Emergency Medical Insurance STANDARD
Covering Cost for Emergency Procedure(s) from Unexpected Complications that are not covered by your Medical Aid.
ZAR 20,000 Limit
The insurance covers YOU for those costs that arise from Unexpected Complication(s) whilst YOU undergo an Elected Procedure.
or during the Recovery Period YOU require an additional Emergency Procedure.
YOU are not covered if the the complication(s) arise as a result of any Pre-existing Medical Condition.
Underwritten by: Abelard , an authorised FSP
Medical Emergency Expenses - ZAR 20.000
Medical Emergency Expenses
What Is Covered?
YOU are covered for an Unexpected Complication(s) arising whilst YOU are undergoing the "Elected Procedure" or occurring during the Recovery Period and requiring an Emergency Procedure to be undergone by YOU the Insured Person.
The “Elected Procedure” means any cosmetic medical procedure undertaken by YOU, performed by a Medical Practitioner and the costs of which, or any procedures resulting therefrom, are not paid by a Medical Scheme.
Emergency Medical Expenses or costs shall mean all actual expenses necessarily incurred by YOU in respect of the Emergency Procedure, within 3 (three) months of the completion of the Elected Procedure;
The “Emergency Procedure” means a medical procedure or treatment, which a Medical Practitioner in his/her professional opinion believes to be necessary to treat an Unexpected Complication.
What Is Not Covered?
The Insurers shall not be liable to pay YOU the Insured Person in respect of claims:
1 due to alleged or proven medical malpractice or negligence by the Medical Practitioner performing the Elected or Emergency Procedure;
2 for Medical Expenses incurred in administering and performing the Elected Procedure for which YOU were admitted;
3 for Medical Expenses incurred for any subsequent surgery or procedure(s) undertaken byYOU with the aim of:
(a) improving the Elected Procedure, or
(b) acquiring the effect originally intended or desired from the Elected Procedure; or
(c) restoring YOU to YOUR physical appearance as prior to the Elected Procedure; and
which does not fall within the ambit of Emergency Procedure;
4 directly or indirectly caused by, contributed to or arising from ionising radiations or contamination by radioactivity;
5 for costs incurred for rest cures, sanitorial or custodial care or periods of quarantine or isolation;
6 for and/or arising out of, caused by or contributed to by suicide (or any attempt thereat) or intentional self-injury or exposure to obvious risk of injury (unless sustained in an attempt to save human life);
7 where YOU have not complied with all medical advice for treatment and/or precautions to be followed by YOU during the Recovery Period;
8 arising from the unreasonable or wilful neglect or failure by YOU to seek and remain under the care of a qualified member of the medical profession once Unexpected Complications manifest.
If the Insurers allege that by reason of this Exclusion, any claim is not covered by this Policy, the burden of proving the contrary shall be upon YOU.