When you have to go to the hospital

How to make sure your hospital admission is covered

Going to hospital is stressful, but the admin doesn't have to be. You might have to go to hospital for a planned procedure or in an emergency. Either way, we're here to help.

Your planned hospital stay

It's important to tell us about your hospital stay as soon as you can. Knowing exactly what we cover will reduce your stress, so that you can focus on getting better.

If your healthcare provider wants to admit you to hospital:

1. Ask who the healthcare practitioners (for example, doctors, specialists or surgeons) are who will look after you when you are in hospital and ask which hospital your doctor recommends.
2. Check if the Fund covers the condition, the treatment, and whether the healthcare professional and the hospital are on the Fund's Networks. You might have to go to another healthcare practitioner or hospital to get the best cover possible. Contact us if you are unsure, or if another healthcare practitioner will be looking after you in the hospital. This is to make sure that your healthcare practitioner is covered by the authorization we have given you.
3. Get authorisation from Engen Medical Benefit Fund. Phone 0800 001 615 as soon as you can, at least 48 hours before you go to hospital.
4. We will review the details, tell you what we will and will not pay for, and give you an authorisation number.
5. Take the authorisation number, your membership card and your ID book or smart ID card with you when you go to hospital.

If your admission is not planned and is an emergency

You can go to the nearest available hospital when it is an emergency.

The healthcare professional that is treating you, or the hospital, can obtain an authorisation from the Fund - as soon as possible after your admission. You, or any of your family members, can also contact the Fund to obtain authorisation. Before you call us, you will have to get details of your treatment from your healthcare professionals.

ER24 provides you with medical emergency transportation services.

If the unthinkable happens and you're faced with a medical emergency, like a car accident or a heart attack, there's only one number you need to remember: 084 124.

ER 24 has over 200 emergency vehicles, as well as a fleet of fixed-wing and helicopter air ambulances. They also provide access to free telephonic advice from registered nurses and trauma counsellors.

Remember, in an emergency call 084 124 - the number is available 24/7.

• Dial 084 124.
• Give your name, and the telephone number you are calling from.
• Identify yourself as an Engen Medical Benefit Fund member.
• Give a brief description of what has happened.
• Give the address at which the incident happened, as well as the nearest landmark.
• The call centre controller will be able to provide you with emergency medical advice while the ambulance is on its way.
• Stay on the call until the controller has disconnected.