Understanding your Hospital Benefit and the authorisation process

To authorise your hospital admission, please phone us on 0860 11 33 22 , from 7:00 to 17:00 during weekdays.

See your doctor before preauthorising your admission

Before you preauthorise your hospital admission (unless it's an emergency or for a birth), you need to visit your doctor for an examination.

You must preauthorise for full hospital cover

You need to preauthorise your hospital admission (except for emergencies) at least 48 hours before. If you don't, we'll only pay 70% of the hospital cover to which you're normally entitled. You'll have to pay the remaining 30%.

You need to give us these details:

• Your scheme membership number
• When you will be admitted into hospital and how long you will stay
• Your treating doctor's name and practice number
• Your diagnosis (ask your doctor for the ICD-10 diagnosis code)
• The procedure name and code, if available (ask your doctor for the RPL procedure codes). Members can send the procedure codes to the Scheme ahead of the procedure to confirm what is covered and if there is any shortfall payable by the member to the treating surgeon specialist if they are not a DSP.
• The name and practice number of the hospital or day clinic.
• If a member does not have gap cover to cover any shortfall from any provider, it is important that the member discusses the possibility of shortfalls with all service providers before having the treatment, to avoid payment demands from the non-DSP doctor practice for the shortfall.
• The date of the procedure.

HOW THE HOSPITAL BENEFIT WORKS

This Benefit covers expenses incurred while you are in hospital, if we have confirmed cover for your admission. The Hospital Benefit covers theatre and ward fees, X-rays, blood tests and the medicine you have to take while you are in hospital, if you have preauthorised your admission.

NETWORK HOSPITALS

To get cover without co-payments, members must use hospitals in the UKZN Medical Scheme Hospital Network. The use of a non-network hospital for a planned procedure will result in co-payments payable by the member. Please note that this only applies to planned procedures. In emergency situations you will always be treated at the nearest hospital. In some cases, you may be transferred to a network hospital when you are in a stable condition and when your treating doctor deems it appropriate to move you to a network hospital.

UKZN MEDICAL SCHEME HOSPITAL NETWORK

KwaZulu-Natal

• Ethekwini Hospital and Heart Centre
• Hillcrest Private Hospital
• Lenmed Howick Hospital Life Chatsmed Garden Hospital Life
• Entabeni Hospital
• Life Westville Hospital
• Midlands Medical Centre
• Netcare Kingsway
• Netcare The Bay Hospital
• Pietermartizburg Mediclinic

Free State

• Horizon Eye Centre
• Life Rosepark Hospital
• Universitas Private Hospital

Western Cape

• Cape Town Mediclinic
• Delta Life HealthCare Hospital
• Life Mercantile Hospital
• Life Vincent Pallotti Hospital
• Melomed Gatesville Medical Centre
• Melomed Mitchells Plain Medical Centre
• Panorama Mediclinic
• Vergelegen Mediclinic

Gauteng

• Arwyp Medical Centre
• Clinix Lesedi Private Hospital
• Clinix Sebokeng Private Hospital
• Clinton Medical Clinic
• Emfuleni Mediclinic
• Genesis Clinic (Saxonwold)
• Legae Mediclinic
• Life Bedford Gardens Hospital
• Life Carstenhof Clinic