*The content is brought to you in partnership with Discovery Health
By Chris Bateman
A near-catastrophic fall that left a South African travelling in the United States in hospital with a brain haemorrhage and cervical spine fracture, has highlighted the broad reach of Discovery Health Medical Scheme’s (DHMS) basket of international travel medical cover.
Spending 24 days in a US hospital at a cost of over R200,000 per day, the Discovery Health Medical Scheme member, a friend and client of popular radio and television insurance commentator, Brian Hirsch, is one of the rarer cases that reached Discovery Health Medical Scheme’s R5 million pay-out limit on the International Travel Benefit. This benefit is offered across all DHMS plans, except KeyCare and has an extended R10 million limit on the Executive Plan. Confirming the pay-out and how it reassured a highly emotional and anxious family, Dr Ryan Noach, Deputy CEO at Discovery Health, said many similar claims were regularly paid out, although this case was rare in reaching the limit. Designed to cover the vast majority of DHMS’s member travel claims, the cover kicks in for 90 days from the day a traveller leaves SA. Noach said that Discovery Health, through its assistance partners, has a solid and strong network of healthcare providers internationally, to ensure immediate attention to DHMS members wherever in the world they might face a medical need.
The dire potential consequences of no cover
Noach warned that the consequences of neglecting to take out travel insurance when travelling internationally could be dire if you found yourself in need of medical attention. “The hospitals will continue to treat, particularly when a patient is in dire straits. But they will pursue the family for the debt often leading to lifelong indebtedness. The expenses ramp-up very quickly and the hospitals will do their utmost to recover the debt from families, wherever they may be”.
Samantha Patron, MD of SP Health Solutions, said Discovery Health was the forerunner in making such cover part and parcel of their product offering, but warned people with pre-existing conditions to take note of the exclusions linked to the policy. She pointed out that in the aged, and in those with pre-existing disease, the claims data demonstrated that there is greatest potential “for things to go wrong”. The first imperative for travellers was to know the rules and regulations governing cover, and not to make assumptions. ‘Read the fine print,’ she advised, “…and consider an additional travel insurance policy if you’re at high risk to complement the DHMS cover”.
Noach added that through the Discovery smartphone application, any eligible member can secure proof of travel cover and will receive the five-page international travel brochure setting out the policy cover details. He encouraged that all DHMS members who are traveling, do this before they left SA shores. The brochure sets out the detail of pre-existing exclusions, which should be carefully considered prior to travel. In fact most, if not all travel insurance policies carry similar or broader pre-existing illness exclusions. Discovery Health pays for all emergency care overseas, but may not to pay for elective care, in non-urgent circumstances, Noach stressed. He cited a current claim in which a South African motor-cross rider fell and twisted a knee, breaking a knee ligament. He was currently stable and three weeks’ post-injury – but required elective surgery. Noach said the emergency care was covered but the elective surgery was declined – on the grounds that he could safely travel home to receive care in SA. In this case DHMS offered to arrange business class accompanied travel home for the patient. Patron warned that the travel cover often offered automatically by credit card companies was too often deemed sufficient by travellers, who failed to even check the terms and conditions.
Non-hospital emergency care rules
In terms of the DHMS International Travel Benefit, Out-Of-Hospital medical emergencies required an up-front co-payment of US$ 100 or US$ 150, (for each person and each journey), but Discovery Health would pay the remaining balance in full. All currencies would be converted to US dollars or Euros, whichever was the most appropriate.
To lodge a claim, a detailed original account from the healthcare provider, and an International Travel Benefit (ITB) claim form are required, plus proof of travel dates (air tickets or passport stamps). All claims must include proof of payment. The only exception to the 90-day overseas cover rule is if your plan covered you for freely available elective treatment at home, in terms of the Scheme rules. Should treatment met the criteria, the member may submit their claim upon return to South Africa. Payment would be based on the SA benchmark equivalent treatment, (medically appropriate with clinical protocols applying) also known as a “global fee”.
A list of healthcare services covered at the South Africa global fee (i.e. not covered by the International Travel Benefit structure but possibly covered by your specific plan) is available from Discovery Health or from its website at www.discovery.co.za.