Casualty
If you are treated in a casualty section or emergency room of a hospital, and you are not directly admitted to hospital from the facility, we will pay the claims for the casualty treatment from your from your Day-to-day benefits (Medical Savings Account, IPB or ATB), subject to available funds. However, if you are admitted to hospital from the casualty section, we will pay your claims from the Major Risk Benefits.
On LA KeyPlus all casualty outpatient treatment must be authorised by the Scheme at the time of the treatment. If the services are obtained from a provider in the Scheme’s Casualty Network DSP, you will have to pay the first R185 of the costs. If the casualty services at one of the KeyCare Network Hospitals are used, you will have to pay the first R185. Any pathology, radiology, medicine and specialist consultations that form part of your casualty visit will be subject to the Scheme’s formularies and clinical entry criteria.
Please note: some casualty sections may charge a facility fee. This will not be covered by the Scheme (most other medical schemes won’t pay these fees).