According to the Medical Schemes Act, emergency care and treatment are Prescribed Minimum Benefits. All medical schemes have to pay for these benefits in full.
An emergency medical condition is defined as:
The sudden, and at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment of bodily functions or serious dysfunction of a bodily organ or part, or would place the person's life in serious jeopardy.
A stroke, cardiac arrest, fractured hip or even an emergency appendicitis or serious eye injury would be regarded as an emergency, despite the fact that the patient may be fully conscious. It is impossible to give a definitive list of all possible conditions that might constitute an emergency medical condition. This determination can only be made by the attending doctor, who must submit the account under the correct emergency codes.
Ambulance and other medical emergency transport
You have access to Discovery911, a service that provides highly trained paramedics in response vehicles who will help you with all aspects of a medical emergency. You can call Discovery911 (0860 999 911) for assistance.
The following services are offered:
- Unlimited 24 hour medical assistance (ambulatory services)
- Transport by road or air. Discovery911 will determine the most appropriate mode of transfer
- Inter-hospital transfers, subject to authorisation and the Scheme's protocols
- Escorted return of minors
- 24-hour access to "Ask the doctor/nurse" health line
- 24-hour crisis counselling service
You must authorise any medical emergency transport by calling Discovery911 or 0860 999 911. Neither Discovery911 nor the Scheme will be liable for the cost if you don't do this.
If you need medically equipped transport, for example an ambulance or helicopter for a medical emergency, we will cover the costs from your Major Medical Benefit, whether you are admitted to hospital or not, as long as you called for authorisation.