Benefits: Emergency Transport

 

What must I do in an emergency that requires transportation by ambulance?

You and your registered dependants who are resident in RSA, and qualifying members and registered dependants resident in Botswana and Namibia (subject to the conditions outlined under Where you are covered, have unlimited access to emergency medical transportation 24 hours a day, provided that this is authorised by ER24. Members are also covered for emergency transportation/evacuation by ER24 within Lesotho and Swaziland. No benefits are, however, allowed for any treatment in Lesotho and Swaziland.

In addition to emergency transportation, you can also obtain emergency medical advice and assistance from ER24. ER24’s operators will guide you through a medical crisis, provide emergency advice and organise for you to receive the support you need. This service is available on a 24-hour basis, 365 days of the year.
 

When should I call an ambulance, and when not?

Avoid having a claim rejected for ambulance transport by understanding exactly when you should, and when you should not, phone for an ambulance to take you to hospital. The most important factor when deciding whether an ambulance is appropriate or not, is whether the situation is a real emergency, or not.

Please note that there is no ambulance cover to go for tests, ambulances should always be available for real emergencies.

The Society and ER24 have embarked on a stringent programme to decrease the misuse of ambulances and to try to ensure that ambulance transports are reserved for patients who fit the definition for emergencies.

All ambulance cases will be audited to assess whether the patient was admitted into hospital and/or whether there was a need for specialised emergency care. If the patient was not admitted and did not require specialised care, the ambulance claim may be rejected, and the member may be billed privately for the transportation.
 

Will an emergency admission to any hospital be covered?

The Society will cover the hospital and specialist charges for emergency hospital admissions in RSA and for qualifying members resident in Botswana and Namibia at cost, provided that it is a justified admission and the Society is informed of the admission on the next working day.

What is an emergency?

The definition is as follows: “An emergency medical condition means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical treatment and/or an operation. If the treatment is not available, the emergency could result in weakened bodily functions, serious and lasting damage to organs, limbs or other body parts, or even death.”

 

What if a non-ER24 service provider is dispatched?

If ER24 dispatches a non-ER24 ambulance service in response to your call, your ambulance benefit will be paid. However, please note that a member will receive no ambulance benefit where the call out was not medically justified and ER did not authorise the claim or where ER24 is not contacted.
 

What if the emergency occurs outside RSA?

If you are an RSA citizen, resident in RSA and are travelling on holiday to Botswana or Namibia or, for that matter, to any other country in the world, you will NOT be covered by ER24 or by the Society. You are therefore encouraged to arrange appropriate travel insurance including medical evacuation (except for Lesotho and Swaziland for medical evacuation) in good time before your departure.

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