Who pays when you get sick on a business trip?

The onus is on you to check your cover

As your mental bandwidth is taken up with details of meetings and budgets, you might not give any consideration to your medical cover in the event of you falling ill.

As an employee you might not be willing to use your personal medical benefits for a business trip. Picture: 123RF/HONGQI ZHANG
As an employee you might not be willing to use your personal medical benefits for a business trip. Picture: 123RF/HONGQI ZHANG

When your company sends you on a business trip, you tend to be far more detached from the arrangements than when you plan a holiday.

And as your mental bandwidth is taken up with details of meetings, presentations or budgets, you might not give the extent of your medical cover in the event of a medical issue a moment’s consideration. Is this cause for concern?

In terms of the cover afforded by your medical scheme, for the three largest open medical schemes in SA — Discovery Health Medical Scheme, Bonitas Medical Scheme and Momentum Health — it makes no difference whether the purpose of travel is business or leisure: you receive the benefits in line with the level of cover offered by your benefit option.  

When you travel within SA, your cover does not change, says Deon Kotzé, head of research & development at Discovery Health. However, if you have selected a network plan, you need to continue to use the relevant network of hospitals and doctors.

“When travelling outside SA, all Discovery Health Medical Scheme members that are not on a KeyCare plan have cover for emergency medical costs up to a defined limit for a period of 90 days from their date of departure,” he says.

Similarly, if you are a member of Momentum Health, you are covered whether you travel for work or leisure. Momentum Health provides international emergency cover as long as your travel outside SA is limited to 90 days or less. This applies to all options except the entry-level Ingwe benefit option. The level of cover you receive depends on the option you have selected.

You must notify your scheme if you are travelling internationally, as you often need to activate the international travel cover before you travel. 
Bonitas principal officer Lee Callakoppen

Bonitas Medical Scheme also offers cover for international emergencies on all but its entry-level BonCap option, Lee Callakoppen, the principal officer, says. This is provided for up to 90 days per trip, no matter how many trips are made during the year, and is limited to R5m per person, she says.

It is subject to certain exclusions (such as pre-existing conditions, which are limited to R100,000, and certain dangerous sporting activities). 

The cover does include mandatory vaccine expenses that you need if this is a condition of travel to your destination, emergency medical expenses, medical evacuation and transport, hospitalisation, outpatient and inpatient treatment, optical and dental expenses and travel assist services.

“You must notify your scheme if you are travelling internationally,” cautions Callakoppen, “as you often need to activate the international travel cover before you travel.” 

This is because the cover is usually underwritten by an insurer that needs time to activate the policy, she says.

Further, your medical scheme will then be able to provide you with the information on any vaccinations you require, as well as details on who to contact in case of an emergency abroad.

Callakoppen highlights the importance of checking with your medical scheme to see what you are covered for as cover varies from one insurer to another.

However, as an employee, you might not be willing to use your personal medical benefits for a business trip, says TIC, the travel insurance specialist at Santam. “And does business in its duty of care have a right to expect that?” 

TIC says your medical scheme’s cover might not be adequate. “Cover offered by medical schemes is usually limited to some medical cover and then terms vary. Some might say you need to pay and claim on return, some might cover only at the SA scale of benefits.

“Claims are incurred in foreign currencies, therefore this limits cover substantially.

“Further, your travel benefit on a medical scheme is limited to medical cover. Other important travel-related risks like cancellation cover and luggage cover are not included in the benefit.”

Most of the time, employers buy a comprehensive travel insurance policy for the traveller, TIC says. This is either an individual policy or a corporate policy that the business buys for all employees travelling on behalf of the business.

“We seldom come across a company that does not use travel insurance to cover and protect employees on business travel,” TIC adds.

Even though the onus is on your company to cover you for business travel, take a look at the policy.

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“Although a master policy is issued for the business or in the name of the business, a policy declaration is issued for each trip an employee takes and is sent to the traveller,” says TIC. “Your company can purchase a travel insurance policy that has an option to include cover for luggage losses too.” 

Callakoppen says: “Travel insurance policies give detailed information about what to do in an emergency situation and have international call centres to assist you. Make sure you have these numbers at hand.”

She also advises that you check the claim process as you might have to keep all records, bills and payment receipts while travelling. Most medical insurance contracts require the invoice, as well as the proof of payment or receipt for reimbursement.

Have time to combine a bit of pleasure with business? Think twice if it falls into the category of “extreme sports”. For example, if you are going snow skiing, you may need to specifically look at taking out “hazardous activity cover”, Callakoppen says.

“Remember, all travel insurance has limits so check those before you go.”  

* This article was first published on our sister site Business Live.