Winding up in hospital in South Africa can be catastrophic…even with medical aid.
Imagine ending up in hospital overseas where local medical aid doesn’t work?
Recently this happened to two of our clients. Both were smallish claims under R5, 000 and they both settled their own bills. But both wanted to know if they could claim.
We can’t speak for all medical aid schemes, but this is how Discovery Health handled it. Your scheme should offer something similar.
All we had to do was email them:
- the invoice
- The client’s proof of payment
- The Discovery Health international travel benefit claim form, and
- A copy of their passport showing the exit and re-entry stamps (which is important because Discovery only covers clients for 90 days outside the country).
Discovery Health then reimbursed them in full since it was an emergency. The good news is that it didn’t come out of their day-to-day savings benefit at all. There was, however. a co-payment since the treatment happened outside of hospital.
By the way, receiving any treatment while in casualty ward isn’t the same as being admitted to hospital. To avoid the co-payment, they needed to be admitted.
But what if the hospital wanted payment upfront?
Hey, it’s bad enough having to make an R8, 000 co-payment upfront here. Imagine an $8, 000 deposit that side?
The good news is that Discovery Health will pay the hospital directly through ER24. The amount they’ll pay is limited to:
- $1 million (around R13 million depending on exchange rates) for clients on their Executive plan, and
- R5 million for clients on all other plans except for KeyCare (which doesn’t qualify).
How does this work in practice?
First thing is, you contact ER24 immediately.
Got no money to make contact? I believe ER24 even accept reverse call charges. ER24 will then:
- confirm your membership, and
- Check that no waiting periods apply
If there aren’t any issues here, they will authorise the procedure and issue a payment guarantee to the hospital.
If you need to be evacuated, ER24 will arrange this as well.
And what if you’re so sick that you cannot be evacuated? Discovery Health will extend the 90-day cover with up to 90 extra days.
The question now is…
What if this wasn’t an emergency?
The same question can be asked about treatment happening after the 90 days travel benefit has expired.
If the treatment:
- is available in South Africa, and
- it is covered by your plan in terms of the rules of the scheme
Discovery Health would reimburse you at what they refer to as a Global Fee.
Basically, this is the average amount they have paid for similar claims in South Africa. The amount paid will also depend on the plan you’re on.
You, on the other hand, would need to pay for the expense upfront and claim from Discovery Health.
What if you’re just taking a chance?
Let’s say you’re not a fan of the local healthcare system and believe there are better doctors overseas.
You concoct a plan whereby you:
- pop over to the US,
- have the operation done there, and
- claim from Discovery.
Will they pay?
No, they won’t. Instead of covering you for the R5 million or so, they will pay a global fee amount which we’ve explained above.
If you’re not on Discovery Health, find out if your medical scheme has a similar benefit. If not, then make sure you take out enough travel insurance to cover the risk.
Secondly, familiarise yourself with the wording of your travel benefit. In the case of Discovery Health, make sure your membership number is available as well as the contact number for ER24. Discovery Health has an app which can assist with all of this.
And don’t worry if you forgot to notify Discovery Health when you popped overseas two weeks ago. Your passport stamp – or plan tickets – are all they need as proof.
And what if you fly overseas regularly?
The 90-day window period at Discovery Health starts afresh every time you leave South Africa.
If you are interested in receiving further information on new Discovery Health Plans for 2019, even if you’re currently a member, leave your details below.
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