When you need emergency medical treatment, the last thing you want is to get hurt twice - by admin, facility and other ER fees. These are the sort of fees which your medical scheme says they "cover", but ultimately come from your pocket savings or day to day benefits.
Easy-ER is a first-of-its-kind KeyHealth initiative that offers all KeyHealth Beneficiaries regardless of their age, free emergency medical cover without any hidden costs.
What is Easy-ER?
- Easy-ER used to only apply to the children of KeyHealth members, but as from 2016 this benefit has been extended to include the entire family.
- Easy-ER gives each Beneficiary direct access to a hospital's Emergency Room (ER) for medical treatment in emergency situations. This immediate access comes without any hassle or unexpected fees. That's right, KeyHealth guarantees full payment in such emergency situations.
- These emergency circumstances may include:
- Sport injuries;
- Playground accidents;
- Car accidents;
- Sudden illness that requires immediate ER care;
- And many other trauma situations/events.
The Easy-ER card for children
One of the greatest things about Easy-ER is the card for children. The reason behind the Easy-ER card is to ensure that all KeyHealth children are able to get immediate access to a hospital's ER facility, even if they do not have a parent with them.
Easy-ER cards have very specific design styles to represent each child's life stage and these cards will certainly be something that they will want to keep with them wherever they go.
Each child's beautifully designed Easy-ER card contains all the details to effectively confirm the eligibility of the child when he or she requires emergency medical care at a hospital's ER facility.
What makes this extremely significant is that the child will gain free access to the ER facilities immediately upon presenting the Easy-ER card. That's surely something that will help any parent sleep just that little bit easier, knowing that your child is well looked after, especially in these most unfortunate circumstances.
In the event that the child does not have the card with him or her, eligibility can be confirmed by calling the 24-hour free call centre number on the card and providing the necessary membership details.
Benefits of Easy-ER
- No upfront payment required.
- KeyHealth guarantees payment of the full ER event – subject to Triage System definition criteria (see TRIAGE section).
- Up until now, this payment was made from the savings/day-to-day benefit (where applicable). If a Member’s savings/day-to-day benefits are exhausted, or their option does not include savings/day-to-day benefits (e.g. Essence) then the amount will be payable by the Member. With Easy-ER this is no longer the case. Even if the Member doesn’t have normal benefits available, the full cost of the ER visit will be covered.
What you must know
- Easy-ER is available to all KeyHealth beneficiaries regardless of their age.
- Easy-ER guarantees free access to and treatment at any hospital ER facility for emergency/trauma situations.
- If a beneficiary gets admitted to hospital, subsequent to the ER treatment, the normal hospital benefit will apply.
- Easy-ER provides a 24-hour free call-centre to confirm eligibility of the beneficiary.
- The call-centre can be contacted on 080 111 0215.
- This call line is not for hospital pre-authorisation, medical advice or any other uses.
- In the event that the beneficiary requires emergency transport (e.g. ambulance services) the normal procedure must be followed. In cases like this the Scheme’s emergency transport provider, Netcare 911, must be called on 082 911.
- By presenting the card, or confirming eligibility through the call-centre, the beneficiary will gain access to the ER facilities without any payment requirements.
- In the case of a dental emergency, based on the above mentioned criteria, the child can go directly to the dental practitioner for treatment. A visit to the hospital’s ER facility is therefore not a pre-requisite to qualify for Easy-ER related dental treatment.
- All ER facilities use a specific system to manage the treatment and flow of patients. This system is called Triage, and it uses colour codes to categorize the priority of patients’ treatments based on the severity of their condition.
- For a Green classification only normal benefits will apply. The child will still gain access to the ER facilities but because Green is not defined as an emergency situation, payment will be made from the normal savings/day-to-day benefits (where applicable).
- For Yellow, Orange and Red, Easy-ER ensures direct access to the ER facilities, no questions asked, and KeyHealth will cover the full ER cost.
- It is daytime (during working hours) and you are able to, and your condition allows you to visit your GP instead of going to an ER facility.
- Yourcondition allows you to wait to see your GP, and you don’t need emergency medical care immediately.
- You are familiar with the Triage system, and you are aware that your condition is classified as “Green” (see TRIAGE section).
- Your condition is a recurring condition which had previously been successfully treated by a GP.
- The condition you are suffering from is toothache, an abscess of the tooth or you damaged your tooth by biting or chewing.
*If you answer yes to any of the abovementioned questions your condition is not classified as an emergency.
*If, after working hours, you are unsure whether your condition meets the Easy-ER criteria, rather choose the safer option and get ER treatment as soon as possible.
Please note: The benefits of Easy-ER should not be abused. In instances when this benefit has been abused, KeyHealth reserves the right to recoup any monies from the Principle Member by any means possible, and to suspend the Easy-ER benefits of such a Member immediately.