Hospital AdmissionsWhat about emergency hospital admissions?
As members cannot choose and negotiate with providers in an emergency *, the Society will cover the hospital and specialist charges for emergency hospital admissions at reasonable cost, provided that the Society is informed within 48 hours or the next working day of such an admission. * Definition of emergency: The sudden and, at the time, unexpected onset of a health condition that required immediate medical or surgical treatment, where failure to provide such medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person's life in serious jeopardy. What if I need an ambulance in an emergency?
As a member of the Benefit Society, you have unlimited access to emergency medical transportation on a 24-hour basis, provided this is authorised by ER24. You and your registered dependants are covered in South Africa, Botswana, Namibia, Lesotho and Swaziland. Services offered by ER24 24-hour access to the ER24 emergency call centre Dispatch of emergency response Emergency telephonic advice Information and advice hotline Medical transportation whether by ambulance or aircraft Inter-hospital transfers
Members and their registered dependents will receive emergency medical advice and assistance. ER24's operators will guide you through a medical crisis situation, provide emergency advice and organise for you to receive the support you need - available at all times. If you have called for emergency transportation, ER24 will coach you telephonically on what you should do at the scene of the accident, while you are waiting for the arrival of the response team. All you need to do is call:South Africa - 084 124 Other countries
Botswana - 390 1601
Lesotho/Swaziland - 011 541 1218
Namibia - 061 230 505 What should I do if I need to go to hospital?
You are required to obtain pre-authorisation before any planned hospitalisation. The Society has a preferred provider arrangement with a number of hospitals throughout South Africa. These hospitals are known as 'network hospitals'. Should you undergo treatment at a network hospital for which you have obtained pre-authorisation for the procedure, you will not have to pay any additional charges from the hospital (except for the R350 co-payment). Please note that should you undergo treatment at a non-network hospital for which you have obtained pre-authorisation for the procedure, you may not receive the same level of benefit as you would have if you used a network hospital. Should you not obtain pre-authorisation for any planned hospitalisation, the Society will have no liability for any of your costs. Getting authorisation for a visit to a network hospital (see the network of hospitals here (page 16) ) is as easy as picking up the phone - simply call 0800 111 669 (toll free) for authorisation. Please remember that when hospitalised, the other component to your hospitalisation will be the costs associated with the specialists. It is your responsibility to check that the specialists' charges are at the NHRPL rates. If they are in excess of these rates, you will have to pay the difference. KNOW BEFORE YOU GO! How can I minimise money spent from my own pocket in the case of an operation?
If you are to have an operation, establish beforehand who all the service providers will be and what they will charge (relative to the NHRPL rate). If necessary, negotiate with them. Find out from your referring doctor or specialist what service providers (other than the network hospital) will be involved in your case, for example -
- surgeon
- anaesthetist
- any doctors or specialists assisting the surgeon
- follow-up treatments in hospital, such as physiotherapy, pathology tests, x-rays, etc.
Ask the doctor/service providers what they will charge in comparison with the NHRPL tariffs. (You can also phone the Society on (053) 807 3400 for information on NHRPL tariffs.) Try to negotiate with all your service providers to charge the NHRPL tariff if they quote a higher rate. If you are not successful, consider using an alternative specialist.
Network Hospitals | 
