Medical care when tragedy strikes

Gary Feldman
13 December 2022
6 min read

The Smith family eagerly prepared for their annual visit to the beach. Spirits were high as they left home in the early hours of the morning to avoid the notorious rush down to the coast in the December holidays. Their trip took a turn for the worst when they hit a pothole, lost control of the car and veered into oncoming traffic. Thankfully, the family survived the accident, but with injuries that required emergency treatment. Since Mr Smith was somewhat clinical about preparing for road trips, he had perused his medical aid cover to understand the benefits available to him, in the event of an accident. If you are going away these holidays, you should too. It will alleviate unnecessary stress in moments when you need it the least.

Understanding your medical aid benefits and knowing how to access them is critical when you are a member of a medical aid scheme. The majority of registered medical schemes offer unlimited cover for planned and unplanned hospital stays. Some, however, don’t afford this cover. This is why it is so important to get a good understanding of your cover in emergency situations.

Emergency medical aid cover

In the case of an accident, an emergency vehicle will be dispatched which should be covered by your medical scheme. It may not necessarily be provided by your healthcare provider because they typically dispatch an emergency vehicle in the vicinity of the accident. If possible, you should try to inform the ambulance crew of your nearest Designated Service Provider (DSP). Depending on the nature of your emergency, the ambulance may be obliged to take you to the nearest medical facility. “Over the December 2021 festive season, a total of 1 685 people died in accidents on our roads. That’s a 14% increase compared with the 2020 statistics. This may seem like a bleak topic, but it does raise some important points. The first, most important point is that car accidents do happen and are more prevalent during the festive season. Rather be prepared for something that may very well not happen, than be unprepared if your trip takes a turn for the worst,” said Gary Feldman, Executive Head of Healthcare for NMG.


Hospitalisation is unlimited on most medical schemes. The actual rate at which members are covered for treatment in hospital will vary based on their plan choice. This rate is reflected as a percentage of the scheme rate and will increase from 100% cover to a higher percentage depending on your plan. “The injuries and deaths caused by car accidents don’t only have great social and economic impacts, but they also create a significant financial burden for the drivers and their families. Added to that, most healthcare specialists charge above the medical aid rates. Not only do you have to live without a car until yours has been repaired, but you will also face the shortfall costs of medical treatment and an insurance excess. All of this can result in a substantial financial burden during a difficult time,” said Feldman.

Life-threatening emergencies

In the case of a life-threatening emergency, members are advised to go to their closest private hospital. Depending on your plan type, you may be transferred to a hospital or other service providers once your condition has stabilised. A report released by the Road Traffic Management Corporation said that from 1 October 2017 to 30 June 2021 a total of 48 330 vehicles were involved in 37 583 fatal crashes. There were 45 232 fatalities recorded with a severity (deaths per crash) of 1.203 over the 3.80-year period. “It is not something you want to think about when you are about to leave for your annual vacation, but these shocking statistics may be what you need to make sure you know what you are entitled to when it comes to your medical aid. Print your benefit schedule out, keep it in a safe place with your medical aid card, ID document and driver’s license so that you don’t have to scramble for these documents in a state of emotional and physical shock,” advised Feldman.

Planned hospital procedures

Planned hospital procedures need to be pre-authorised with your medical scheme. You will need to phone the number on your medical aid card to get planned hospital procedures pre-authorised. In some cases, the doctor may do this on your behalf. Alternatively, the doctor will provide you with the necessary codes and descriptions to obtain the authorisation yourself. “Once again this stresses the importance of having your medical aid card handy, along with all the necessary contact details so that you don’t waste time when dealing with hospitalisations – planned or unplanned,” noted Feldman.

Consider signing up for gap cover

It is becoming more important each year to consider taking out gap cover.  Gap cover is a short-term insurance product that is purchased separately from your medical scheme. It is an effective way to make sure that you are covered for hospital shortfalls. These shortfalls arise because there is no forced regulation on provider charges. As mentioned, medical schemes often only cover up to a certain rand value, and your medical scheme may have co-payments and deductibles. Gap cover will assist in covering these resultant in-hospital shortfalls.

Research conducted by the International Transport Forum revealed that, “In 2019 the country had made strides in reducing road crash fatalities since their peak in 2006. However, the numbers are still high, especially when you compare these numbers with international averages. In 2017, road crashes cost South Africa 3.5% of gross domestic product and, between 2000 and 2018, the number of road deaths increased by 52%.”

“The bottom line is that regardless of how well you drive, you can’t control the way others drive. Even if you are cautious and follow all the rules of the road, you could still be involved in an accident – especially when the roads are busy. Be prepared, be vigilant and be patient on the roads this festive season,” concluded Feldman.

If you need help understanding the medical aid benefits that are available to you in the event of a car accident or any other emergency, you can contact NMG for professional assistance.

The NMG SA Group of Companies are authorised financial service providers t/a NMG Benefits


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