Cover for going to casualty
If you are admitted to hospital from casualty, we will cover the costs of the casualty visit from your Hospital Benefit, as long as we confirm your admission.
If you go to a casualty or emergency room and you are not admitted to hospital, we will pay the costs according to your Health Plan:
Executive, Comprehensive and Priority Plans
We pay for these claims as a day-to-day medical expense from your available Medical Savings Account and Above Threshold Benefit.
Saver Series
We pay for these claims as a day-to-day medical expense from your available Medical Savings Account.
Core Series
You need to pay these costs as the plans in the Core Series do not have a Medical Savings Account.
KeyCare Plus
You must visit a casualty unit at a KeyCare network hospital. If you go to one of our preferred casualty units in the KeyCare network of hospitals, you pay R95 of the casualty unit’s account. The preferred casualty units are marked on the list of KeyCare network of hospitals.
You can also visit other casualty units in the KeyCare network of hospitals that are not part of the preferred casualty units. In this case you will pay the R210 of the casualty unit’s account.
X-rays and blood tests
If you need an x-ray or blood tests, we will only pay for tests on the day-to-day radiology and blood test lists
Medicine
If medicine is dispensed by the hospital casualty unit, we will pay up to R100 for the medicine for each person. No medicine list will apply. If your treating general practitioner in the casualty dispenses medicine, we will pay up to the Discovery Health medication rate and not apply any medicine list or the R100 limit. If your chosen GP dispenses the medicine, we will only pay for the medicine if it is on day-to-day medicine list. If you get your medicine from a pharmacy after their casualty visit, we will not cover it.
Specialists
Any specialist visits in casualty will be paid from the Specialist Benefit limit of R2 000 for each person each year.
Note that not all KeyCare network hospitals have casualty units. See the list of hospitals and casualty units
KeyCare Core
We do not cover casualty visits on the KeyCare Core Plan.
