential Med is a medical insurance company. In other words, they offer benefits which are stated to you upfront. In other words, if you end up in hospital for some illness, the maximum they will ever pay is set out upfront.

Medical aid, on the other hand, pays an amount for every procedure based on the anticipated cost of that procedure. The amount paid must bear some relation to the actual cost of the procedure and is paid from a communal pot.

Medical schemes are not allowed to make a profit while medical insurance companies are.

Good, now we’ve got that out of the way…

What then is the benefit of belonging to Essential Med?

The one thing that caught my eye on their home page was their “Build Your Plan” button.

Curious, I clicked on it and it took me to an option to customise my plan.

Remember what we said right on top…about being able to choose what you want? Turns out this is exactly that.

Here’s what happened as I went through it screen by screen:

They wanted to know my family size to which I duly replied, “Single with 1 dependant”.

Then it asked me to tick a box if my dependant and I were older than 55. Turns out you must be younger than 65 to join.

Then I was asked whether I wanted:

  • Day-to-Day cover, or
  • Hospital

Since I don’t see doctors all that often, I clicked on the Hospital option. Two things happened at that point:

  • It showed me a cost of R292.39 per month which was based on their assumptions and which I changed as I went along.
  • I was offered a funeral benefit and Essential Rewards which I didn’t accept purely because I wanted to see the medical cost only

Below this, what I’d like to call the buffet menu appeared with seven options:

  • Accident Hospitalisation
  • Illness Hospitalisation
  • Maternity
  • Emergency Casualty Visits
  • Dread Disease
  • Permanent Disability
  • ICU Care

Next to each of the above options, on the far right, there was a circle with a number in it.

I clicked on the circle next to Accident Hospitalisation, and that’s where the fun started.

Accident Hospitalisation

A screen popped up asking me to select between 5 levels of cover with level 1 offering the least cover and level 5 the highest cover.

  • Choosing level 1 meant I had R300,000 cover for the year at a cost of R259.61 per month.
  • Level 2 offered me R500,000 cover for the year at a cost of R292.39 per month
  • Level 3 offered R800,000 cover at R319.92 per month
  • Level 4 offered R1,200,000 cover at R451.04 per month
  • Choosing level 5 gave me R2,000,000 cover for the year at a cost of R582.16 per month.

I chose level 2 which kept my cost at R292.39 per month. By the way, this cover was not optional.

Illness Hospitalisation

Here I was given 3 options:

Level 1

  • R6,500 for day 1
  • R4,500 for each of day 2 and 3
  • R1,500 for the balance up to 21 days in hospital
  • Cost was now R247.81 per month

Level 2

  • R10,000 for day 1
  • R6,500 for day 2
  • R5,000 for day 3
  • R1,500 for the balance up to 21 days in hospital
  • Cost was R292.39 per month

Level 3

  • R10,000 for day 1
  • R4,500 for each of day 2 and 3
  • R1,500 for the balance up to 21 days in hospital
  • Hernias paid a flat R20,000 regardless of days in hospital
  • Appendectomies paid a flat R35,000 regardless of days
  • Gallbladder and kidney stones paid a flat R35,000
  • Miscarriage paid a flat R10,000
  • Hysterectomy paid a flat R45,000
  • Cost was R339.60 per month

All levels had a 3-month waiting period while level 3 had a 12-month waiting period for the conditions where a flat amount was paid. Hysterectomies had a 24-month waiting period before being allowed to claim.

The Illness Hospitalisation benefit is optional, but I chose level 2 even though I have medical aid. Cost stayed at the R292.39 per month mark for me.

Maternity

Entirely optional benefit with 1 level only:

  • R25,000 for natural delivery
  • R35,000 for a C-Section if required by your specialist
  • 1 claim allowed every 12 months
  • Cost jumped to R364.51 per month, but I opted out because I ain’t going to get pregnant anytime soon.

Emergency Casualty Visits

3 levels on offer:

  • Level 1 – up to R2,000 every 12 months and the cost stayed the same for me
  • Level 2 – up to R4,000 every 12 months and cost went up to R305.51 per month
  • Level 3 – up to R6,000 every 12 months with cost going to R318.62 per month

You know me, I went with Level 1 keeping my cost at R292.39 per month. Once again, this is not an optional benefit but you can choose Level 1 at no cost.

Dread Disease

3 optional levels:

  • Level 1 – R185,000 cover taking the cost to R312.06 per month
  • Level 2 – R250,000 cover with a cost of R331.73 per month, and
  • Level 3 – R350,000 cover at a cost of R344.84 per month

A 12-month waiting period applies and 24 months for pre-existing conditions. So yes, if you have had a bout of cancer in the past, then you may claim after 24 months have elapsed.

I slapped on Level 1 cover taking my total cost to R312.06 per month.

Permanent Disability

3 optional levels once again:

  • Level 1 – up to R200,000 paid less costs, and only the main member qualifies. This took the cost to R351.40 per month.
  • Level 2 – up to R250,000 paid less costs, main member only. Cost came in at R364.51 per month.
  • Level 3 – up to 250,000 paid less costs, main member and spouse. Cost came in at R390.73 per month.

I went with level 1 which took my cost to R351.40 per month.

ICU Care

2 options with a 3-month waiting period if because of an illness:

  • Level 1 – R12,500 per day for up to 5 days at R390.74 per month, and
  • Level 2 – R20,000 per day for up to 5 days at R416.96 per month

I went with Level 2 taking my cost to R416.96 per month.

Conclusion

R416.96 per month for me and one dependent and this is what I got for the year ahead:

  • Accident Hospitalisation – R300,000 cover
  • Illness Hospitalisation – R10,000, then R6,500, then R5,000, then R1,500 up to 21 days
  • Emergency Casualty Visits – up to R2,000
  • Dread Disease – up to R185,000 cover depending on the severity of the disease
  • Permanent Disability – up to R200,000 for me as main member
  • ICU Care – R20,000 per day for 5 days

What’s nice is that I can chop and change as I go along. If I take out a disability policy elsewhere, I can always remove it here. On the other hand, what if I can’t get permanent disability cover elsewhere? At least I know I can get it here.

If you’re interested in receiving a quote simply leave your details below & authorised Essential Med consultant will call you.

 

Essential Med

If you have any questions please don’t hesitate to contact us

The InsuranceFundi Team

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