Pre-authorisations

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

  • 1
    Call: 0800 007 092

    Required information

    Membership number Patient full name Birthdate of patient Hospital practice number Doctor's practice number CPT4 number or tariff code Date of admission or procedure date Doctor's costs
  • 2
    If approved, the operator will provide you with a pre-authorisation number - use this as a reference.
  • 3
    Your authorisation will be visible on the website when you log in.
  • 4
    Provide your doctor with the pre-authorisation number.

Chronic medication pre-authorisations

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 Medicine Risk Management Programme.