HIV & Trauma Assistance
ASSAULT, TRAUMA & HIV PROTECTION
The HIV-protection treatment service enables the Member to make use of, at his/her own discretion, the following services, which can be paid out of the defined benefit of the policy:
• 24-hour access to trauma counsellors, providing telephonic trauma counselling as well as counselling for post-traumatic stress disorder
• Three consultations (per incident) with a specialist, which can be either a general practitioner, trauma-trained registered nurse or trauma counsellor
• Three HIV blood tests (per incident): one immediately after the incident and the second and third at six weeks and three months respectively (should the Member be HIV positive at the time of the initial blood test, further testing is not covered)
Provided that exposure has been established, and strictly on the treating doctor’s orders, if the Member is HIV negative (following a rapid test) he/she will also be provided access to:
• A 30-day starter pack of antiretroviral medication
• A seven-day course of STI (Sexually Transmitted Infections) medication
• A ‘morning-after pill’ to prevent pregnancy in the case of rape
• Registration for an HIV-management programme, where applicable
• 24-hours-a-day, 365-days-a-year telephonic access to an HIV counselling centre for information, advice and support
Should the Member be HIV positive at the time of the event, he/she will be provided access to:
• 24-hours-a-day, 365-days-a-year telephonic trauma counselling
• 24-hours-a-day, 365-days-a-year telephonic HIV counselling
• Three consultations (per incident) with a specialist, which can be either a general practitioner, trauma-trained registered nurse or trauma
• A seven-day course of STI medication
• A ‘morning-after pill’ to prevent pregnancy
The call centre is a 24/7 facilitation centre that has the infrastructure for Members suffering from trauma to have access to immediate assistance. The call-centre nurses take control of situations and manage the process of communication with individuals and service providers to refer the Members to an appropriate service provider.
In the event of HIV infection a Member must call the helpline and give details of their circumstances, any immediate dangers and their condition. The nurses will arrange for the necessary assistance, be it the police or the nearest local emergency assistance services etc. The nurses will monitor the medical condition of the Member. Should the situation develop into a medical emergency, the nurses will:
• Arrange for emergency medical evacuation, either by road or air ambulance
• Arrange for the Member to be transported to a hospital with emergency facilities closest to the scene of the incident
• Monitor the Member's transportation and condition
Claims Procedure & Requirements
The Member will ideally be referred to a public trauma centre or medical facility, but can also be referred to a private counsellor for counselling.
The Member contacts the call centre to report the incident telephonically, following the initial telephone counselling by the resource nurse and her referral – if necessary. Claim forms will be faxed or mailed to the Member to complete.
The Member pays for treatment and claims back expenses. The Member submits the following documentation:
• Claim form and police case number (for assault)
• Medical reports in the event of injury
• Certified copy of the Member's identity document
• Banking details of the Member
We will review the above documents to make a decision on the validity of the claim. If the claim is valid, we will reimburse the Member. Claims must be submitted within 30 days.
The Member must notify the call centre immediately following the incident. If the insurer repudiates any claim, the insurer will be relieved of liability unless summons is served within 90 days of repudiation.
Compensation will not be payable as a result of the Members’ participation in any riot, civil commotion, labour disturbance, strike or lockout or public disorder or any act of activity which is calculated or directed to bring about willful misconduct or performance or attempt to perform:
• Any act on behalf of any organisation, body or group of persons calculated or directed to overthrow or influence any state or government, or any provincial, local or tribal authority with force, or by means of fear, terrorism or violence
• Any act which is calculated or directed to bring about destruction or damage or bodily injury in order to further any political aim, objective or cause, or to bring about any social or economic change or in protest against any state or government or any provincial, local or tribal authority for the purpose of inspiring fear in the public or any section thereof
Should an HIV-accidental exposure claim not be reported within 48 hours (up to a maximum of 72 hours), we cannot accept the claim for the HIV-protection medication, although Members can still make use of the telephonic advice and trauma counselling. This exclusion pertains to the fact that the antiretroviral medication or starter pack will no longer be effective after expiry of 72 hours after exposure.
Our company will not be liable for:
• Any claim which is in any respect fraudulent
• Loss, damage or bodily injury deliberately caused by the Beneficiary or any person acting in collusion with the Member
• Consequential loss or damage except as specifically provided