Pre-authorisations

Procedures and hospital admissions

Prior to a patient being admitted to a hospital, facility or specialist rooms, pre-authorisation is required. Failure to obtain pre-authorisation will result in a co-payment amounting to 20% of the cost of the hospital account, subject to a maximum of R1 000.

The pre-authorisation process checks benefits availability and determines if a medical procedure is clinically required. The granting of pre-authorisation does not guarantee full payment of your claims.

Annexure C of the Society's rules provides a comprehensive list of procedures that are excluded from payment.

Request pre-authorisation

  • 1
    call Call: 0800 007 092

    warning Required information

    Membership number help Patient full name help Birthdate of patient help Hospital practice number help Doctor's practice number help CPT-4 number or tariff code help Date of admission or procedure date help Doctor's costs help
  • 2
    call If approved, the operator will provide you with a pre-authorisation number - use this as a reference.
  • 3
    web Your authorisation will be visible on the website when you log in.
  • 4
    call Provide your doctor with the pre-authorisation number.

Chronic medication pre-authorisations

info A chronic condition is persistent or otherwise long-lasting in its effects. The term ‘chronic’ is often applied when the course of the disease lasts for more than three months.

PMB conditions are covered subject to a care plan, formulary, generic and therapeutic reference price. Read more about our PMB Programme.

Other chronic conditions are subject to pre-authorisations by the Medicine Risk Management Department.

Please review our feedback Medicine Risk Management Programme.