Medical evacuation and repatriation cover in Africa, explained

IPMIAfrica explains the benefit that matters most in much of Africa: what medical evacuation and repatriation cover, who decides when they happen, how pre-authorisation works, how a plan benefit differs from a standalone assistance membership, and what to check in the wording.

Why evacuation matters more in Africa

In many countries an expat can assume that a hospital able to handle a heart attack, a serious road accident or a complicated birth is a short drive away. In much of Africa that is not a safe assumption. Private hospitals of the standard an expat would expect are concentrated in a handful of cities, and for some conditions the right treatment is in another country altogether: a regional hub such as Johannesburg or Nairobi, or Europe, the UK, India or home.

The medical evacuation benefit is the part of an international private medical insurance plan that bridges that gap. It pays for, and more importantly arranges, the journey from where you are to a hospital that can treat you. In the markets covered by our country guides, it is the benefit that decides whether the rest of the plan can do its job. A high annual limit is of little use if you cannot reach the hospital where it would be spent.

Evacuation and repatriation are different benefits

The two words are often used together and sometimes confused. They cover different journeys and are usually separate lines in the benefit table.

Medical evacuation is transport to the nearest appropriate medical facility when the treatment you need is not available where you are, or not available to an adequate standard. The destination is chosen on medical grounds. It may be another hospital in the same country, a hospital in a neighbouring country, or a hospital much further away. Evacuation is about getting you to treatment.

Medical repatriation is transport back to your home country, or sometimes your country of residence, once you are stable enough to travel, so that you can continue treatment or recover there. It is about getting you home. The same benefit heading usually also covers repatriation of mortal remains, which is the return of a body for burial or cremation, and sometimes local burial as an alternative.

Some plans add related benefits: travel and accommodation for a companion or family member, a return journey after treatment, and compassionate travel for a relative to visit you. Each is a separate line and a separate limit. Check which are included rather than assuming that "evacuation" covers them all.

Who decides, and how pre-authorisation works

This is the part of the benefit that people most often misunderstand, and the misunderstanding is expensive. An evacuation is almost never something you decide to do and claim for afterwards. It is something the insurer's assistance service decides is medically necessary and then arranges.

In practice the sequence is: you, a companion or the treating doctor contacts the insurer's assistance line, which is staffed around the clock. The assistance team speaks to the treating doctor, assesses whether the local facility can provide the treatment to an adequate standard, and decides whether to move you, where to, and by what means. If they decide to evacuate, they arrange the transport, the receiving hospital and the medical escort, and they pay the providers directly.

This is what pre-authorisation means for evacuation. The benefit is conditional on the insurer agreeing to it before it happens. If you arrange your own air ambulance and submit the bill, most plans will decline it, or pay only what they would have paid for a journey they considered necessary, which may be nothing if they would have treated you locally.

• Keep the assistance number where you and your family can find it, and give it to your employer, school and household.
• In an emergency, get the patient to the nearest hospital first and call the assistance line from there. The call does not have to precede first aid.
• The medical decision is the insurer's, taken with the treating doctor. A preference for a particular country or hospital is not, on its own, grounds for evacuation.

A plan benefit versus a standalone assistance membership

Many expats in Africa hold, or are given by an employer, a standalone air ambulance or assistance membership in addition to their health insurance. The two are not the same thing and it helps to understand how they differ.

An evacuation benefit inside a health insurance plan is part of a wider policy. The insurer decides whether evacuation is necessary, arranges it through its assistance partner and pays for it up to the benefit limit. The same policy then pays for the treatment at the destination, within the plan's limits and area of cover. Everything is coordinated by one organisation.

A standalone assistance membership is a contract with an assistance or air ambulance company. It typically covers the transport itself, from the scene or the local hospital to an appropriate facility, often within a defined region, and may offer medical advice lines and other services. It does not usually pay for the treatment once you arrive. The member or their health insurer pays for that.

Holding both can be sensible, particularly if you live or work far from a city and want a provider with aircraft and crews based locally. But you need to know three things: which one responds first, whether each requires its own pre-authorisation, and whether the health insurer will accept a transfer arranged by the membership provider or insist on arranging its own. Ask both providers in writing. The worst outcome is two policies, each assuming the other is responsible.

What to check in the wording

Evacuation benefits look similar on a benefit table and differ a great deal in the policy wording. Work through these with every plan you compare.

How the benefit works in different parts of Africa

The same benefit plays out differently depending on where you live.

• In South Africa, which is usually the destination of evacuations rather than the origin, the benefit matters most for travel elsewhere in the region and for remote sites.
• In Kenya and Tanzania, Nairobi is the regional hub. The question is whether the plan covers the first leg to Nairobi and a second leg beyond it.
• In Nigeria and Ghana, evacuation abroad is common for complex treatment, so the area of cover must include the likely destination and the wording must not exclude your location.
• In Egypt and Morocco, Europe is close, and the question is whether the plan treats it as inside the area of cover.
• In Mauritius, every evacuation is a flight off the island, and the plan needs to pay for the treatment at the destination.

How to prepare before you need it

1. Read the evacuation section of the wording, not only the benefit table, and ask the broker to confirm anything unclear in writing.
2. Save the assistance number in your phone, your family's phones and at your workplace.
3. Carry your membership card or policy number. In an emergency the hospital will ask for it.
4. If you hold a standalone assistance membership as well, write down which responds first and tell your family.
5. If you live or work somewhere remote, ask the insurer whether its assistance partner can reach you and what the first leg would look like.

When you compare plans, treat the evacuation wording as a filter before you look at price. The IPMIAfrica insurer pages summarise how each insurer structures the benefit, and Nomi asks where you live and work so that the plans it ranks are ones whose evacuation benefit fits your situation.

Frequently asked questions

This page is general information, not personal or medical advice. Prices are indicative and confirmed by the insurer at underwriting. For advice on your situation, speak to an experienced broker.