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Frequently asked questions

Mutual understanding is a very important element of our business, we encourage you to ask questions.

Have a look at our Health Insurance FAQs for a deeper understanding of our product.

Can I go to any Doctor and are the visits unlimited?

Answer: The Network Doctor you choose will become your regular GP. The GP visits are unlimited subject to Essential Employee Benefits Wellness’s Maximum Expenditure Formulary. Please note that should

your GP charge a higher rate than the benefit payable on your plan, you shall be responsible for payment of the difference. Please also request your GP to prescribe medication within our formulary if appropriate.

The member is responsible for payments for all medication outside of our formulary

When I see a GP/ Dentist, do I have to pay cash for the consultation?

Answer: You do not need to pay your GP in advance and there is no co-payment required by you for your consultation.

What happens if I am ill and out of town?

Answer: The Essential Employee Benefits Essential Day-to-Day Plan caters for unlimited out-of-area visits, provided they are within South Africa. Please also request your GP to prescribe medication within our formulary. The member is responsible for payments for all medication that is not within our formulary. This also applies to Pathology and Radiology.

What happens if there isn’t a Network Doctor in my area? Can I nominate my own GP?

Answer: Call Essential Employee Benefits on 086 999 0913 or email us at to nominate your own doctor. We will first establish if there is an existing GP in the area and if not, we will contact your GP to establish if he would like to join the network.

Are Specialist visits covered?

Answer: Yes, up to a maximum amount of R2000 per annum per member up to R4000 per family will be paid. You need to be referred by an EEB GP Network Provider and receive authorisation from EEB.

Do I have to select a Dentist from the Network list?

Answer: Yes, you have to select a Dentist from the Network and remember; only basic dentistry is covered i.e., preventative treatment (cleaning), pain control, fillings and normal extractions from the chair only.

Can I go to any hospital?

Answer: With an Essential Employee Benefits Combined Plan you can go to any hospital i.e., Private or State, but remember the Stated Benefits as described in the brochures.

What happens if I am ill, and I am admitted to hospital for less than 24 hours?

Answer: A member has to be admitted to hospital for a full 24 hours before the benefits are payable.

What happens if I fall ill or have an accident outside SA?

Answer: You are only covered within South Africa, but if you have an accident or fall ill in one of the immediate neighbouring countries, being Swaziland, Lesotho, Botswana, Namibia, Mozambique or Zimbabwe, you will have to travel to the nearest South African border post and request assistance by calling 010 020 9008.

How do I get admitted to hospital?

Answer: You call the Essential Employee Benefits Wellness 24hr pre- authorisation number 010 020 9008 as displayed on your Essential Employee Benefits Wellness ID Card. Quote your membership number and/or the reason for your admission (more than likely you will have a doctor’s note which you can relay to the authorisation clerk).

Always remember to carry your Essential Employee Benefits

Membership ID card with you or saved on your phone.

How do I claim my Combined plan benefits?

Answer: Following your discharge from hospital, you must ensure that all claims are submitted within 90 days following discharge from hospital. Claim can be emailed to

Any claim received after 90 days following discharge from hospital, will be declined

Remember to attach all the necessary hospital and doctor invoices to your claim. Not doing so will result in a delay in the settlement of your claim.