Emergency/Casualty

Even if your chosen Benefit Option has designated specific hospitals as the providers that should be used to ensure cover in full, we will cover your emergency admission in full as a Prescribed Minimum Benefit in any hospital you are admitted to.

You, the hospital, or one of your family members must inform the Scheme of your admission as soon as possible after the emergency – and at least within 48-hours thereof.

In the case of LA KeyPlus or LA Focus members, where only certain hospitals may be used for planned procedures and non-emergency PMBs, the Scheme will not transfer members to another hospital, except where the required medical treatment is not available from the non-network hospital to which the member was admitted.

Moving a member from a non-network hospital to one that is in the network, other than in the above situation, would only be done in consultation with the member and the treating doctor, where the member is out of danger but is likely to remain hospitalised for a lengthy period for monitoring purposes, or to receive ongoing treatment.

If you choose to stay in the non-DSP hospital (without further clinical motivation), we will pay your claims in terms of the specific rules of your chosen benefit option and you may have to make a co-payment or self-fund the shortfall.