Essential Plan A

Health insurance is a contract with an insurance company, which agrees to pay some or all of your medical bills based on your “coverage,” or the terms of your policy. In exchange, the insurer is paid a set amount of money — a “premium” — on a regular basis. Most Swazis have health insurance, either through their employer’s group plan or through buying their own individual policy. Others are covered under public “safety net” programs such as Medicaid and Medicare.

Cover will depend on the policy you choose and the amount that you pay, but it may include:

• Outpatient treatments
• Day-patient treatments
• In-patient treatments

14 days after submission of refund form.

1. Claim form
2. Bank statement
3. Receipt
4. If it is Cashback: A discharge letter.

After 45 days your policy is suspended. After 90 days, your policy is lapsed.

Yes, we need an affidavit for same.

Only Parents, Parents in Law and immediate family members can be covered.

Not yet, but the company is working on rolling this out soon.

Yes, only through referral in South Africa, Botswana and Mozambique. However, clicks South Africa is also accessible directly through our card.

No.

No.

• 1-month general waiting period.
• 3 months waiting period for Hospitalisation
• 6 months waiting period on chronic illnesses (Except for HIV).
• 6 months waiting period for Funeral, Optometry and Dentures.
• 6 months waiting period for Hospital Cash back benefits and Mental Health.
• 12 months waiting period for Pre-existing conditions, Major Procedures and Maternity (ANC & Scans).
• 12 months waiting period for Wellness Benefit.

You still continue to renew your cover.

We have invested in a real time fully automated/integrated digital system. There is no longer a need to call for outpatient authorizations, for inpatient and emergency theatre authorisations we now have a 24 hour operative Case Management department for authorisations at 800 3300.

To minimize the procurement of unprescribed medicines which can be a health hazard. We promote clients going to seek medical attention from Healthcare providers who will best asses their health.

No. A taxi is not an ambulance. An ambulance has the necessary equipment to take care of you in an emergency whilst in the journey to hospital. Taxi’s do not offer that service.

Client should inform us of their preferred service provider at onboarding stage. However, should it be the case, the client may come to claim back their refund using the claiming procedure outlined in Question 2 above.

No.