What to do in an emergency
As a member of Libcare, you have access to emergency response and evacuation. Netcare 911 provides emergency transport in South Africa as well as in Namibia, Botswana, Swaziland, Lesotho or Mozambique (as far north as Beira or Vilan Culos along the coast).
Their services include:
- emergency medical response by road or air to the scene of a medical emergency.
- transfer of life-saving medication and emergency blood to the scene of an accident.
- transfer by road or air to the most appropriate medical facility when medically justified according to Netcare 911medical protocols.
- inter-hospital transfers (one way), when medically justified according to Netcare 911 medical protocols and motivated by a medical practitioner.
Please note: If you use the services of another provider for emergency transportation, you must notify Netcare 911 within 48 hours. Failure to do so may result in you being held liable for payment of the service.
Netcare 911 for emergencies within South Africa
If you are treated in hospital casualty, this is regarded as an out-of-hospital event. Fees would therefore be paid out of your available day-to-day benefit (MSF, OHEB or Threshold) and not from the Major Medical Benefit.
When casualty is used outside of normal hours and is subject to authorisation, day to day benefits are not impacted.
Casualty visits during normal hours (Monday to Friday 08:00 to 18:00 excluding public holidays) are not paid from the Casualty Benefit but rather the day-to-day benefits (MSF, OHEB, ATB)
If approved hospital admission immediately follows casualty, the casualty fee will be paid from the Major Medical Benefit up to the Libcare Rate.
Note: Authorisation is still required for a hospital admission which follows casualty - you or the hospital or the attending doctor must phone Hospital Authorisations on 0800 12 CARE (2273). Some hospitals will send the account to Libcare, others will ask for payment at the time of service. If you pay the hospital, forward the paid account with a receipt attached to Libcare for reimbursement from your available benefits.
After-hours emergencies and physical injury emergencies
Normally, if you are treated at a casualty facility, this is regarded as an out-of-hospital event. Fees would therefore be paid from of your available day-to-day benefits (MSF, OHEB or Threshold) and not from the Major Medical Benefit. Treatment in an emergency room or casualty facility that leads to pre-authorised hospitalisation will be covered from your hospitalization benefit. If not authorised, it will be subject to your other available day-to-day benefits. All claims will be processed and paid up to the Libcare Rate.
Motor Vehicle Accident Benefit
The Road Accident Fund ("RAF") is a public entity set up to pay compensation to people injured as a result of road accidents due to negligent driving of a motor vehicle within South Africa.
The RAF is liable for compensation of damages and medical treatment costs arising from a Motor Vehicle Accident ("MVA").
MVA claims are third party claims and in terms of Libcare Scheme Rules, the beneficiaries of the Scheme are required to assist the Scheme in the recovery of any benefits for which a third party may be liable.
In the event that you or your dependant is involved in an MVA, Libcare will have a claim against the RAF for medical costs incurred as a result of the accident. Therefore, monies recovered from the RAF for your medical expenses that are not due to you MUST be refunded to Libcare Medical Scheme.
Libcare has appointed Batsumi Claims Management Solutions (Batsumi) to administer the MVA claims recovery process on its behalf. To proceed with the claim, you or you dependant will be required to complete an Accident Report Form and an Indemnity Form (this is an undertaking that you will reimburse the Scheme at finalisation of the claim.)