Expats Living In Africa: Making A Claim With William Russell

At William Russell we have always been proud of our gold-standard customer service and claims support and are keen to ensure members have a smooth and hassle-free experience in any of their dealings with us. We appreciate that often the true test of an insurance plan will generally come at the point of claiming so our dedicated team is available to support our members throughout the process.

We have been working in Africa for more than 25 years and operate in more than 30 countries across the continent. Using our own experience in the region as well as working in partnership with our local broker partners in various countries, we have developed a number of cover options tailored to members in Africa. We understand that medical treatment can vary greatly across Africa and can prove challenging under certain circumstances.

To support this focus on providing a good range of benefits and coverage in Africa:

• All our plans include emergency medevac as standard as well as local road or air ambulance costs to reassure members they will be able to receive the care they need wherever they may be.
• The plans are operated on client choice meaning members are free to have treatment at the facility of their choice (within their designated cover zone), but we already have network arrangements in place, either directly or through our agents in Africa, with more than 5,000 medical facilities across the region.

How our claims process works for expats living in Africa

Medical treatment abroad can be really expensive. Cancer is the most expensive treatment for expats, while diabetes, dentistry and maternity care also incur staggering costs.

In 2020, William Russell has paid out almost US $156,000 in COVID-19 related claims across the globe. We paid out $155,793.29 on 54 related claims in 26 countries. This included an evacuation case Malawi to Kenya with all additional requirements due to the COVID-19 pandemic, which the insurer said resulted in much higher costs than usual.

• Direct billing: where possible, we will look to settle hospital claims directly to the medical facility if a member is physically admitted into the hospital either as an in-patient or day-patient. Most other claims will be settled on a reimbursement basis once the claim has been approved.
• Same currency: as standard, claims will be reimbursed in the same currency as the member’s premium is paid unless we are specifically asked to settle in a different currency.
• 24/7 support: our reliable and award-winning claim team is available from 6am – 6pm UK time Monday to Friday and outside these hours, our members are supported by Cega Assistance who operate as our Assistance Service.
• Reliable partner: we have worked with Cega for approaching 20 years and they understand how we operate and our service standards meaning member experience is seamless throughout their claim.

Most claims will generally fall into one or other of the below segments:

1/ In-patient or day-patient admissions

Hospital treatment can be expensive and our aim is to make the process as smooth as possible for our clients and make sure they understand what will be covered by the insurance.

All planned hospital admissions require pre-authorisation meaning the member contacts us when they are informed they will require a hospital procedure and our team will confirm the treatment is covered by the plan and contact the medical facility to arrange the direct settlement of the eligible claim costs (sometimes called a Guarantee of Payment).

If an excess or co-insurance applies to the claim, this will be deducted from the amount we will authorise with the medical facility when we set up the payment arrangements and the member will need to settle this with the hospital themselves.

In the event of an emergency admission where it is not possible to pre-authorise the medical treatment, we ask that members (of their representative or doctor) contact us within 24 hours of the admission so that we can still authorise the claim and avoid any inconvenience for the member or their family.

Examples of medical service providers include clinics, hospitals, doctors, surgeons and anaesthetists.

2/ Out-patient treatment

For most other claims where a member is not admitted to the hospital, the member will self-pay for their medical claim and then complete a claim form and provide the relevant receipts or invoices for reimbursement. We have a simple online claim form available on our website or, if preferred, there is a PDF form that members can download and complete. Read more in our full guide on making a claim.

If a claim is likely to be more than US$500 (or equivalent), there is a section that needs to be completed by the doctor in order to pay the claim, so we ask that members take the form with them to their appointment to avoid any delay.

Examples of out-patient treatment are wide-ranging but may include GP visits, prescriptions costs, specialist consultations, laboratory tests, diagnostic scans, physiotherapy, dental treatment and many others.

3/ Medical evacuations

Each evacuation is different as we will assess each patient’s conditions and injuries individually to make a decision on the most suitable location to transfer the member to and the most suitable method of evacuation, for example, via air ambulance, or commercial flight with a doctor escort or a nurse escort.

The plans automatically include cover for medical evacuation so that, in the event a member requires immediate in-patient care for a life-threatening or limb-threatening condition which would be covered by the plan, if this treatment or care is not adequately provided locally, our team will arrange for the member to be moved to the nearest hospital able to provide appropriate medical care.

Our assistance team, CEGA Assistance, will liaise with our own claim team and medical specialists, and also with the medical doctors on the ground, to decide whether a medical evacuation is required and also whether it is medically safe. They will then make the arrangements to transfer the member across to the new medical facility.

Evacuations will be impacted by the medical treatment required and also by considerations such as any visa requirements or travel restrictions that may apply, operating suites, surgeons and anaesthetists availability, and on the stability of the member to be moved. Regardless of the cover zone selected, we would never evacuate a member to, from or within the USA.

Who we work with: our global medical network of 40,000+ providers. Air Ambulance

We have direct relationships with a number of facilities globally, and, in Africa, we also work with appointed strategic partners – Medical Services Organisation (MSO) and Alliance International Medical Services (AIMS) – to facilitate network access to over 5,000 medical service providers.

Our medical service providers and hospital network

Listed below are a selection of some of the main hospitals and groups where we can place a Guarantee of Payment for member’s admissions:

• Netcare Hospital Group
• Mediclinic Hospital Group
• Life Healthcare Group
• Palm Beach Hospital
• Gertrude’s Children’s Hospital
• North Valley Hospital
• MP Shah Hospital
• Garden Specialist Hospital
• Upper Hill Medical Centre
• Reddington Hospital (regularly)
• Genesis Specialist Hospital
• Paelon Memorial Clinic
• Ideal Eagle Hospital /Ultra Care Hospital & Clinic
• Abuja Clinics
• Clean Springs Specialist Hospital
• EHC Clinic

This is an example list and not exhaustive but if we have not worked with a facility prior to a claim being submitted we are always happy to contact the new facility to arrange settlement on behalf of the member.

Air Ambulance (AA) providers:

A number of variables determine which Air Ambulance (AA) company is used and where the AA is sourced from and destination. Here are only a few examples:

A few AA companies that we have worked with (not limited to these):

• Awesome Air
• Netcare 911
• Amref Flying Doctors
• Aspen Medical
• Okavango Air Rescue

Have peace of mind with William Russell

For 30 years, William Russell has provided international health insurance for people living and working abroad. With over 40,000 hospitals in our worldwide network, you can travel with the knowledge you have access to the best medical care wherever in the world you are.