My Scheme and benefits while I am overseas

We have received queries from members that are planning to spend some time overseas, both for work and for private reasons. These members asked us what they needed to know about the impact on their benefits, membership and entitlements while abroad in general, but also considering a possible Covid-19 treatment.

I am planning to spend some time overseas - what do I need to know about my benefits and membership?

As long as your contributions are paid in full every month, your membership stays active for as long as you are away. If you are employed, your employer will keep paying your contributions and your membership will remain active. There is a possibility that your membership can be put on hold while you are working overseas for a longer time; your employer would discuss this with you and arrange it accordingly. If you are a pensioner and fully subsidised, your contributions would continue to be paid as per your pension agreement. If you are paying part of your contributions yourself, ensure that these payments will not be interrupted. If there is a break in contribution payments, your membership can be suspended. If no payments are collected, it can be terminated. If your membership is terminated, you unfortunately cannot re-join due to the restricted nature of the Scheme. You can only (re)apply for AMS membership while you are an active employee of one of our participating employers (not a retiree) - regardless of whether you were a member previously.

Does the Scheme cover my medical expenses overseas?

For members of the Value Care Plan, the Scheme cannot assist with overseas claims at all as this is a network option limited to contracted South African providers of service and hospitals. For members of the Standard Care Plan and Managed Care Plan, the Scheme will consider your claims in accordance with the Rules and necessary authorisations. If the event meets the Scheme's criteria for cover the Scheme will assist with funding your overseas healthcare costs. You will, however, first have to pay the expenses upfront before you can claim them back from the Scheme. The Scheme can only refund an amount up to the Scheme Reimbursement Rate as if the healthcare services had been provided in South Africa and can also only pay the monies into a South African bank account. You would be reimbursed for relevant healthcare providers or hospitals once you have completed the necessary documentation (as described in the Benefit Guide and on the Scheme website). Take note that no currency conversion will be done.

What if I have to go to hospital overseas?

Whether you are in South Africa or overseas, you still have to follow the normal authorisation process before undergoing treatment. All funding conditions and reimbursement rules for hospitals in South Africa would apply, even if hospitals overseas would follow different protocols or processes.

How do I ensure that I can pay for healthcare costs overseas upfront?

To avoid outlaying the cost of healthcare services upfront, which, for catastrophic events could be a few million rands, we strongly recommend that you take out travel insurance. If you buy travel insurance, the relevant insurer can assist you with advanced payments overseas. If you qualify for benefits from another insurer, you would have to claim from that insurer before submitting a claim to the Scheme.

What about my chronic medication if I am overseas?

South African pharmacies only dispense chronic medication for one month at a time. If you are travelling for a longer period of time, please call our medicine management team on 0860 222 633 for advice and assistance. In some instances, you can get an advanced supply of medication to take with you, as long as the time frame doesn't extend into the next calendar year. The Scheme cannot prefund the next year's expected expenses. You can also speak to your pharmacist if and how they can assist you with dispensing of your medication.

I have to travel on business for my employer, will the Scheme pay my medical expenses?

Firstly, speak to your employer as they will most likely cover you under a company group insurance policy which should take care of all your expenses. If you require chronic medication, buy it in advance as described above. All other normal day-to-day healthcare expenses resulting from minor illnesses can be claimed in the same way as if you were traveling for personal reasons, provided you have not claimed them from another insurer. You cannot claim twice, and the Scheme will consider assisting you with a shortfall should there be one.

Will my expenses be paid if I get Covid overseas?

The Scheme does not treat Covid-19 any differently from any other medical condition. You will need to pay the costs upfront and claim the expenses after the event as described above. If you need to be quarantined while overseas, the Scheme will not consider your expenses as it is not a covered benefit in South Africa. For this reason, and as hospitalisation can be very expensive, we strongly recommend you take out adequate travel insurance.

Is proof of my Scheme membership good enough for my visa application?

This is dependent on the country you are visiting. You would need to consult the relevant embassy or travel agent, but in general, full travel insurance is what is required.

Published: November 2021.