What is it and why it’s a good idea to get it

12 Oct 2022 

Sometimes it’s called pre-approval, pre-authorisation, or prior authorisation, but they all mean the same thing. Certain treatments require you to get prior approval by requiring you to submit a Pre-authorisation (Treatment Guarantee) Form in advance.

Following approval, cover for these required treatments or costs can then be guaranteed. You won't need to get Pre-authorisation for all the care you receive. It's mostly for in-patient and high cost treatments.

Pre-authorisation may be required for some benefits. These are mostly in-patient and high-cost treatments and, depending on your plan, can include the following:

  • All in-patient treatments
  • Day-care treatment
  • Out-patient surgery
  • PET and CT-PET scans
  • Nursing at home or in a convalescent home
  • Routine maternity, complications of pregnancy and childbirth
  • Oncology
  • Kidney dialysis
  • Occupational therapy
  • Rehabilitation treatment
  • Medical evacuation or repatriation
  • Travel costs of your family members in the event of an evacuation/repatriation
  • Repatriation of mortal remains
  • Travel costs of your family members in the event of the repatriation of mortal remains
  • Expenses for one person accompanying an evacuated/repatriated person
  • Palliative care and long term care
  • Preventative surgery

The pre-authorisation process helps us assess each case, organise everything with the hospital before your arrival and make direct payment of your hospital bill easier, where possible.

  1. First, check if your plan covers the treatment you are seeking. Your Table of Benefits will confirm which benefits are available to you. You can access your Table  of Benefits via MyHealth Digital Services. Simply login via browser or use the MyHealth app and click on “My Benefits”. Your Table of Benefits will also confirm which treatments require our pre-authorisation.
  2. Download a Pre-authorisation (Treatment Guarantee ) Form (available here). The form must be fully completed by you and your physician.
  3. Send the completed form to us for approval at least 5 working days before your planned treatment. Scan and email, fax or post (details on the form).
  4. We will respond within 24 hours of receiving a fully completed form.
  5. We then contact your medical provider directly to arrange settlement of your bills.

When receiving  treatment in the US, simply show your membership card to the medical provider and make sure to check if the provider has  your most up to date policy details on their file. The provider will contact us to sort any paperwork related to your treatment. Make sure you attend a network provider, where we can pay your medical bills directly.

In case of emergencies, just get the emergency treatment you need and call us if you need any advice or support.

If you are hospitalised, either you, your doctor, one of your dependants or a colleague needs to call our Helpline (within 48 hours of the emergency) to inform us of the hospitalisation. We can take Pre-authorisation Form details over the phone when you call us. However, coverage for emergency medical costs are subject to the terms of your health plan.

The pre-authorisation process gives us the opportunity to assess whether a treatment recommended to you is medically necessary, and at a reasonable cost. When we have good control over the cost of medical treatments for all our members, we’re better able to continue offering competitive premiums.

For you, pre-authorisation also offers a number of benefits:

  • Ensuring your planned treatment is covered under your plan. In the case of an evacuation/repatriation, we will organise and co-ordinate this on your behalf – so you can focus on getting better.
  • Keeping out-of-pocket expenses in check. In many cases, we’ll be able to settle your bill directly with the provider – meaning you may be able to curb upfront payments for your treatments.
  • Optimising your plan. Through the pre-authorisation process, we help you ensure that you are receiving a more  cost-effective treatment, so you can get the most out of the available limits on your plan.

It is important that you submit a Pre-authorisation Form where required, prior to treatment, as we reserve the right to decline a claim or apply a penalty if this process is not followed.

So it's always a good idea to double check your benefits before receiving any non-emergency medical care, to ensure that you know your plan's pre-authorisation requirements. If you are in doubt, just contact our Helpline in advance of obtaining your treatment.