Pre-authorisation is based on a clinical decision and is not a guarantee of payment. Benefits are funded subject to the benefit limits and availability of funds at the time the claim is received by the Scheme for processing, and in accordance with the relevant protocols and Scheme rules. Authorised services or treatment must commence within three months of authorisation.
Authorisation does not include the fees charged by the attending medical practitioners, It is the member's responsibility to obtain pre-authorisation, which should be obtained at least seven days prior to the commencement of treatment or services. In case of after-hours emergencies, authorisation must be obtained the next working day.