Pre-Authorisations

Prior to a patient being admitted to private or public facilities, including MRI/CT scans, as well as PMB-related admissions, a Pre-Authorisation (0860 467 374) is required.

The Pre-authorisation (0860 467 374) process validates benefits availability and determines if a medical procedure is clinically required. The granting of pre-authorisation (0860 467 374) does not guarantee full payment of your claims. The Scheme requires pre-authorisation (0860 467 374) for all in hospital services and specific out of hospital services. See below which services require pre-authorisation (0860 467 374).

Failure to obtain hospital pre-authorisation (0860 467 374) will result in a R500 co-payment

THE FOLLOWING BENEFITS REQUIRES PRE-AUTHORISATION (0860 467 374)

  • Major Medical Expenses
    • All in-hospital services
    • Post-operational physiotherapy - after hip, knee & shoulder replacement surgery and spinal surgery only
    • Diagnostic services
      • Radiology & Pathology - in hospital
      • MRI, CT and Radio-isotope scans - in and out of hospital
      • Ultrasound scans - in and out of hospital
      • PET scans - in and out of hospital
      • Sleep studies - in and out of hospital
    • Nursing services, sub-acute care and Hospice services - at an out of hospital facility
    • Ambulance services
    • Internal prostheses - in hospital
    • Renal Dialysis - all related services
    • Organ transplants - all related services
    • HIV & Aids - in and out of hospital
    • Maternity benefits, including maternity care plan - all related services
    • Rehabilitation - patients acutely disabled due to the results of a stroke, spinal cord injuries or brain injuries
    • Psychiatric institutions and substance & alcohol abuse - in hospital
    • Stoma care products - in and out of hospital
    • Cochlear implants
    • Dental related surgery - in hospital
    • Excimer laser, Radial keratotomy, Holmium procedures, LASIK, Phakic lenses and intra-stromal surgery - in hospital/ eye clinic
    • Breast reduction and cosmetic surgery - if clinically appropriate
    • Prosthetic limbs and eyes - in hospital, every two to five years
    • Infertility - PMB only
    • Oncology - in and out of hospital
    • Home Oxygen cylinders, concentrators and ventilation expenses - out of hospital
    • External medical appliances - out of hospital. Only items above R1 000 require pre-authorisation (0860 467 374)
    • Hearing aids - out of hospital. Over a three year cycle
    • Chronic medicines - out of hospital
  • Dental Services

    Imperialmed provides five different day-to-day (out-of-hospital) dental benefit categories of which three requires pre-authorisation (0860 467 374).

    It is important to discuss treatment with your dentist in advance in order to establish whether the treatment that is needed or planned falls in a category that requires pre-authorisation (0860 467 374) and to obtain pre-authorisation (0860 467 374) in advance for the treatment.

    Day-to-Day/Out of hospital dental treatments that do require pre-authorisation (0860 467 374) is listed below:

    • Specialised dentistry - day to day/out of hospital (Health Plan only)
    • Dental implants - day to day/out of hospital (Health Plan only)
    • Orthodontic treatment - day to day/out of hospital (Health Plan only)

    Email the dental quotation and X-rays to dentalauth@mmiholdings.co.za to obtain pre-authorisation or call 0860 467 374 for assistance.


Request a Pre-Authorisation (0860 467 374)

  • 1
    You, your treating doctor or hospital should phone Imperialmed on 0860 467 374

    Required information

    Membership Number The name and practice details of the admitting doctor The date of admission to hospital or clinic The name of hospital or clinic The medical condition The diagnosis The ICD-10/procedure codes The type of procedure/operation (where applicable) The expected length of stay
  • 2
    If the authorisation is granted, the caller will be given the authorisation number and it will be e-mailed/faxed to the hospital and/or treating doctor
  • 3
    A case manager will liaise with the hospital staff and/or treating doctor to ensure the appropriate treatment is received

Hospital pre-authorisation Reference Guide

Imperialmed Dental Benefits