EMERGENCY & ACCIDENT BENEFIT OPTION
When life happens you want to be cover’d. We can help with that.
We offer a wide range of benefits from private hospitalisation and casualty visits, to specialised radiology scans and 24-hour medical emergency services, and… and… and…
WHY CHOOSE ESSENTIAL PRIMARY PLUS?
It is our health insurance offering that provides essential healthcare solutions to individuals and families. Choose between our Day-to-Day Benefit Option, Emergency and Accident Benefit Option or our Day-to-Day, Emergency and Accident Benefit Option.
Our options complement your medical aid cover, or it can be taken as your primary health cover if you don’t have medical aid cover. Our options are subject to open enrolment, community rating and cross-subsidisation.
WHAT DOES OPEN ENROLMENT, COMMUNITY RATING AND CROSS-SUBSIDISATION MEAN?
Open enrolment means cover is available to everyone. Community rating means we do not discriminate against individuals based on factors such as race and gender. Cross-subsidisation means that all premiums paid by our clients are paid into one risk pool where all claims are paid from.
WHO DO WE COVER?
We cover only you if you choose to join as an individual.
If you join as a family, we cover you, your spouse and any child dependant of whom you are the parent or legal guardian.
MONTHLY PREMIUM
As an individual aged 61 or older you will pay a higher premium from the first day of cover, unless you can submit proof of medical aid or primary healthcare insurance cover for 15 or more consecutive years from the age of 35 onward.
Children aged 20 years or younger pay child dependant premiums. Children aged 21 years or older pay adult dependant premiums if they are full-time students and proof of financial dependency is submitted every year.
We accept proof from the educational facility or stamped copies of your child’s bank account statements of the past 3 months.
EMERGENCY AND ACCIDENT COVER
You are covered for emergencies and accidents at your nearest private hospital and the hospital’s casualty facility.
We do not cover planned medical procedures, such as childbirth or having cataracts removed.
Visit www.unityhealth.co.za, contact us for assistance or download our mobile app. Haven’t downloaded our app yet? Click here for a step-by-step guide.
OVERALL POLICY LIMIT (OPL)
There is no Overall Policy Limit (OPL) on our Emergency and Accident Benefits but benefit limits apply as indicated.
HOSPITAL CARE
EMERGENCY COVER
PRE-AUTHORISATION IS REQUIRED
We will cover the cost to transport you to your nearest private hospital and the cost of stabilisation in the hospital’s emergency unit when you are admitted as an in-patient for a medical emergency, limited to R 22 000 per person per event.
We do not cover medical procedures that you need after being admitted to hospital for stabilisation, such as a heart bypass. If you need further treatment after stabilisation, we will cover the cost to transfer you to a public hospital and any costs thereafter will be your responsibility.
WE DEFINE MEDICAL EMERGENCIES AS…
unexpected events or health conditions, such as a heart attack or stroke, that can result in serious bodily impairment and/or death if you do not receive immediate treatment.
ACCIDENT COVER
PRE-AUTHORISATION IS REQUIRED
You are covered at the nearest private hospital when you need medical treatment for physical injuries caused by accidental events, such as injuries from a motor vehicle accident.
We will cover your hospital and all related healthcare providers’ accounts during your stay in hospital, limited to R 1 100 000 per person per event.
WE DEFINE ACCIDENTAL EVENTS AS…
events where immediate medical treatment is required as a result of a physical injury caused by physical impact, such as a motor vehicle accident.
CASUALTY VISITS
PRE-AUTHORISATION IS REQUIRED
Medical treatment for a physical injury caused by a minor accidental event is covered at your nearest private hospital’s casualty facility, limited to R 6 000 per person per event.
MRI AND CT SCANS
PRE-AUTHORISATION IS REQUIRED
When you are admitted to hospital as a result of an injury caused by an accident, the cost of your MRI or CT scan will be covered limited to R 16 000 per person per year.
PHYSICAL REHABILITATION CARE
PRE-AUTHORISATION IS REQUIRED
We cover the cost of your physiotherapist and/or occupational therapist when you need physical therapy for an injury caused by an accident for which you have been admitted to hospital.
You must receive therapy and/or treatment within 3 months from the date that you are discharged from hospital, limited to R 3 000 per person per year.
24-HOUR MEDICAL EMERGENCY SERVICES
Our 24-hour national emergency contact centre can assist with the following services in the event of a medical emergency:
• ambulance transfers between hospitals;
• emergency transport services by air or road;
• repatriation of a loved one’s mortal remains within the borders of South Africa, limited to R 7 500 per policy per year;
• telephonic medical advice.
PAYOUT BENEFIT
ACCIDENTAL DEATH
We cover you and/or your registered spouse in the event of your and/or your spouse’s death due to an accident, limited to a benefit amount of R 10 000 per person, which will be paid out to your nominated beneficiary.
WELLNESS BENEFIT
ESSENTIAL ASSISTANCE PROGRAMME (EAP)
Our wellness partner, Reality Wellness Group, offers unlimited 24/7 telephonic advice and counselling services for:
• financial advice;
• legal advice;
• HIV/AIDS counselling; and/or
• trauma counselling.
We do not cover personal face-to-face counselling.
WAITING PERIODS
EMERGENCY AND ACCIDENT BENEFIT OPTION
Waiting periods do not apply to our EMERGENCY AND ACCIDENT BENEFITS and ESSENTIAL ASSISTANCE PROGRAMME (EAP).
*LIFESTYLE BENEFIT
Our Lifestyle Benefit is offered at no cost to you.
FUEL REWARDS
Fill up at any SHELL service station and get rewarded with 22 cents per litre of diesel and 15 cents per litre of petrol.
This Health Insurance policy is not a medical aid, does not provide similar cover as that of a medical aid and cannot be substituted for medical aid membership.