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Pre-authorization
  

Pre-authorisation Process & Forms

 

 

The Pre-authorisation Process

Some treatments (mostly in-patient and high cost treatments) need to be pre-approved by us in advance. This 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. Simply follow these simple steps:

Step 1:

First, check that your TOB covers the treatment you are seeking. If so, Download Pre-authorisation Form 

Step 2:

Complete the form and send it to us at least five working days before treatment. You can send it by email, fax or post to the address shown on the form.

Step 3:

We contact the hospital to organise payment of your bill directly, where possible.

Pre-authorisation Form

If your treatment requires pre-approval from us, you can download the pre-authorisation form below and submit it to the address shown on the form. 


If it’s an emergency

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. For more information, please refer your Benefit Guide.

Please note that we may decline your claim if Pre-authorisation is not obtained, where required

What happens if my pre-authorisation request is not approved?

 Unless we and your company agree otherwise, if you make a claim without obtaining our pre-approval, the following will apply:

  • If the treatment received is subsequently proven to be medically unnecessary, we reserve the right to decline your claim.
  • If the treatment is subsequently proven to be medically necessary, we will pay 80% of in-patient benefits and 50% of other benefits. 

Pre-authorisation Forms for different regions

The Pre-authorisation forms for our regional healthcare plans are listed below, simply click on your plan cover to download the form. You can find the name of your plan on the cover of your Benefit Guide.
If your plan is not listed, or if you are unsure about which Pre-authorisation Form to use, please call our Helpline.