When to call for pre-authorisation

You need to obtain pre-authorisation for the following types of medical treatment.

This will ensure that we can assist you with your case, that you have access to quality care, and that your claims will be processed against the correct benefits:

• Hospitalisation (elective or planned and non-elective or emergency admissions)
• Renal (kidney) dialysis (inpatient and outpatient)
• Emergency evacuation (in-country and international)
• An appliance or a prosthesis
• Ambulance services (air and road)
• Cancer treatment (inpatient and outpatient)
• Specialised radiology (inpatient and outpatient)
• Chronic medicines
• Organ transplants
• Specialised dentistry
• Specialised optometrist

How to contact us for pre-authorisation

You or your healthcare provider can contact us by telephone or email, using the contact details below, at least 48 hours (2 business days) before any planned admission.

In the case of an emergency hospital admission, you should ask a friend or family member to contact us for pre-authorisation, within 48 working hours of the event, to ensure that your claims are paid. Or, if it is a weekend or public holiday, they should contact us on the next working day.

Information we need:

• Patient’s full name, policy number and date of birth
• Treating healthcare provider details: full name and practice number
• Hospital details: full name of hospital and practice number
• Reason for admission or emergency visit (medical and/or surgical condition)
• Date of admission and proposed date of the procedure
• Additional supporting documents where required
• When a procedure is done out of hospital, for example, MRI (out-patient radiology), you need to supply the healthcare provider’s name and practice number

We will give you feedback within 48 hours (2 business days)

We will send you an email within 48 hours (2 business days) to let you know the outcome of your request. You will receive a pre-authorisation number as part of the email when we approve a request.

Please update us regularly on your hospital stay

You and your healthcare provider need to update us regularly on the level of care that you need and the length of the hospital stay required. Payment will be made based on the pre-authorisation and available benefits