What to Do in a Medical Emergency, A Quick Guide for UKZN Medical Scheme Members

Medical emergencies are stressful and often unpredictable. Knowing the right steps to take ensures you get the care you need quickly and that your medical aid covers the costs.

What Is a Medical Emergency?

An emergency medical condition is the sudden and unexpected onset of a health problem that requires immediate medical or surgical treatment. Without treatment, it could:

• Seriously impair bodily functions
• Cause serious dysfunction of an organ or body part
• Place a person's life in serious jeopardy

Examples include stroke, cardiac arrest, a fractured hip, emergency appendicitis, or a serious eye injury even if the patient is fully conscious. Only the attending doctor can determine whether a condition qualifies as an emergency. Claims must be submitted with the correct emergency codes.

ER24 Emergency Services

ER24's highly qualified emergency personnel provide medical assistance and transport, including ambulances and helicopters if needed

The Scheme covers emergency transport from your Hospital Benefit, whether or not you are admitted to hospital.

Services Include:

• Unlimited 24-hour medical assistance (ambulance services)
• Transport by road or air (ER24 decides the most suitable option)
• Transfers between hospitals (with preauthorisation and subject to Scheme Rules)
• Escorted return of minors

Full Emergency Cover

Even if your benefits are exhausted, you are still covered for life-threatening emergencies listed under Prescribed Minimum Benefits (PMBs). This means your hospital expenses will be covered until your condition is stabilised.

Cover for Casualty Visits

• If admitted to hospital: Costs for casualty/emergency room visits will be paid from your Hospital Benefit, provided UKZN Medical Scheme is notified within 48 hours of an admission.
• If not admitted: Costs will be paid from your General Benefit Pool or day-to-day benefits.
• Note: Some casualty wards charge a facility fee, which is not covered by the Scheme.

What to Do in a Medical Emergency

Step 1: Get Medical Help Immediately

• Go to the nearest hospital or emergency room or call ER24 for an ambulance.
• Do not delay treatment while trying to contact the Scheme.

Step 2: Use a Network Hospital (if possible)

• This helps reduce out-of-pocket costs and ensures smooth claims processing.
• Not sure which hospitals are in-network? Contact UKZN Medical Scheme or check the website.

Step 3: Notify UKZN Medical Scheme within 24 Hours

• Contact UKZN Medical Scheme for authorisation.
• Provide your membership number, hospital name, date, incident details, and any admission documentation.

Call: 0860 11 33 22
Email: service@ukznms.co.za

Step 4: Keep All Documentation
Save all records related to your treatment, including:

• Hospital invoices
• Admission and discharge summaries
• Doctor's notes
• Prescriptions or referrals

Step 5: Follow Up

• Confirm your claim has been received
• Check if additional documents are required
• Ensure the hospital/provider is paid directly (or that you are reimbursed if you paid upfront)