Benefits & claims
Pre-authorisation explained
By Naledi Mokoena · 4 min read · Updated 24 June 2026
Pre-authorisation is approval you get from your medical aid before a planned hospital admission or certain procedures, confirming the scheme will cover the care and telling you any co-payment. Without it, the scheme can apply a penalty or reject the claim, even for treatment it would otherwise have paid.
Pre-authorisation is one of the easiest ways to avoid a nasty bill, yet it is often forgotten in the rush of a hospital booking. This short guide explains what needs it and how to get it.
What needs pre-authorisation
You typically need pre-authorisation for:
- Any planned hospital admission
- Day surgery and many procedures
- Scopes, MRI and CT scans
- Specialised radiology and oncology treatment
Your benefit guide lists exactly what needs authorisation on your plan. When in doubt, call the scheme before the date.
How to get authorised
To get pre-authorisation:
- Get the procedure and tariff codes from your doctor.
- Call the scheme or use the app with your membership number, the codes, the hospital and the date.
- The scheme issues an authorisation number and tells you any co-payment.
- Give the authorisation number to the hospital on admission.
Do this a few days ahead of a planned admission where possible.
Emergencies
In a genuine emergency you cannot stop to phone first, and you do not have to. Get treated at the nearest facility, then notify the scheme and arrange authorisation as soon as reasonably possible, usually within a day or two. Emergencies are PMBs, so valid emergency care must be covered even without prior authorisation.
Penalties for skipping it
If you skip pre-authorisation on a planned admission, the scheme can apply a penalty - often a percentage of the claim - or decline the claim. This is avoidable money lost. Always get the authorisation number before a planned procedure, and confirm any co-payment so there are no surprises on the bill.
Frequently asked questions
What is pre-authorisation?
It is approval from your medical aid before a planned hospital admission or certain procedures. The scheme confirms cover, issues an authorisation number, and tells you any co-payment that applies.
What procedures need pre-authorisation?
Planned hospital admissions, day surgery, scopes, MRI and CT scans, and specialised treatments usually need it. Your benefit guide lists the exact procedures for your plan.
Do I need pre-authorisation for an emergency?
No. In a true emergency, get treated at the nearest facility and notify the scheme afterwards, usually within a day or two. Emergencies are PMBs and must be covered.
What happens if I skip pre-authorisation?
The scheme can apply a penalty, often a percentage of the claim, or reject it. Getting the authorisation number before a planned procedure avoids this avoidable cost.
How do I get an authorisation number?
Call the scheme or use the app with your membership number, the procedure and tariff codes, the hospital and the date. The scheme issues the number, which you give to the hospital.
How far in advance should I pre-authorise?
A few days before a planned admission is ideal. This gives time to confirm cover and any co-payment, so there are no surprises on the day of the procedure.
