Health Plans: Essential Option

Essential Option 2020

• Annual limits are limited to PMB conditions only for in and out of hospital benefits and are subject to sub-limits not being exceeded

• Prorated benefits are applicable if you join after the 1st of January of a benefit year

• Statutory Prescribed Minimum Benefits (PMBs).  Services rendered are payable at 100% of cost at designated service providers (DSPs) with no annual limit

• 3 Month General Waiting Periods (Subject to the rights of interchangeability)

• 12 Months condition specific waiting period for pre-existing conditions (Subject to the rights of interchangeability)

• Claims received later than the last day of the 4th month in which the service was rendered will not be covered

• The Essential Package does not cover emergencies when travelling abroad

Download shows Benefits across all Options