Emergency/Casualty

What is a medical emergency?

A medical emergency is the sudden, unexpected onset of a health condition that needs immediate medical or surgical treatment. If this treatment is not provided, the person’s life would be at risk or the emergency would result in serious impairment or dysfunction of an organ or body part.

Cover for medical emergencies in South Africa

You have access to ER24, a service that provides highly trained paramedics in response vehicles who will help you with all aspects of a medical emergency.

In an emergency, you must call ER24 on 084 124 for ambulance approval. You will find this number on your membership card and car sticker for easy reference. If you do not get authorisation from ER24 for emergency transport, you will have to pay for it.

Even in an emergency you have to let ER24 know as soon as you can after the event.

Cover for going to casualty

If you are admitted to hospital from casualty, Remedi will pay the casualty costs as long as you authorise your admission as soon as you can after being admitted.

If you go to a casualty or emergency room and you are not admitted to hospital, we will pay for the costs from your Insured-Out-of-Hospital benefit on the Comprehensive and Classic options, subject to the overall annual limit and relevant sub limits. On the Standard option it will be covered as part of the Out of Area benefit.

Cover for out-of-area and after-hours visits on the Standard option

Members are entitled to 3 out-of-area visits per family per year up to a limit of R1 350 for practices that are not part of the Remedi Standard Option network, these include pharmacies, radiology, general practitioners and pathology. The out-of-area benefit is for providers that are not contracted with Remedi Medical Scheme, any facility fee charged will be for the member’s own account.

Cover while travelling overseas

If you are overseas and need medical care, you will have to pay for these expenses. When you are back in South Africa, you must submit the claim to Remedi (translated into English), together with proof of payment. Remedi will refund you at the Scheme Rate for that specific procedure or treatment if it would normally be covered under your benefits.

These claims are paid at Remedi’s discretion.