Can you use your health insurance in emergencies?
Medical emergencies can happen at any time. Without insurance cover, you may find yourself in need of medical attention that will leave you out of pocket.
However, even if you do have medical insurance, certain insurers may not cover your emergency bills, depending on the contract you have with them.
So, what constitutes an emergency?
There are no actual ‘definitions or parameters’ to what constitutes a medical emergency, as this is usually determined on the spot by medical professionals such as the ambulance personnel or the medical doctor who responds to the event.
What does the SA Constitution say about emergency treatment?
Section 27(3) of the Constitution states that “no one may be refused emergency medical treatment”. Susan Erasmus of Fin24 says “… it is a provision that is not without its complexities and ethical problems, and the law states that even private healthcare establishments have to render basic medical treatment “without fear, favour or undue financial demand”.
Does Affinity Health cover emergencies?
When it comes to your cover with Affinity Health, you are covered by among other, a day-to-day plan, a hospital plan or a combination of the two. There are also several booster options for maximum cover.
If you have day-to-day cover, you receive casualty room treatment as a result of an accident before the commencement date, of up to R1 000 per policy. This benefit has a one month waiting period from the date of approval.
Affinity Health’s hospital plan gives you 24/7 Emergency medical advice, ambulance services and inter-hospital transfers, hospital pre-authorisation required to arrange a guarantee of payment to the treating facility.
Pre-Authorisation must be obtained in all instances, including emergencies prior to admission. Pre-authorisation can be obtained by contacting Affinity Health by telephone on 0861 11 00 33, on WhatsApp at 071 314 5862 or by sending a “please call me” to 071 314 5862. Upfront payments are available to all treating hospitals.