Question 1

What is Patient Cover?

Accepted Answer

Patient Cover pays you a fixed cash amount if a medical procedure causes you a permanent injury, or if it causes your death. It covers every surgical, invasive, anaesthetic and obstetric procedure performed at a registered hospital or other medical facility, and the care you receive during that admission. Nobody has to be found at fault. An independent clinical assessor rates the injury, and the amount is read off a published table, up to R3,000,000 for each insured life.

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Question 2

Is this a medical scheme?

Accepted Answer

No. Patient Cover is insurance, not a medical scheme, and it is not a substitute for medical scheme membership. It does not pay for treatment. It pays you a cash amount when treatment causes a permanent injury or death, and you decide how to use it.

Question 3

How do I get it, and what does it cost?

Accepted Answer

At launch, Patient Cover is offered through partners: medical schemes, insurers, healthcare providers, employers and membership programmes. If your scheme or employer offers it, you will be enrolled through them and the premium will be shown on your enrolment documents. It is a flat monthly premium, the same for every member, and a newborn's cover costs nothing extra. If you are not with a partner yet, leave your email address on the partners section of the homepage and we will tell you when direct cover is available.

Question 4

What is covered, and what is not?

Accepted Answer

Covered: every surgical, invasive, interventional, endoscopic, radiologically guided, anaesthetic or obstetric procedure at a registered hospital, day clinic, unattached theatre or step-down facility in South Africa, whether planned or emergency, together with the care during that admission, including anaesthesia, medication, blood products, monitoring and nursing. There is no list of named procedures. Not covered: cosmetic treatment that is not medically necessary (reconstructive surgery after injury, disease or a procedure is covered); experimental treatment or clinical trials; treatment outside South Africa; a missed or delayed diagnosis where there was no admission or procedure; care outside a medical facility, such as frail care, home nursing or a doctor's rooms outside a health establishment; dental work in a dental practice; complementary, alternative or traditional medicine; and medication you take after discharge other than as prescribed. The policy wording has the full list.

Question 5

Do I have to prove that someone was at fault?

Accepted Answer

No. Patient Cover is no-fault cover. The question is whether a procedure caused a permanent injury, not whether anyone was negligent. You do not need a lawyer to claim, and no assessment or payment is a finding against any doctor or hospital.

Question 6

How much is paid?

Accepted Answer

The amount depends on the injury's whole person impairment rating, assessed by an independent clinical assessor using the AMA Guides. Ratings of 6% and above are paid, from R30,000 at 6% up to R3,000,000 at 100%, on nine published bands. Death is paid at R3,000,000. For example, a 10% rating pays R225,000 and a 50% rating pays R1,650,000. The table is in the Benefits Schedule, and you can explore it in the "What it pays" section of the homepage. Nothing is negotiated case by case. If your injury has not yet stabilised, part of the amount is paid as soon as the injury is confirmed and the rest when a final rating is possible.

Question 7

How does a claim work, and how long does it take?

Accepted Answer

Email claims@nownow.insure within 12 months of the procedure (36 months from birth for a newborn). You give consent for your records to be obtained, and within 30 days you provide the documents we ask for. An independent clinical assessor obtains the records, reviews them, and where needed examines you, then rates the injury. We aim to complete the records review within 15 business days of having everything we need, and to issue the final decision within 10 business days of the examination. While records are being collected we write to you at least every 10 business days to say what is outstanding. Once you have signed the settlement agreement and we have verified your bank details, the payment instruction goes to the insurer within 2 business days and you should receive payment within 7 business days after that. Every claim gets a named person at nownow.

Question 8

Can I still sue?

Accepted Answer

Before accepting a payment, you can choose in writing, within 10 business days of the offer, to pursue your rights at law instead of taking the benefit. That choice is final. If you accept the payment, it is full and final settlement for that injury and you cannot also pursue compensation from the doctor or hospital for it. A newborn is treated differently: the first payment is made without any waiver, and the child keeps any claim for damages above what Patient Cover has paid.

Question 9

How are babies covered?

Accepted Answer

Every baby born to a covered mother is insured from the start of labour, with its own R3,000,000, at no extra cost and with no enrolment. The mother's cover must have started at least 270 days before the delivery begins, or she must have been covered from her scheme's first day, or the antenatal record must show the baby was conceived after her cover started. If a birth injury is confirmed, R250,000 is paid at once, and the rest once the child can be rated, usually at the second birthday. Any single payment above R250,000 is paid into a trust held for the child, run by trustees including an independent professional, and spent only on the child's care, treatment, education and maintenance. nownow pays the trust's costs.

Question 10

Is there a waiting period, and what happens if cover ends?

Accepted Answer

If you join through a partner on the day the partner's scheme starts, there is no waiting period. Otherwise, cover for planned procedures starts 30 days after your cover is activated: your enrolment date through a partner, or the day we receive and confirm your first premium if you join directly. Emergency Procedures are exempt from this 30-day wait. The Newborn Extension has separate waiting rules; see 'How are babies covered?' A claim for a procedure that happened while you were covered survives if your cover later ends, for any reason other than fraud. Changes to the cover need 90 days' written notice and never reduce the benefit for an injury that has already happened. Each year we publish the benefit ratio for the previous year; if claims were under a quarter of premiums, half of the gap is given back to members as higher cover or a lower premium. That is not a cash refund and no individual member has a right to it.

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