Pre-Authorised Admissions on hospital plans
The purpose of a hospital plan is as straightforward as it sounds – it exists to cover the expense of hospitalisation and related medical procedures. Depending on the type of hospital plan you have and the operation being performed, your medical aid will cover the entire cost of the in-hospital procedure and your overnight hospital stay, subject to certain conditions such as pre-approval, having been met.
All Selfmed’s options will cover 100% of the Agreed Tariff for hospital accommodation, theatre, medicine and materials used while you are being hospitalised.
Although outpatient treatment and medicine after discharge is not always covered, the SelfmedMEDXXI Hospital option nonetheless constitutes great value for money. Knowing that one is comprehensively covered in terms of hospitalisation brings with it a great sense of peace of mind.
In the case of pre-authorised hospital admissions, you’ll know ahead of time whether your operation has been approved, as well as what percentage of the expense your hospital plan will cover, based on the benefits available to you.
Over and above paying for pre-authorised operations, there are a number of medical procedures not directly associated with hospitalisation that are covered by Selfmed’s hospital plans. A 100% benefit is paid for upper and lower gastro-intestinal endoscopies, as well as for laser tonsillectomies, MRIs and CT-Scans. Some of these procedures are subject to separate pre-authorisation if they are undertaken not as part of hospitalisation. Selfmed will also cover the cost of blood transfusions, should these be required by the member. (please check with consultant; these benefits are subject to change)
Medical aid hospital plans serve to ensure that expenses incurred as a result of hospitalisation are covered by your medical aid scheme. It is important to note, however, that when your procedure is pre-authorised, payment of your claim is not necessarily guaranteed. Any payment made by South African medical aid companies are subject to the benefits available to members at the time.
The onus is on the member to contact Selfmed in order to verify whether the requested pre-authorised procedure is fully covered.