Immediate Actions in a Health Emergency

Knowing the correct procedures during a medical emergency is crucial for all Affinity Health members. When an urgent health situation arises - be it a car accident, sudden illness, or a severe injury - your rapid, informed response can make a meaningful difference. Below you'll find the key steps to follow to access the emergency benefits of your Affinity Health plan.

• Remain calm and assess the situation for any immediate dangers.
• Call emergency medical services or an ambulance. Clearly state your location and details of the emergency.
• If you are an Affinity Health member, inform the responder and be ready with your plan membership details.

Emergency Authorisation Process

Emergency cover is included on every Affinity Health plan, with no waiting period and no need to activate these benefits. Affinity Health provides an emergency coordination benefit for eligible hospital plan members. This ensures necessary ambulance transfer and hospital admission authorisation are aligned with your policy. To ensure smooth approval of your benefit:

• Once an ambulance is dispatched, notify Affinity Health’s emergency line as soon as it is safe to do so.
• Provide your member number, full name, and a clear description of the incident.
• Affinity Health will authorise hospital admission and coordinate with the attending medical response team.

For a complete overview of plan options that include emergency medical response, please submit a contact form via our Hospital Plan page.

Choosing the Hospital Facility

Affinity Health offers flexible hospital choice. In a life-threatening situation, the paramedics may transport you to the nearest facility for stabilisation, but your benefits are available at any hospital. Once stabilised, you may be transferred, if necessary, for ongoing care. You can check the most up-to-date provider list via Find a Hospital Provider on our site.

What Happens After Emergency Admission?

Once you have been admitted to a facility, it’s important to follow Affinity Health’s claims and communication protocols to ensure a seamless claims process and continuous care.

• Notify Affinity Health as soon as reasonably possible if you were unable to do so prior to admission.
• Keep all documentation - ER reports, ambulance slips, referral notes - as these will be required for benefit processing.
• An Affinity Health case manager may liaise with the treating medical team to confirm eligibility of care and manage benefit usage.

Understanding Post-Emergency Cover and Exclusions

Hospital plan benefits are designed for accidental injury, acute illness, or sudden medical need. Extended or elective procedures may not be covered. Elective procedures should be scheduled only after any applicable waiting period ends. Always review what your plan includes by checking your latest policy documents.

• Emergency admissions are for medically necessary events such as trauma or sudden illness requiring immediate intervention.
• Outpatient follow-up care, chronic treatment, or rehabilitation are usually not included in the emergency hospital benefit but may be included under Combined or Day-to-Day plans. See Combined Health Plan details for broader coverage.

Tips to Prepare for an Emergency as a Member

• Save Affinity Health emergency numbers in your phone, and let your close family members know where to find your membership details.
• Check the nearest private hospitals in your area for access in an emergency.
• Understand your benefit limits by reviewing your plan specifics, which can be found in your latest policy documents.

Sources

• Affinity Health - Hospital Plan Information
• Affinity Health - Find a Hospital Provider
• Affinity Health - Policy Details and Limits
• Affinity Health - Homepage
• South African Government - Emergency Medical Services