DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the following: 4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with: 4.1.1 their name and address; 4.1.2 their membership number and date of birth; 4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the Member’s representative; 4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required; 4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment. 4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Centre. 4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their representative shall contact a Specialty Emergency Services Call Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided. 4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents. 4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
Appears in 3 contracts
Samples: Health Insurance Agreement, Health Insurance Agreement, Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the following:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their representative shall immediately telephone the Specialty Emergency Services Control Call Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their name and address;
4.1.2 their membership number and date of birth;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Call Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their representative shall contact a Specialty Emergency Services Call Control Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
Appears in 3 contracts
Samples: Health Insurance Agreement, Health Insurance Agreement, Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the followingfollowing terms:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their name and address;
4.1.2 their membership number and date of birth;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and appropriate, cost-effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Call Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their representative shall contact a the Specialty Emergency Services Call Centre as soon as possible and in any circumstances within 48 (forty4 8(forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence in the form of the medical reportreports, original accounts, invoices, statements of accounts and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
4.3.2 Any amount approved and paid to the member shall be paid less the appropriate deductible amount, where applicable.
Appears in 2 contracts
Samples: Terms and Conditions, Terms and Conditions
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the followingfollowing terms:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their name and address;
4.1.2 their membership number and date of birth;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their representative shall contact a Specialty Emergency Services Call Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
Appears in 2 contracts
Samples: Health Insurance Agreement, Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the followingfollowing terms:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their representative shall immediately telephone the Specialty Emergency Services Control Call Centre and shall furnish the Specialty Emergency Services’ representative with:
4.1.1 their name and address;
4.1.2 their membership number and date of birth;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-cost- effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Call Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their representative shall contact a Specialty Emergency Services Call Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
Appears in 2 contracts
Samples: Health Insurance Agreement, Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the following:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their his representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their his name and address;
4.1.2 their his membership number and date of birthnumber;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their his representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-cost- effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their his representative shall contact a Specialty Emergency Services Call Control Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence proof in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
4.3.2 Any amount approved and paid to the member shall be paid less the appropriate deductible amount. This deductible amount does not apply to Platinum+.
Appears in 1 contract
Samples: Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the followingfollowing terms:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their name and address;
4.1.2 their membership number and date of birth;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their representative shall contact a Specialty Emergency Services Call Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
4.3.2 Specialty Emergency Services reserves the right to verify authenticity of the documents presented to it and shall withhold reimbursement until verification is completed.
4.3.3 Any amount approved and paid to the member shall be paid less the appropriate deductible amount.
Appears in 1 contract
Samples: Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the following:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their his representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their his name and address;
4.1.2 their his membership number and date of birth;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their his representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-cost- effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their his representative shall contact a Specialty Emergency Services Call Control Centre as soon as possible and in any circumstances within 48 (forty48(forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence proof in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty48(forty-eight) hours immediately following the Medical Emergency as specified above.
4.3.2 Any amount approved and paid to the member shall be paid less the appropriate deductible amount, where applicable.
Appears in 1 contract
Samples: Terms and Conditions
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the following:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their his representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their his name and address;
4.1.2 their his membership number and date of birth;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their his representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-cost- effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their his representative shall contact a Specialty Emergency Services Call Control Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence proof in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
4.3.2 Any amount approved and paid to the member shall be paid less the appropriate deductible amount.
Appears in 1 contract
Samples: Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the following:
4.1 10.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their his representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their 10.1.1 his name and address;
4.1.2 their 10.1.2 his membership number and date of birth;;
4.1.3 10.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 10.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 10.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 10.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their his representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-cost- effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Centre.
4.2.1 10.2.1 In the event of an incident resulting in hospitalisation medical evacuation prior to notice having been given to Specialty Emergency Services, the Member or their his representative shall contact a Specialty Emergency Services Call Control Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment transportation provided.
4.3 10.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence proof in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 10.3.1 Provided also that the same are received by Specialty Emergency Services within 90 30 (ninetythirty) days of the occurrence of the Medical Treatment Emergency and provided further that Specialty Emergency Services has been informed of the Medical Treatment Emergency within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
10.3.2 Any amount approved and paid to the member shall be paid less the appropriate deductible amount.
Appears in 1 contract
Samples: Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the following:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their name and address;
4.1.2 their membership number and date of birth;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their representative shall contact a Specialty Emergency Services Call Calll Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
Appears in 1 contract
Samples: Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the followingfollowing terms:
4.1 11.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 11.1.1 their name and address;
4.1.2 11.1.2 their membership number and date of birth;
4.1.3 11.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 11.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 11.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 11.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Call Centre.
4.2.1 11.2.1 In the event of an incident resulting in hospitalisation medical evacuation prior to notice having been given to Specialty Emergency Services, the Member or their representative shall contact a Specialty Emergency Services Call Control Centre as soon as possible and in any circumstances within 48 (forty-forty- eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment transportation provided.
4.3 11.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence in the form of the medical report, original accounts, invoices, statements of accounts and other appropriate or applicable documents.
4.3.1 11.3.1 Provided also that the same are received by Specialty Emergency Services within 90 30 (ninetythirty) days of the occurrence of the Medical Treatment Emergency and provided further that Specialty Emergency Services has been informed of the Medical Treatment Emergency within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
Appears in 1 contract
Samples: Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the following:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their his representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their his name and address;
4.1.2 their his membership number and date of birthnumber;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their his representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-cost- effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their his representative shall contact a Specialty Emergency Services Call Control Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence proof in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
4.3.2 Any amount approved and paid to the member shall be paid less the appropriate deductible amount.
Appears in 1 contract
Samples: Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the followingfollowing terms:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their name and address;
4.1.2 their membership number and date of birth;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and appropriate, cost-effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Call Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their representative shall contact a the Specialty Emergency Services Call Centre as soon as possible and in any circumstances within 48 (forty4 8(forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence in the form of the medical reportreports, original accounts, invoices, statements of accounts and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
4.3.2 Any amount approved and paid to the member shall be paid less the appropriate deductible amount, where applicable.
4.4 Fraud, Misrepresentation and the Abuse
Appears in 1 contract
Samples: Terms and Conditions
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the following:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their his representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their his name and address;
4.1.2 their his membership number and date of birth;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their his representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-cost- effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member Member. or their his representative shall contact a Specialty Emergency Services Call Control Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence proof in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
4.3.2 Any amount approved and paid to the member shall be paid less the appropriate deductible amount.
Appears in 1 contract
Samples: Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the following:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their representative shall immediately telephone the Specialty Emergency Services Control Call Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their name and address;
4.1.2 their membership number and date of birth;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Calll Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their representative shall contact a Specialty Emergency Services Call Control Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
Appears in 1 contract
Samples: Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the following:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their his representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their his name and address;
4.1.2 their his membership number and date of birthnumber;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their his representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-cost- effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their his representative shall contact a Specialty Emergency Services Call Control Centre as soon as possible and in any circumstances within 48 (forty48(forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence proof in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty48(forty-eight) hours immediately following the Medical Emergency as specified above.
4.3.2 Any amount approved and paid to the member shall be paid less the appropriate deductible amount, where applicable.
Appears in 1 contract
Samples: Terms and Conditions
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the following:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their his representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their his name and address;
4.1.2 their his membership number and date of birth;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their his representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their his representative shall contact a Specialty Emergency Services Call Control Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence proof in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
4.3.2 Any amount approved and paid to the member shall be paid less the appropriate deductible amount. This deductible amount does not apply to Platinum+.
Appears in 1 contract
Samples: Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the following:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their his representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their his name and address;
4.1.2 their his membership number and date of birthnumber;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their his representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-cost- effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member Member. or their his representative shall contact a Specialty Emergency Services Call Control Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence proof in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
4.3.2 Any amount approved and paid to the member shall be paid less the appropriate deductible amount.
Appears in 1 contract
Samples: Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the following:
4.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their his representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their his name and address;
4.1.2 their his membership number and date of birthnumber;
4.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their his representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-cost- effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Centre.
4.2.1 In the event of an incident resulting in hospitalisation prior to notice having been given to Specialty Emergency Services, the Member or their his representative shall contact a Specialty Emergency Services Call Control Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment provided.
4.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence proof in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 Provided also that the same are received by Specialty Emergency Services within 90 (ninety) days of the occurrence of the Medical Treatment and provided further that Specialty Emergency Services has been informed of the Medical Treatment within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
Appears in 1 contract
Samples: Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the following:
4.1 10.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their his representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 their 10.1.1 his name and address;
4.1.2 their 10.1.2 his membership number and date of birthnumber;
4.1.3 10.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 10.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 10.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 10.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their his representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-cost- effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Centre.
4.2.1 10.2.1 In the event of an incident resulting in hospitalisation medical evacuation prior to notice having been given to Specialty Emergency Services, the Member or their his representative shall contact a Specialty Emergency Services Call Control Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment transportation provided.
4.3 10.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence proof in the form of the medical report, original accounts, invoices, statements and other appropriate or applicable documents.
4.3.1 10.3.1 Provided also that the same are received by Specialty Emergency Services within 90 30 (ninetythirty) days of the occurrence of the Medical Treatment Emergency and provided further that Specialty Emergency Services has been informed of the Medical Treatment Emergency within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
10.3.2 Any amount approved and paid to the member shall be paid less the appropriate deductible amount.
Appears in 1 contract
Samples: Health Insurance Agreement
DUTIES OF THE MEMBER. The provision of Assistance in terms of this Agreement is governed by the followingfollowing terms:
4.1 10.1 In the case of a Medical Emergency (unless the circumstances are such as to require prior action to be taken) the Member or their representative shall immediately telephone the Specialty Emergency Services Control Centre and shall furnish Specialty Emergency Services’ representative with:
4.1.1 10.1.1 their name and address;
4.1.2 10.1.2 their membership number and date of birth;
4.1.3 10.1.3 the name, place, telephone and email where Specialty Emergency Services can reach the member and/or the representative of the Member’s representative;
4.1.4 10.1.4 a brief description of the Medical Emergency and the nature of the Assistance required;
4.1.5 10.1.5 the Member must get approval from Specialty Emergency Services before commencing any treatment.
4.2 10.2 Notwithstanding anything to the contrary contained in clause 4.1, where there is a real threat to life, the Member or their representative must endeavour to arrange for the immediate transfer of the Member to a hospital near the place of the incident by the most appropriate and cost-effective and immediate means and shall thereafter notify the Specialty Emergency Services Control Call Centre.
4.2.1 10.2.1 In the event of an incident resulting in hospitalisation medical evacuation prior to notice having been given to Specialty Emergency Services, the Member or their representative shall contact a Specialty Emergency Services Call Control Centre as soon as possible and in any circumstances within 48 (forty-eight) hours of the incident, failing which Specialty Emergency Services will not be liable for the costs incurred and treatment transportation provided.
4.3 10.3 Claims for reimbursement from Specialty Emergency Services for expenses paid and/or incurred by the Member, for which Specialty Emergency Services would normally be responsible in terms of this Agreement or which have been incurred with the consent of Specialty Emergency Services, shall be paid directly by Specialty Emergency Services to the Member, provided such a claim is pre-approved by Specialty Emergency Services and supported by documentary evidence in the form of the medical report, original accounts, invoices, statements of accounts and other appropriate or applicable documents.
4.3.1 10.3.1 Provided also that the same are received by Specialty Emergency Services within 90 30 (ninetythirty) days of the occurrence of the Medical Treatment Emergency and provided further that Specialty Emergency Services has been informed of the Medical Treatment Emergency within 48 (forty-eight) hours immediately following the Medical Emergency as specified above.
Appears in 1 contract
Samples: Health Insurance Agreement
