Hospital plans don’t cover visits to the emergency or casualty rooms as these are considered ‘out-of-hospital’. Unless the scheme offers a specific emergency benefit, the visit to the ER would be paid from your medical savings. Thus, if your medical savings are depleted, you would be paying for casualty ward expenses from your pocket.
Including a casualty cover benefit on your gap plan allows for R10 000 per family per annum for emergency treatment in the casualty ward of a hospital in the event of accidental injury. Cover is also extended for emergency after-hours treatment required for illness, at a registered medical facility, for children younger than 5 years of age.