Emergency/Casualty

Even if your chosen plan has designated specific hospitals, as the providers that should be used to ensure cover in full, we will cover your emergency admission in full as a Prescribed Minimum Benefit in any hospital you are admitted to.

You, the hospital, or one of your family members must inform the Scheme of your admission as soon as possible after the emergency – and at least within 48-hours thereof.

Moving a member from a non-network hospital to one that is in the network, other than in the above situation, would only be done in consultation with the member and the treating doctor, where the member is out of danger but is likely to remain hospitalised for a lengthy period for monitoring purposes, or to receive ongoing treatment.

If you are admitted to hospital from casualty, we will cover the costs of the casualty visit as long as we pre-authorise your hospital admission. If you go to a casualty or emergency room and you are not admitted to hospital, we will pay the costs from your available Primary Care Benefits for members on TFG Health Plus. If you are on TFG Health, you will need to use only casualty facilities that are a part of the KeyCare network and will be liable for the first R355 of the consultation.