Your cover for emergency hospital admissions

Emergencies can happen unexpectedly, so it's crucial to know what to do if you suddenly need emergency treatment at a hospital. This article outlines the steps to take in an emergency, how you're covered for Prescribed Minimum Benefit (PMB) treatment when admitted to a hospital, and the differences in cover across the three Remedi benefit options.

Understanding emergency hospital admissions and PMB cover

In the event of an emergency, it's important to understand your cover and the actions you need to take. Remedi offers three benefit options: Standard, Classic and Comprehensive. Each option provides different levels of cover for emergency hospital admissions and PMB treatment. PMBs are a set of defined benefits that ensure all medical scheme members have access to certain minimum health services, regardless of the benefit option they have chosen.

The Facts

1. Remedi benefit options

• Remedi Standard
• Remedi Classic
• Remedi Comprehensive

2. PMB Hospital Network
Remedi has contracted with the Mediclinic group of hospitals to provide a PMB Hospital Network. This network aims to limit your out-of-pocket costs by ensuring full cover for PMB conditions at these facilities. Here's how it works:

• You choose a primary provider who has a Direct Payment Arrangement (DPA) with the Scheme to facilitate the admission to hospital.
• You get treatment at a hospital within the PMB Hospital Network.
• All related accounts during the admission are covered at the contracted rate or at cost provided the treatment falls within the definition of PMB level of care.

If you choose to use a healthcare provider that is not contracted with Remedi (the Remedi Designated Service Providers or Network providers), we may limit the payment to up to 100% of the Scheme Rate. However, if you involuntarily use a non-designated service provider, the costs of PMB treatment will be paid in full. This situation may occur, if you are admitted to a PMB Hospital Network facility in an emergency, and an anaesthetist who is not contracted with the Scheme is assigned to you. In such cases, you do not have the option to choose a non-designated service provider.

3. Emergency medical conditions
An emergency medical condition is defined as the sudden and unexpected onset of a health condition that requires immediate medical or surgical treatment. Without this treatment, there would be serious impairment to bodily functions, serious dysfunction of a bodily organ, or life-threatening consequences.

4. Cover details

• In an emergency, you can go to any hospital, and Remedi covers the cost for the first 24 hours or until you are stable.
• If further treatment is needed, you may be moved to a hospital within the PMB Hospital Network.
• If you choose to stay at the initial hospital, you may be responsible for costs above the Scheme Rates.

5. Hospital admissions
Hospital admissions are funded from your chosen benefit option's hospital benefit, covering hospital costs and related accounts (eg, admitting doctor, anaesthetist, radiology, pathology).

The Actions

1. Understand your benefits
   • Familiarise yourself with the benefits available under your chosen Remedi option.
2. Notify Remedi
   • In case of an emergency or after-hours admission, notify Remedi within 24 hours or on the next working day. Your family may need to send us a notification on your behalf if you are not able to do so yourself.
   • Call 0860 116 116 to speak to a consultant and get an authorisation number.
3. Choose the right provider
   • Use the Remedi app or website to find designated service providers (DSPs) and make sure your chosen providers are part of the PMB Hospital Network.
4. Keep your information handy
   • Always carry your medical scheme registration details.
   • Download your electronic membership card from the Remedi app and keep a copy in your wallet.
5. Allocate a primary GP
   • If you are on the Remedi Standard Option, ensure you have allocated a primary GP from the Remedi Standard GP Network.
6. Preauthorise casualty admissions
   • If admitted to hospital from casualty, ensure preauthorisation within 24 hours to avoid penalty charges.

By following these steps, you can make sure that you receive the necessary care in an emergency and that your PMB-related claims are paid correctly. Contact us on
0860 116 116 in the event that your claims are not paid correctly.