When a provider should call for pre-authorisation
The provider needs to obtain pre-authorisation for the following types of medical treatment. This is to ensure that all claims are processed against the correct benefits:
- Hospitalisation (elective or planned and non-elective or emergency admissions)
- Cancer treatment (inpatient and outpatient)
- Renal (kidney) dialysis (inpatient and outpatient)
- Specialised radiology (inpatient and outpatient)
- Emergency evacuation (in-country and international)
- Chronic medicines
- An appliance or a prosthesis
- Organ transplants
- Ambulance services (air and road)
- Specialised dentistry
- Antenatal and deliveries
- Any surgery (Minor/Intermediate/Major) involving the use of anaesthesia
When a member should call for pre-authorisation
- When accessing care outside the network (for a covered service)
- When travelling out of the country of coverage (to confirm if the plan is covered outside the country in case of a refund)
- Annual medical check-up