If You Are Having a Medical Emergency
Call 10111 (police), 10177 (ambulance), or your nearest emergency number immediately.
If someone is unconscious, confused, having a seizure, or showing signs of a heart attack or stroke — call emergency services first, before reading anything else on this page.
Right Now: First 24–48 Hours
If you or someone you care for has just been hospitalised with a diabetes-related emergency:
-
Your medical aid must cover emergency treatment. This is a PMB (Prescribed Minimum Benefit). No scheme can refuse emergency care for a diabetes complication. This applies even if you haven't registered on a chronic benefit programme.
-
Get an authorisation number. Once stabilised, contact your scheme's emergency line and ask for pre-authorisation for continued hospitalisation. The number is on the back of your medical aid card. If you can't find it, call 0861 000 016 (Discovery), 0860 002 108 (Momentum Health), or your scheme's main line and ask for emergency authorisation.
-
Don't focus on cost right now. The financial side comes after stabilisation. Your job right now is to focus on getting the right treatment.
-
If you have gap cover, it activates automatically for in-hospital specialist shortfalls. You don't need to call your gap provider before admission — the claim is submitted after discharge.
The Likely Scenarios
Scenario A: Hyperglycaemic crisis (very high blood sugar — HHS or DKA)
This is an emergency where blood glucose has risen to dangerous levels. It typically happens when diabetes has been undiagnosed, undertreated, or when something else (infection, stress, missed medication) has caused glucose to spike.
What the hospital will do: Intravenous fluids, insulin infusion, electrolyte correction. Usually 2–5 days in hospital.
What it costs: ~R25,000–R40,000 at a private hospital.
What your scheme covers: Emergency treatment is PMB. The scheme pays its PMB rate. If specialists (internist, endocrinologist) charge above the scheme rate, that gap — potentially R5,000–R15,000 — is covered by gap cover if you have it.
What you owe if you have gap cover: Likely R0–R2,000 in copayments, depending on your plan.
What you owe without gap cover: The specialist shortfall — potentially R5,000–R15,000+.
Scenario B: Cardiac event (heart attack or stroke linked to diabetes)
Diabetes significantly increases cardiovascular risk. If someone with T2DM has a cardiac event, this is a major hospital admission.
What the hospital will do: Emergency catheterisation/angioplasty (heart attack), thrombolysis or thrombectomy (stroke), ICU admission, specialist management.
What it costs: R150,000–R300,000 at a private hospital for a cardiac event.
What your scheme covers: PMB level — the base hospital tariff and emergency treatment. Specialists (cardiologist, neurosurgeon) charge 300–500% of scheme rate. The scheme pays 100%. The gap is real and large.
What you owe with gap cover: Depends on your policy limits, but a good gap cover policy substantially reduces the shortfall.
What you owe without gap cover: R30,000–R80,000 in potential specialist shortfalls is not unusual. This is the primary financial risk of poorly treated T2DM.
Scenario C: Diabetic foot complication (infection, ulcer, potential amputation)
This is often slower-developing but can escalate to emergency admission.
What it costs: R30,000–R100,000 depending on severity. Major amputation at the higher end.
What your scheme covers: PMB-funded at scheme rate. Vascular surgeon, orthopaedic specialist shortfalls relevant.
What gap cover does: Covers the specialist shortfall. Podiatry (wound care) is typically not gap-covered — that is a day-to-day benefit question.
This Week
-
Ask the treating doctor for a treatment plan in writing. How long in hospital? What is the next step after discharge? What medications will be prescribed?
-
Ask to be assigned a case manager. Major hospitalisations trigger a case manager from your medical aid. Call your scheme and ask who your case manager is. Get their direct number. They coordinate benefits and can prevent billing errors.
-
Check your gap cover status now. Log in to your gap cover provider's app or call them to confirm your policy is active. If you don't have gap cover — see below.
-
If you do NOT have gap cover: On some gap policies, you can activate cover during a hospitalisation for future events (waiting periods apply to non-emergency follow-up treatment, not the current acute event). Contact a broker or AURA to check options.
The Financial Picture
| With gap cover | Without gap cover | |
|---|---|---|
| Hyperglycaemic crisis (~R30,000 hospital cost) | ~R0–2,000 out-of-pocket | ~R5,000–15,000 out-of-pocket |
| Cardiac event (~R200,000 hospital cost) | ~R5,000–20,000 out-of-pocket | ~R30,000–80,000 out-of-pocket |
| Diabetic foot (~R60,000 hospital cost) | ~R2,000–8,000 out-of-pocket | ~R10,000–25,000 out-of-pocket |
Estimates based on 2026 private sector data and average gap cover policy limits. Actual amounts depend on your specific scheme, hospital, and specialists.
What Happens Next
After stabilisation, T2DM management moves to outpatient care. Your long-term plan will involve:
- Chronic medication (funded by your scheme's CDL benefit — every scheme must do this)
- Regular monitoring (HbA1c, kidney function, lipids, eyes, feet) — 3–6 monthly
- Possible referral to an endocrinologist or diabetes specialist for ongoing management
- Lifestyle modification (diet, exercise) — this genuinely affects outcomes
The financial dust settles quickly once you're discharged and on a stable chronic regimen. The ongoing cost of T2DM management is manageable — it's the acute events that create financial exposure.
Need Help Right Now?
Let's focus on what we can control. AURA can check your medical aid and gap cover status right now — what's covered for your diabetes, what the gaps are, and what to do about them.
It takes 10 minutes.
This article provides information and is not medical or financial advice. Emergency decisions should be made by qualified medical professionals. Cost figures are estimates based on 2026 South African private sector data. For detailed references and sources, see the full reference article: Is Type 2 Diabetes Covered by Medical Aid in South Africa?