Hospitalisation

As a member of the Standard Care Plan, you have access to day clinics, facilities and private hospitals on the Scheme's Hospital Network. If you choose a non-network facility, a co-payment of R3 615 will apply. If a member is admitted to a non-network facility in a medical emergency (where a patient's life is in danger), no co-payment will be required.

For planned admissions, ensure your specialist works from a day clinic, facility or hospital on the network.

Search for "Private Hospitals and day clinics" in the provider search after logging in, or find a facility on the Hospital Network here or by calling the Call Centre.

Planned hospital admissions must be authorised. Most hospitals require benefit confirmation before admission and completing Anglo Medical Scheme's simple authorisation procedure will prevent any delay at the time of admission. Call us on 0860 222 633 for authorisation.

Hospital cover is unlimited and paid at 100% of the Scheme Reimbursement Rate (SRR).

Hospital services includes allied healthcare services (as determined by the Scheme), day cases, blood transfusions, radiology, pathology, professional services and 7-day supply of to-take-out medication.

You will not have to pay for any claims for the treatment of Prescribed Minimum Benefit conditions except for specific Scheme exclusions. Scheme protocols apply.

Members have access to step-down facilities where intermediate care is necessary, subject to Scheme protocols. Contact the Call Centre on 0860 222 633 for authorisation.

Internal surgical prostheses are subject to an annual limit of R77 295 per beneficiary.

Specific procedures can also be done in doctors' rooms instead of a hospital. You still need to call us to get authorisation for these procedures.

Emergency Hospital Admissions
You do not require an authorisation for emergency admissions at the time of the emergency. However, please contact Anglo Medical Scheme on 0860 222 633 the next day. Once the Scheme is aware that you have been hospitalised, more effective management of the case is possible. Emergency admissions (where a patient's life is in danger) do not result in a co-payment should you be admitted to a non-network hospital.

Psychiatric admissions are limited to 21 days in-hospital treatment or 15 days out-of-hospital psychotherapy sessions per beneficiary per annum for certain mental health conditions.

Information required when calling for authorisation:

• Membership number
• Date of admission
• Name of the patient
• Name of the hospital
• Type of procedure or operation, diagnosis with CPT code and the ICD-10 code (obtainable from the doctor)
• The name of your doctor or service provider and the practice number