What you need to know about medical emergencies

Definition of a medical emergency

According to the Medical Schemes Act 131 of 1998, an "emergency medical condition" is defined as "the sudden and unexpected onset of a health condition that requires immediate medical or surgical treatment. If not treated immediately, it could result in serious impairment to bodily functions, serious dysfunction of a body organ or part, or place the person's life in serious jeopardy."

Let's have a closer look at the key criteria for an emergency

1. Sudden and unexpected: The health condition must arise suddenly and be unexpected, not something you've been dealing with for weeks.
2. Immediate treatment required: The condition must need immediate medical or surgical treatment. Waiting for treatment would not be an option.As part of our ongoing commitment to enhance security and protect your personal information, we are pleased to announce the implementation of multi-factor authentication (MFA) on our website. Your privacy and data security are ourtop priorities. By implementing MFA, we aim to safeguard your account against unauthorised access and potential cyber threats.
3. Serious consequences: Without immediate treatment, the condition could lead to serious impairment, dysfunction of a body part or organ, or death.

What to do in case of an emergency

1. Seek immediate medical attention: Get to the nearest hospital or medical facility as quickly as possible. Your health and safety are the top priority.
2. Authorisation: You do not need pre-authorisation for emergency hospital admissions.
3. Contact the Scheme: As soon as possible, preferably the next working day, call us, or ask somebody to call us on 0860 222 633 to inform us of your emergency admission.
4. Follow-up: Ensure you follow any additional instructions provided by the Scheme for submitting claims and obtaining necessary authorisations for ongoing treatment. Check all your claims carefully to ensure information on the claims is correct.

Example

If you experience food poisoning with vomiting and diarrhoea, it might feel as if it is an emergency. Unless it leads to severe dehydration or other complications that threaten life or bodily functions, it does not meet the emergency criteria.

Published December 2024