When to call for pre-authorisation
You need to obtain pre-authorisation for the following types of medical treatment.
This will ensure that we can assist you with your case, that you have access to quality care, and that your claims will be processed against the correct benefits:
- Hospitalisation (elective or planned, including day case admissions, and non-elective or emergency admissions)
- Cancer treatment (inpatient and outpatient)
- Renal (kidney) dialysis (inpatient and outpatient)
- Specialised radiology (inpatient and outpatient CT and MRI scans)
- Emergency evacuation (in-country and international)
- Chronic medicines (for more than one month, or for a total chronic medication script exceeding Kshs 12 500 per month unless otherwise advised)
- An appliance or a prosthesis
- Organ transplants
- Ambulance services (air and road)
- All dental services including specialised dentistry (unless otherwise advised)
- Outpatient services for amounts exceeding Kshs 12 500 per treatment unless otherwise advised
- Auxiliary services, e.g., physiotherapy, speech therapy, occupational therapy
- Wellbeing benefit (when the benefit is applicable)
- Optical services
How to contact us for pre-authorisation
In the case of an emergency hospital admission, the Heritage Insurance approved healthcare provider should contact us for pre-authorisation, within 12 working hours of the event, to ensure that your claims are paid. Or, if it is a weekend or public holiday, they should contact us on the next working day.
Information we need:
- Patient’s full name, membership/policy number and date of birth
- Treating healthcare provider details: full name
- Hospital details: full name of hospital
- Reason for admission or emergency visit (medical and/or surgical condition)
- Date of admission and proposed date of the procedure
- Additional supporting documents where required
- When a procedure is done out of hospital, for example, MRI (out-patient radiology), you need to supply the healthcare provider’s name
