Do I need Pre-authorisation for treatment in hospital?

It is a requirement set by the medical aid fund, that authorisation should be obtained from the Fund before any hospital procedures are performed. Pre-authorisation protocols ensure that procedures are covered by the Fund and proof of membership is verified.

Please note: Pre-authorisation is not a guarantee of payment.

Pre-authorisation for treatment in hospital is only valid and restricted to conditions for which such pre-authorisation has been requested and subsequently granted. Any treatment falling outside of the scope of such pre-authorised treatment will require an update and further authorisation from NHP and Medscheme Namibia.

Benefits Excluded:

  • Breast reduction and enlargement
  • Hyperbaric oxygen treatment
  • Injuries arising from alcohol/drug abuse
  • Injuries arising from riots and civil war
  • Complications arising from procedures not covered by the Fund