Members on the Standard Care Plan must authorise planned hospital admissions. Most hospitals require benefit confirmation before admission, and completing Anglo Medical Scheme's simple authorisation procedure will prevent any delay at the time of admission. Call us on 0860 222 633 for authorisation.
Hospital cover is unlimited and paid at 100% of the Scheme Reimbursement Rate (SRR).
Hospital services includes allied healthcare services (as determined by the Scheme), day cases, blood transfusions, radiology, pathology, professional services and 7-day supply of to-take-out medication.
You will not have to pay for any claims for the treatment of Prescribed Minimum Benefit conditions except for specific Scheme exclusions.
A co-payment of a minimum of R180 per day applies up to a maximum of R540 for a hospital stay for non-Prescribed Minimum Benefit conditions.
Members have access to step-down facilities where intermediate care is necessary, subject to protocols. Contact the Call Centre on 0860 222 633 for authorisation.
Anglo Medical Scheme participates in our Administrator’s network of orthotists and prosthetists, members need to use one of the participating Designated Service Providers.
Internal surgical prostheses are subject to an annual limit of R63 130 per beneficiary.
Specific procedures can also be done in doctors’ rooms instead of a hospital. You still need to call us to get authorisation for these procedures.
Emergency Hospital Admissions
You do not require an authorisation for emergency admissions at the time of the emergency. However, please contact Anglo Medical Scheme on 0860 222 633 within 48 hours of the admission. Once the Scheme is aware that you have been hospitalised, more effective management of the case is possible.
Psychiatric admissions to hospitals are limited to 21 days.