When an international holiday is interrupted by a medical emergency, a travel agent's guidance on immediate communication with the insurer can make the difference between a fully reimbursed claim and a delayed administrative process.
Travel insurers say late notification and missing supporting documentation are among the most common complications in processing international medical claims. This is particularly difficult when records, such as medical reports, treatment records and itemised invoices, must be requested from overseas treatment facilities after the traveller has returned home.
Santam warned that failure to notify the emergency assistance company at the earliest reasonable opportunity could affect benefits where the delay prevents the insurer from managing the claim effectively, verifying the medical necessity of treatment, controlling costs or arranging suitable care.
“Where this does not happen, our liability may be limited under the policy terms and conditions,” said Santam.
Anrieth Symon, Head of Travel Insurance at Bryte, said: “For South Africans travelling overseas, a claim is much easier to handle if the traveller asks for help as soon as possible and collects the right documents before leaving the medical facility or returning home.”
Why early notification matters
Agents should ensure that clients – and ideally their emergency contacts – have access to the insurer’s 24-hour emergency assistance details before departure and know how to make contact as soon as the traveller is admitted to hospital, receives emergency treatment or incurs significant medical expenses overseas.
Early notification allows the assistance provider to liaise directly with the medical facility, monitor the traveller’s condition and, where appropriate, arrange payment guarantees, transfers or medical repatriation.
Symon said Bryte’s emergency contact details were available on the traveller’s insurance certificate, with assistance accessible by phone, email and WhatsApp.
Upfront payments and guarantees
Another complication can arise when foreign medical facilities require travellers to pay upfront or will not accept a guarantee of payment from the insurer.
Santam advised travellers faced with an upfront payment demand to contact the emergency assistance centre immediately and tell the medical facility that the insurer had been notified.
“Our assistance team will work with the facility to establish the required medical information and, where applicable, issue a guarantee of payment,” the insurer said.
However, Symon noted that not every hospital, clinic, or doctor overseas would accept a guarantee of payment from the insurer.
“This means that in some cases, especially for smaller outpatient treatment, the traveller may need to settle the account themselves and then submit a claim afterwards. If this happens, they should ask for the medical report or doctors’ notes, an itemised invoice and proof of payment before leaving,” she said.
“The client can claim the money back, as long as they submit the claim within 30 days of the incident along with the necessary documentation.”
Critical paperwork
Both insurers stressed that retrieving medical records from an overseas facility after returning to South Africa could significantly complicate the claims process.
According to both insurers, the standard supporting documentation required for all claims includes:
- Clear, legible copies of the medical reports and doctor’s notes
- Itemised invoices and receipts from the emergency service providers, hospitals and doctors
- Proof of payment when a policyholder pays for their treatment
- A copy of the policyholder’s full return international airline itinerary
- Copies of the traveller’s passport pages showing both exit from and re-entry into their home country
- Any additional documentation that may be requested, depending on the nature of the claim and the supporting evidence required for assessment. This can include documents such as prescriptions, test results, police reports and, in some cases, translations.
Language should not be a barrier. Both Bryte and Santam said travellers did not need to arrange or pay for translations of foreign-language medical documents.
Where the insurer’s emergency assistance provider is dealing directly with the overseas facility, translation can be handled as part of the assistance process. Santam similarly said its claims team and assistance partners would arrange any translation or interpretation required to assess a claim at no additional cost.
