Disclaimer: All benefits paid at 100% of Scheme Reimbursement Rate (SRR), negotiated rate or at cost if PMB. Tariffs available from the Call Centre if a quote is provided.
Familiarise yourself with the most important Scheme exclusions and Rule reminders.
Benefit and contribution information on this website is a summary of the registered Scheme Rules, subject to the approval of the Council for Medical Schemes. In case of discrepancies the Rules shall prevail.
To obtain authorisation
Procedures, treatments, hospitalisation, external medical or surgical appliances, specialised radiology
To access benefits and to ensure they are available and correctly paid, call 0860 222 633 to get authorisation before the event as indicated in the benefit table, for
- specialised radiology,
- internal surgical prostheses and
- external medical appliances exceeding R3 000
Elective admissions need to be authorised 48 hours before the event. Emergency admissions require authorisation the next working day after the event.
Information required when calling for authorisation:
- Membership number
- Date of admission
- Name of the patient
- Name of the hospital
- Type of procedure or operation, diagnosis with CPT code and the ICD-10 code (obtainable from the doctor)
- The name of your doctor or service provider and the practice number
This authorisation number must be quoted on admission. It will be valid for a period of four months or until the end of the year, whichever comes first. Please phone 0860 222 633 if any of the details change such as the date of operation, procedure etc. If the admission is postponed or not taken up before it becomes invalid, a new authorisation number will need to be obtained.