Pre-authorising your hospital admission

In an emergency, go straight to hospital but call us or get someone to call us on the first working day after your admission. To authorise your hospital admission, please phone us on 0860 002 134, from 8:00 to 17:00 during weekdays. Please preauthorise your admission at least 48 hours before you go to hospital.

You need to give us these details:

• Membership number
• The date you will be admitted to hospital and how long you will stay
• Admitting healthcare provider's name and practice number
• Diagnosis (ask your healthcare provider for the ICD-10 diagnosis code)
• Procedure name and code, if available (ask your healthcare provider for the RPL procedure codes)
• Name and practice number of the hospital or day clinic
• Date of the procedure.

Please note:

• If one of your dependants is admitted, give us their details
• There is no overall hospital limit on either network option
• Limits apply to some healthcare services and procedures.

Cover is subject to our rules

We pay for medically appropriate claims. Your cover is subject to our Scheme rules, funding guidelines and clinical rules. There are some expenses that you may incur while you are in hospital that your benefit does not normally cover, for example private ward costs. Private wards are covered for medically justifiable cases only and subject to preauthorisation. Certain procedures, medicines or new technologies need separate confirmation while you are in hospital.

Cover for Prescribed Minimum Benefits

For Prescribed Minimum Benefits, we pay hospital admissions for a defined list of 271 diagnostic treatment in full at our Designated Service Providers.

How we cover your childbirth

We cover childbirth, including home births done by midwives with valid practice numbers and who are appropriately registered with the Board of Healthcare Funders. You must authorise the childbirth admission to hospital or home birth with us before you go to hospital. Remember to register your baby with us as soon as possible so we can cover the baby.

There are certain limits for childbirth benefits:

How we cover your healthcare providers

Your healthcare providers accounts are separate from the hospital account. Healthcare provider accounts may include specialist accounts and other related accounts, for example accounts from a surgeon, anaesthetist, pathologist, or radiologist.

If your healthcare provider is a provider participating in the network, he or she will be covered in full. You can access the find a healthcare provider tool to search for the healthcare providers who participate in the network.

Benefits

All admissions are subject to prior authorisation.

Note: Discovery and the Scheme's in-hospital clinical protocols will be applied.