Procedures and Hospital Admissions

If you require hospitalisation for procedures and treatment, you need to obtain pre-authorisation.

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.

Failure to obtain hospital pre-authorisation will result in you being liable for the full cost of hospitalisation and any related expenses.

In the event of emergency hospitalisation, where you are unable to obtain pre-authorisation, your spouse or a family member must inform the Scheme on 0860 00 50 37 within 48 hours (two days) of admission. This will enable the Scheme to ensure you receive quality care and the account is processed correctly.

Request a Pre-Authorisation

  • 1
    Call: 0860 00 50 37

    Required information

    Membership number Your membership number The name and practice details of the admitting doctor The date of admission to hospital or clinic The name of hospital or clinic The medical condition The diagnosis The ICD-10/procedure codes The type of procedure/operation (where applicable) The expected length of stay
  • 2
    If approved, the operator will provide you with a pre-authorisation number; use this as a reference - it's valid for 30 days from the date of issue.
  • 3
    Your authorisation will be visible on the website when you login
  • 4
    Provide 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 effect. 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-authorisation by the Medicine Risk Management Department. Please review our Medicine Risk Management Programme.