Follow the best medical aid in the industry on facebook

Hospitalisation and networks


How do hospital benefits work?

  • Medihelp pays benefits for hospitalisation at 100% of the Medihelp tariff (the tariff contracted with hospitals for services).
  • Your cover for hospitalisation has no overall annual limit.
  • You may be responsible for procedure-specific co-payments for certain non-PMB procedures.
  • Sub-limits or maximum benefits for services and products such as prostheses as determined by your benefit option, will still apply.
  • All non-emergency hospital admissions have to be pre-authorised. If you don’t pre-authorise an admission, you will be responsible for a 20% co-payment on your hospital account.
  • All emergency admissions must be authorised on the first working day after the admission.
  • Emergency admissions are subject to the definition for emergencies as specified in the Medical Schemes Act.
  • Prime Network and Necesse members who voluntarily use non-network hospitals will be responsible for a 35% co-payment.

What information do I need to pre-authorise hospitalisation?

  • Your membership number
  • The details of the patient
  • The procedure and diagnosis codes as provided by your doctor
  • The doctor’s details and practice number
  • The details and practice number of the hospital you will be admitted to
  • The date and time of the planned admission
  • The details of the aneasthetist if you are having a dental procedure

REMEMBER: Some procedures will only be pre-authorised after you have submitted additional information such as test results, X-rays etc.(Which might require that you phone well in advance to pre-authorise a planned procedure.) Medihelp’s pre-authorisation consultants will advise you on what you will need when you contact us for pre-authorisation.


How do I pre-authorise hospitalisation?

  • Get immediate electronic pre-authorisation for certain procedures: Log in to Medihelp's Member Zone
  • You can use Medihelp’s smartphone app for members
  • Email all the detail as required to hospitalauth@medihelp.co.za
  • Contact Medihelp’s pre-authorisation consultants at 086 0200 678
  • Fax the details to 012 336 9535
  • For dental procedures, you can phone the Dental Risk Company (DRC) at
    012 741 5143 or email auth@dentalrisk.co.za.


Can I get immediate e-authorisation for some procedures?

Yes. Medihelp has an e-authorisation process for all the procedures listed below:

  • Adenoidectomy
  • Appendectomy
  • Caesarean section
  • Cholecystectomy
  • Circumcision
  • Colonoscopy
  • Cysto-urethroscopy
  • Dilatation and curettage
  • Gastroscopy
  • Hysterectomy
  • Hysteroscopy
  • Intra-uterine devices
  • Laparoscopy
  • Myomectomy
  • Myringotomy
  • Normal birth
  • Sterilisation
  • Tonsillectomy
  • Vasectomy


How do I get immediate e-authorisation for a procedure?

  • Click on Login/Register at the top of this page, select “Members” to go to the member secured site and click on Login. If you haven’t registered for the secured site yet, click on “Register”, follow the easy steps to register and then log in to the secured site for members.
  • Click on the “Pre-authorisation” option on the menu and select “Hospital authorisation”. Follow the steps to authorise you hospital admission. You will receive an SMS and an email from Medihelp with your authorisation reference number within moments.


How do I get authorisation for dental procedures that need hospitalisation?

The Dental Risk Company (DRC) manages Medihelp’s dental benefits and you can phone them directly at 012 741 5143 or email auth@dentalrisk.co.za to pre-authorise hospital admissions for dental procedures. The DRC consultant will also be able to tell you whether your benefit option covers the treatment.

The DRC consultant will need the following information:

  • Your membership number
  • The details of the patient
  • The procedure and diagnosis codes as provided by your dentist
  • The treating dentist’s details and practice number
  • The details and practice number of the hospital/day clinic where you will be admitted
  • The date and time of admission
  • Details of the aneasthetist
Medihelp chat bot
Loading

Loading...