how to get pre-authorisation of selected services

To avoid unnecessary co-payments you will need to get pre-authorisation before specific healthcare services are rendered.

Members can apply for pre-authorisations on the following platforms

Visit the member secured websiteDownload the Medihelp member appContact us

Medihelp Medical Scheme email detail

Visit http://toolbox.medihelp.co.za - all relevant forms are available on this site.


Important note: There are also selected procedures for which members can obtain immediate pre-authorisation on this site. These procedures include tonsillectomies, normal and caesarean births and hysterectomies.

     IStore Medihelp Medical Scheme     Playstore Medihelp Medical Scheme     Windows Medihelp Medical Scheme

The Medihelp member app is available on the IStore, PlayStore and Windows store for mobile devices

 Medihelp Medical Scheme email detail     Medihelp Medical Scheme fax detail     Medihelp Medical Scheme contact detail

Medihelp Call Centre: 086 0100 678

Please see the list for all the email addresses, phone and fax numbers.

Which services/procedures should be pre-authorised?

Service/procedureContact details and information Medihelp needsMore information
All hospital admissions

Tel: 086 0200 678
Fax: 012 336 9538
Email: hospitalauth@medihelp.co.za

Required information

  • Membership number
  • Details of:
    • patient
    • admission, procedure and
    • diagnostic codes
    • doctor
    • practice number
    • hospital
  • Please pre-authorise at least 3 workdays before admission 
  • If not pre-authorised, a 20% co-payment on the hospital benefit amount will apply
  • Emergency admissions must be registered on the first workday after admission
  • Voluntary admission to a non-network hospital will result in an additional 35% co-payment on Dimension Prime 1, 2 or 3 Network options and Necesse
  • Standard co-payments apply to certain procedures (please refer to the product brochure)
Private nursing, hospice services and sub-acute care as an alternative to hospitalisation

Tel: 086 0100 678
Fax: 012 336 9538
Email: hmanagement@medihelp.co.za

Required information

  • Membership number
  • Procedure and diagnostic codes
  • Doctor’s motivation
  • Quotation for the services of the facility
  • Details of:
    • patient
    • doctor
    • practice number
    • facility
  • Authorisation will be considered only if required as an alternative to hospitalisation, according to Medihelp’s protocols 
  • Please phone in advance to allow enough time for the authorisation process
  • If not pre-authorised, a 20% co-payment on the benefit amount may apply 
  • Benefits do not include frail care services
Prescribed minimum benefits (PMB)

Tel: 086 0100 678
Fax: 086 0064 762
Email: pmb@medihelp.co.za

Required information:

  • Membership number
  • Details of patient
  • Completed PMB registration/ pre-authorisation form
  • ICD-10 code
  • Procedure code
  • PMB conditions must be registered and pre-authorised to qualify for PMB
  • Hospital admissions for PMB conditions must also be preauthorised
  • Emergencies must be authorised on the first workday following the emergency

Specialised dentistry

  • Dental procedures in hospital under anaesthesia
  • Dental procedures in the dentist’s rooms under
    intravenous conscious sedation
  • Crowns and bridges
  • Orthodontic and periodontal treatment
  • Implants

Denis
Tel: 086 0104 941
Fax: 086 677 0336
Email: medihelpenq@denis.co.za

Required information:

  • Membership number
  • Item and procedure codes
  • Details of:
    • patient
    • dentist
    • practice number
    • hospital
    • anaesthetist
    Medihelp must also pre-authorise the hospital admission where extensive dental treatment is performed under general anaesthesia or where impacted teeth are removed.
    Emergency transport services

    Netcare 911 (in 2017)
    082 911

    Required information:

    • Membership number
    • Details of patient
    • Netcare 911 is Medihelp’s preferred provider of emergency transport services (in 2017)
    • Comprehensive benefits are available for residents of South Africa, Mozambique, Botswana, Lesotho, Namibia and Swaziland (except Necesse)
    • A 50% co-payment applies if not pre-authorised
    Chronic and PMB chronic medicine

    Tel: 086 0100 678
    Fax: 012 334 2466
    Email: medicineapp@medihelp.co.za

    Required information:

      • Membership number
      • Details of patient

      Chronic medicine
      Your doctor will have to complete certain sections of the PMB/chronic application form

      PMB chronic medicine

      • Please complete a PMB/ chronic application form,
        especially the sections about entry criteria
      • PMB for a condition on the Chronic Diseases List (CDL) will only apply from the date on which the PMB application was finalised
      Medicine supply for more than 30 days

      Tel: 086 0100 678
      Fax: 012 334 2425
      Email: medicineapp@medihelp.co.za

      Required information:

      Please obtain pre-authorisation before obtaining the medicine or travelling abroad.
      Specialised radiology
      MRI, CT and PET scans (PET scans for Medihelp
      Plus only)

      Tel: 086 0200 678

      Fax: 012 336 9523

      Require information:

      • Membership number
      • Details of the radiologist
      • Details of patient
      • Date of service
      • Item and procedure codes
      • ICD-10 codes
      • All CT and MRI scans, as well as PET scans in the case of Medihelp Plus, must be preauthorised
      • If not, these scans will be excluded from benefits
      Oxygen (not during hospitalisation)

      Tel: 086 0100 678
      Fax: 012 334 2466
      Email: medicineapp@medihelp.co.za

      Required information:

      • Membership number
      • Details of patient
      • Doctor’s motivation/ prescription
      Oxygen that is not administered during hospitalisation must be pre-authorised. If not, a 20% co-payment applies.
      Oncology (cancer treatment)

      Tel: 086 0100 678
      Fax: 086 0064 762
      Email: oncology@medihelp.co.za

      Dimension Prime
      network options
      Oncology medicine DSP
      Dis-Chem Oncology
      Tel: 010 003 8948
      Fax: 086 597 0573

      Email: oncology@dischem.co.za

      Required information:

      • Membership number
      • Details of patient
      • Completed ICON/ oncology application form including ICD-10 codes
      • Oncology must be obtained:
        • within the Independent Clinical Oncology Network (ICON), and
        • according to the ICON treatment protocol
      • Co-payments will apply if the above is not followed.
      • Oncology treatment must be pre-authorised by Medihelp

      HIV/Aids programme 

      All information will be treated confidentially

      Disease management programme
      OneHealth
      Tel: 086 014 3258
      Emergencies: 071 786 4520
      Fax: 086 644 4945
      Email: medihelp@onehealth.co.za

      Medicine
      Dis-Chem Direct
      Tel: 011 589 2788
      Fax: 086 641 8311
      Email: direct@dischem.co.za

      Required information:

      • Membership number
      • Details of patient

      Comprehensive benefits are offered for the treatment of HIV/Aids, including –

      • antiretroviral therapy, and
      • post-exposure prophylaxis
      Medical procedures obtained abroad
      (not emergencies) and which are not available in South Africa

      Tel: 086 0100 678
      Fax: 012 336 9540
      Email: enquiries@medihelp.co.za

      Required information:

      • Membership number
      • Details of patient
      • Date of service
      • ICD-10 code of a similar local procedure
      • Doctor’s motivation
      • These services must be pre-authorised by Medihelp
      • If approval is granted, benefits are paid according to the applicable tariff payable for a similar service in South Africa
      • Members receive 90 days’ emergency cover 
      • PMB is not applicable abroad

      Optometric services

      • Optometric examinations
      • Spectacles
      • Contact lenses

      PPN

      Tel: 086 1101 477
      Email: info@ppn.co.za

      You can phone PPN with any questions regarding your optometry benefits.

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