Procedures and Hospital Admissions
Prior to a patient being admitted to a Hospital, Facility or Specialist rooms a 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 a Pre-Authorisation
1Call: 0800 001 607
2If approved the operator will provide you with a Pre-Authorisation Number, use this as a reference
3Your Authorisation will be visible on the website when you login
4Provide your Doctor with the Pre-Authorisation Number
Chronic Medication Pre-Authorisations
A chronic condition is a disease that 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.
Other Chronic Conditions are subject to Pre-Authorisations by the Medicine Risk Management Department.
Please review our Medicine Risk Management Programme.
The BPMAS Chronic Conditions Not Covered List provides a list of Chronic conditions not covered.