I will be travelling outside the borders of South Africa. Does Anglovaal Group Medical Scheme provide benefits for healthcare services I receive in other countries?
If you're going overseas and you need travel insurance, please contact one of the following prior to departure to arrange for this:
- Your travel agent
- Your bank
You will have to pay for all emergency hospital and non-hospital expenses upfront and claim from the Scheme when you return to South Africa. You will be reimbursed at the Scheme Rate and in accordance with your Scheme benefits. Please call 0860 100 693 for more information on your cover.
1. What must I do if there is an emergency and someone in my family needs an ambulance?
In an emergency, go straight to hospital. If you need medically equipped transport, call Discovery 911 on 0860 999 911, this number is displayed on your membership card and car sticker for easy reference. This line is managed by highly qualified emergency personnel who will send air or road emergency transport to you, depending on which is most appropriate.
If you are admitted to hospital, it is important that you, a loved one or the hospital let us know about your admission as soon as possible, so that we can advise you on how you will be covered for the treatment you receive.
For medically equipped transport, for example an ambulance or helicopter for a medical emergency, we will cover the costs from your Hospital Benefit, if you are admitted to hospital or from the Insured Procedures Benefit (IPB) if you are not admitted to hospital. We will cover your emergency transportation at 100% of the Scheme Rate, subject to an annual limit.
2. Do I have cover if I have a medical emergency and I need to go to a casualty room?
What is a medical emergency?
A medical emergency is the sudden and unexpected onset of a health condition that needs immediate medical or surgical treatment, where failure to provide this treatment would result in:
- Serious impairment to bodily functions
- Serious dysfunction of a bodily organ or part
- The person's life being placed in serious jeopardy.
Cover for going to casualty
If you are admitted to hospital from casualty, we will cover the costs of the casualty visit from your Hospital Benefit, as long as we confirm your admission. If you go to a casualty or emergency room and you are not admitted to hospital, we will pay the costs from your day-to-day benefits. Some casualties charge a facility fee, which we do not cover.
3. Who do I contact for pre-authorisation?
We cover you in hospital for emergency and planned hospital admissions. In an emergency, go straight to hospital but call us or get someone to call us within 12 hours. For planned hospital admissions, please call us 48 hours before you go to hospital to confirm your admission.
Before you go to hospital for any planned procedure, you must:
- See your doctor
- Call us on 0860 100 693 to confirm your hospital admission at least 48 hours before you go to hospital. If you do not confirm your admission, we will only pay 70% of the costs that we would normally cover.
When you contact us, give us the following details:
- Your membership number
- When you will be admitted to hospital and how long you will stay
- The date of the procedure
- The name of the hospital or clinic
- Your treating doctor's name, practice number and phone number
- Your diagnosis (ask your doctor for the ICD-10 diagnosis code)
- The procedure name
- If one of your dependants is admitted, give us their details.
- There is no overall hospital limit on the Anglovaal Plan.
- Limits apply to some healthcare services and procedures.
4. What is an MRI scan?
MRI is short for magnetic resonance imaging, which is a procedure that creates images of the human body without the use of X-rays. It is an imaging technique used to view internal structures of the body, particularly soft tissue.
5. What is a CT scan?
A CT scan is a special radiographic technique that uses a computer to incorporate X-ray images of the body into a two-dimensional image.
6. Do I have cover for MRI and CT scans?
If an MRI or CT scan is done as part of a pre-operative work-up for a planned surgical procedure, in other words the scan could have been performed before the admission. We will pay the MRI or CT scan as an out-of-hospital scan.
How we pay MRI and CT scans needed for conservative back and neck treatment
If an MRI or CT scan is needed during an approved admission for a chronic back or neck condition, we will pay the MRI or CT scan as an out-of-hospital scan.
In-hospital
We pay approved MRI and CT scans performed during an approved hospital admission from the Hospital Benefit as long as the scan is related to the reason for the admission.
Out-of-hospital
We pay the account from the Insured Procedures Benefit, up to an annual limit per family per year.
1. Do I have to get a preauthorisation number for specialised dentistry?
When you need dental treatment done in a hospital, you must contact us by calling 0860 100 693 to preauthorise your hospital admission, at least 48 hours before you go to hospital. It is always better to contact the contact centre beforehand to verify your benefits and to find out if there will be an amount you have to pay yourself (co-payment) and if a particular treatment will be covered.
2. How do I find the details of the doctors in the AVGMS network?
If you are looking for the nearest doctor, go to 'HOSPITAL AND DOCTOR VISIT' and click on 'Going to see a healthcare professional'. You can search by healthcare professional name or by area.
3. I need to submit a claim, how do I do that?
Various options of submitting your claims to the Scheme are available to you:
- Download the Discovery app and submit your claims by taking and submitting a photo of your claims, using your smartphone camera
- Use our website to submit your claim
- Send your claims in hard copy to PO Box 652509, Benmore, 2010
- Email your claim to claims@avgms.co.za
- Fax your claim to 0860 329 252
4. How do I access my claims statement?
You can obtain your claims statement as follows:
- After a claim has been submitted, an email will be sent to the email address registered with the Scheme to confirm receipt of the claim and the amounts processed and paid.
- Download the Discovery app and use it to request a copy of your claims statement.
- You can also view your claims history using the Discovery App.
- Claim statements may also be viewed and downloaded via the website.