Hospital plans and emergency hospital admittance
Selfmed’s Hospital plans cover expenses that are incurred as a result of being hospitalised, or from undergoing medical procedures in such a facility. Generally speaking, the cost of an operation that has been pre-authorised by your medical aid provider will be covered, either partially or in full, by your hospital plan. Yet what happens if you’re involved in an accident? What if you have to be rushed to hospital as a result of an unforeseen medical complication?
Accidents do happen, and under such circumstances Selfmed must be informed within 48 hours of your hospital admission. While our MEDXXI hospital plan covers both pre-authorised and emergency admissions, this notification procedure is a mandatory requirement.
Most South African medical schemes will only process claims for emergency procedures that have been submitted within two working days of the policyholder’s admittance to hospital.
Selfmed’s hospital plans cover various emergency-related expenses, including ambulance services and blood transfusions. A number of additional services rendered as a result of hospitalisation may also be included in your hospital plan coverage. These are subject to pre-authorisation, and include certain consultations, scans and clinical procedures.
Medical aid hospital plans are favoured by younger, healthier individuals who are more likely to require emergency medical care than pre-authorised procedures. It is virtually impossible to predict when one will need hospitalisation, yet the Selfmed hospital plan is designed to cover unforeseen expenses arising from such events. Our professional call centre consultants are trained to handle emergency and pre-authorisation notifications with speed and sensitivity, and will go the extra mile to ensure that claims are processed as swiftly as possible.
You can rest assured knowing that, in the event of an emergency, you’ll receive professional medical care, with the majority of your expenses – if not all of them – being covered by your Selfmed hospital plan.
Significantly, the MEDXXI hospital plan pays out 100% of the Selfmed Maximum Rate if you make use of our preferred medical service providers, so bear this in mind when planning pre-authorised hospital procedures.
For emergency transfer to and from a hospital, Selfmed has contracted with ER24 as the preferred ambulance service provider. A 100% benefit is payable where the services of ER24 is utilised.