Our Claims Process
Pre-authorisation: 0861 911 011
Client Services: 0861 70 70 70
Network Provider
For network GPs, dentists, medication, radiology, pathology &
optometry
1. Prior to treatment
Present your membership number or card
to the provider
2. Get treatment or medication
3. Claim submission
The provider will submit the claim to
EssentialMED
4. Settlement
EssentialMED will pay the provider directly according to your
benefits
Reimbursement
For non-network GPs and specialists.
1. Prior to treatment
Present your membership number or card
to the provider
2. Get treatment or medication
3. Claim submission
Submit your claim by filling in the
claim form and attaching a detailed account
as well as proof of payment. Send to claims@essentialmed.co.za
4. Settlement
EssentialMED will reimburse you
according to your benefits
For accident, casualty, hospitalisation, maternity, dread disease
and permanent disability claims.
1. Prior to admission
Present your membership number or card
to the hospital. Your EssentialMED policy may be known to the
hospitals under the name Africa Assist
2. Pre-Authorisation
The hospital, or you, phones 0861 911 011 to
get authorisation.
3. Acknowledgement
You may be asked to sign
acknowledgement of the authorisation and cover provided under your
benefits
4. Admission
You will be treated at the hospital or
casualty ward
5. Claim Submission
The hospital will submit the claims to
EssentialMED
6. Settlement
EssentialMED will pay the providers
directly according to the acknowledged benefits
Hospital
For accident, casualty, hospitalisation, maternity, dread
disease and permanent
disability claims.
Day-to-Day
Network Provider
For network GPs, dentists, medication. radiology, pathology
and optometry.
Day-to-Day
Reimbursement
For non-network GPs and specialists.