International Travel Benefit (ITB)

Daberistic are brokers for the following medical aids:

• Discovery health
• Bonitas
• Momentum Health
• Fedhealth
• Profmed

However, due to majority of our clients being on Discovery Health, we will focus the below International Travel Benefit procedure on Discovery Health.

Below are medical aid's client services and International SOS numbers:
Discovery: 0860 99 88 77,  International SOS +27 11 541 1222
Bonitas: 0860 00 21 08,  International SOS +27 11 991 8174
Fedhealth: 0860 002 153,   International SOS +27 86 000 2153
Momentum Health: 0860 117 859,   International SOS +27 11 541 1263

Majority of the major open scheme medical aid companies include international travel medical benefits, but each company's benefits are different. In lieu of the increased frequency of international tourism, the importance for medical aid to cover international travel becomes crucial.

Daberistic assists about ten international travel medical claims every year and here are two examples:
1. Mr. D traveled to Southeast Asia and was bitten by a wild monkey in Cambodia. He was taken to the hospital by the police for rabies vaccination, and additional four follow up shots. After returning to South Africa, client claimed for this incident, Discovery reimbursed majority of this incident's medical expenses.

2. Ms. M was hospitalized in Beijing for an unexpected disease for a month and put in claim to Discovery for this incident. Discovery authorized  the claim payout, once Discovery received the original bills.

Although many medical aid companies include international travel benefits, but according to our practical experience, we find that Discovery's cover is very well set up. Discovery has set up many offices overseas with providing our clients with good support, and when client reaches claims stage it becomes simple and efficient.

Below explanation for  international travel benefits is related to Discovery medical aid. Customers who are insured with other medical aid can also refer to it to understand the general contents of International travel benefits.

Discovery ITB options	International Travel Benefit (ITB) is available on the Executive, Conprehensive, Priority, Saver, Smart, and Core plans. The ITB is not available on the KeyCare plans.
What does ITB do and don't cover	Cover: The benefit covers costs associated with relevant health services obtained outside of South Africa for a condition or health even that occurs as a result of an accident or emergency, within 90 days from departure from South Africa. Cover ends on your return home, or after 90 days from your date of departure from South Africa, whichever happens first. It is important to note that ITB cover cannot be extended beyond 90 days, if you are unable to return to South Africa and your trip last more than 90 days, you will not have the same level of indemnity cover that ITB offers. You will be covered as if you were receiving care in South Africa and Discovery will reimburse your claims for the medical care you receive at the equivalent South African rates. Comprehensive, Priority, Saver, Smart and Core plans have cover for emergency medical costs of up to R5 million per person on each journey while Executive plan covers up to US$1 million. In the case of air travel: If the medical condition necessitates emergency transport and evacuation to the nearest appropriate facility and you are fit to travel, Medical Services Organization International (MSOI) will arrange this. If you are fit to travel and can return to South Africa but choose not to, the Scheme will not pay the costs of transport, evacuation or repatriation at a later stage. All medical expenses incurred after this date will be paid according to the South African global fee equivalent for your plan. If you medical condition needs hospitalization and you are unable to return to South Africa, your cover may be extended for such period as is reasonably necessary to enable you to return to South Africa, up to a maximum of 90 days from the date of admission to hospital. The cover available in terms of this benefit is subject to Rules of the scheme, and includes payment for: The usual, reasonable and medically necessary medical, surgical, relevant dental and/ or other treatment as may be provided in-hospital as authorized by a medical professional as a result of an accident or any emergency Emergency transport and evacuation to the nearest appropriate facility. The additional cost necessary for your return to South Africa to receive further treatment, as determined by the scheme. In the case of travel, the International Travel Benefit covers the cost of changing the return flight date only and/ or if required, a change to the grade of the flight booking upon review by the  Scheme, but excludes any cost of return if you are not in possession of a valid flight ticket. Don't cover: Not covered during your waiting period If healthcare professional is not qualified and registered. Optical work - refractive surgery not covered, the cost of spectacles and the cost of lenses (contact and/or insertion in spectacles). However these claims can be covered in accordance to your normal plan benefits, in line with the Scheme Rules.
Notify Medical Services Organisation Internation A.S.A.P after your emergency	If you need emergency hospitalisation while travelling overseas, notify MSOI as soon as possible after the emergency on +27 11 529 6900. If you need assistance in contacting MSOI, you can also contact the international operator of the country you are visiting and request to be connected to MSOI on reverse call charges. Once connected, MSOI will calidate your membership and confirm any waiting periods. Before they authorise the admission and issue a payment guarantee, they will also identify whether the current funding request relates to a medical or surgical condition that existed previously.
Out of hospital emergency treatment	You need to pay the first US$150 or EUR100 (European countries) in respect of emergency out-of Hospital treatment within 90 days of departure, per person per journey. The balance will be covered by the Scheme. Your medical savings account and other day to day benefits will not be used fior emergeny out of hospital treatment covered by the international travel benefit. The co-payment applies to each person, per joutney and not to each claim. If you are travelling in a country with a differenct currency, your claim will be coverted to US dollars or Euros, whicever is the most appopriate, to calculate what you are responsible for, and what we need to pay.
Dental treatment under certain circumstances	The benefit will only cover you for emergency dental treatment on sound teeth relating to temporary caps and/fillings for teeth that have broken, re-cementing of crowns and bridges, and root canal treatment for pain control. Your plan may cover you for other dentistry from your available day to day benefits, as long as you haven't reached any limits that may apply
How to claim for out of hospital emergency medical expenses	You can choose between these options: Pay upfront for out of hospital emergency medical expenses, and claim back from the scheme on your return, or if the total cost of your out of hospitl emergency claims is more that EUR100 or US$150 for each person, you can call medical services Organisation International while you are still overseas. They will provide you with approval if the claim is related to a medical emergecy and will contact your healthcare professionals overseas to make sure they are paid directly.
List of healthcare services covered at the equivalent local cost	The following may be covered in accordance with your health plan benefits at the global fee and subjects to benefit limits, where applicable: Pregnancy or childbirth when travelling contrary to medical advice, or should medical emergencies arise after the 24th week of pregnancy. If the baby is born outside South Africa, they will not be covered by the Scheme until you register them on the Scheme. Situations where you or your dependents are aware of a reason which could give rise to any claim. Situations where you or your dependents are travelling contrary to medical advice, or with the intention of obtaining medical treatment, or where a terminal prognosis has been given. Renal dialysis or chemotherapy as well as healthcare services relating thereto. Any emergency treatment for acute or chronic condition, and complications and/any other treatment that may be required as a consequence thereof, for which treatment or medical advice was received at any time during the 30 day period immediately preceding the date of departure from South Africa. Healthcare services  in respect of cancer diagnosed and/or treated within the 12-month period immediately before the date of departure from South Africa. Healthcare services in respect of organ failure diagnosed and/or treated within the 12-month period immediately before the date of departure from South Africa. Any Non-emergency, planned or elective treatment. In circumstances where you and/or your dependent uses a relevant health service and where the health service is casually related to or caused by the same condition that resulted in the accident or emergency for which the scheme has requested you or your dependant to return to South Africa for further treatment. This applies if you or your dependant fails or refuses to return even after the medical professional who is treating you whilst you are abroad, approved your return. Dentistry, except those stated as covered above. Prescribed Minimum Benefits do not apply beyond the borders of South Africa.
How to submit claims you have already paid	Discovery requires the following: Completed ITB claim form - ITB Form click here. Proof of travel dates in the form of air ticket stubs or passport stamps A detailed invoice/account in English If the original invoice/account is in another language, please provide the original invoice/account and a translated version of the account The invoice needs to include the following details: Patient name, surname, the diagnosis, provider details, date of service, treatment description and cost of the treatment. Proof of payment for all attached claims in English Confirmation of the diagnosis in a form of a doctor's report/letter in English The above details needs to be emailed to claims@discovery.co.za (Please keep all copies for your own records.)