Benefits & claims
Emergency and ambulance cover explained
By Naledi Mokoena · 4 min read · Updated 24 June 2026
An emergency medical condition is a Prescribed Minimum Benefit, so every medical scheme must cover genuine emergencies in full, including emergency ambulance transport, even if you have to use the nearest facility rather than a network one. You get treated first and sort out authorisation afterwards.
Emergencies are exactly when you do not want to worry about cover. This guide explains your emergency rights, how ambulance cover works, and what to do in the moment so the bill is the scheme's problem, not yours.
Emergencies are a PMB
By law, an emergency medical condition is a Prescribed Minimum Benefit. That means:
- The scheme must cover genuine emergency care in full
- You can use the nearest facility, even out of network, in a real emergency
- Pre-authorisation can be arranged afterwards, not before
An emergency is one where delay could cause serious harm, loss of a limb, or death.
How ambulance cover works
Most schemes contract an emergency medical services provider as the DSP for ambulances. In an emergency you call that number (it is on your member card and the scheme app), and the call centre dispatches help and directs you to an appropriate hospital. Using the scheme's emergency line means the ambulance and transport are covered under the PMB emergency benefit.
What to do in an emergency
- Call your scheme's emergency number, or the national emergency number if you do not have it to hand.
- Get the patient to the nearest appropriate facility.
- Give the hospital your membership number.
- Notify the scheme and arrange authorisation as soon as you reasonably can, often within a day or two.
Do not delay treatment to phone for authorisation first - your health comes first.
After the emergency
Once the immediate crisis is over, the scheme may move the patient to a network hospital to continue care under normal benefits. Keep all paperwork and follow up on authorisation so the emergency claim is processed as a PMB. If the scheme tries to apply a co-payment to a genuine emergency, dispute it - PMB emergency care must be paid in full.
Frequently asked questions
Are emergencies covered on every medical aid?
Yes. An emergency medical condition is a Prescribed Minimum Benefit, so every scheme must cover genuine emergencies in full, including on a basic hospital plan, even at a non-network facility.
Does medical aid cover ambulance services?
Yes. Emergency ambulance transport is part of the PMB emergency benefit. Most schemes contract an emergency services provider as the DSP, and the number is on your member card and app.
What do I do in a medical emergency?
Call your scheme's emergency number or the national emergency line, get to the nearest appropriate facility, give your membership number, and arrange authorisation afterwards. Do not delay treatment to phone first.
Can I use any hospital in an emergency?
Yes. In a genuine emergency you can use the nearest appropriate facility even if it is out of network, and the scheme must cover the PMB emergency. You may be moved to a network hospital later.
Do I need pre-authorisation for an emergency?
No. You get treated first and arrange authorisation afterwards, usually within a day or two. Emergencies are PMBs and must be covered even without prior authorisation.
What if the scheme charges a co-payment on an emergency?
Dispute it. Genuine PMB emergency care must be paid in full. If the scheme will not correct it, complain to the Council for Medical Schemes at medicalschemes.co.za with your records.
