Pre-Authorisations

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

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

Failure to obtain hospital pre-authorisation will result in a R500 co-payment

THE FOLLOWING BENEFITS REQUIRE 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 treatment plan - all related services
    • Rehabilitation - patients acutely disabled due to the result of a stroke, spinal cord injury or brain injury
    • 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 - PMBs 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

    Imperial Motus Med 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 and to obtain pre-authorisation in advance for the treatment.

    Day-to-day/out-of-hospital dental treatments that do require pre-authorisation 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 mailto:dentalauth@momentum.co.za to obtain pre-authorisation or call 0860 467 374 for assistance.


Request Pre-Authorisation

  • 1
    You, your treating doctor or hospital should obtain pre-authorisation 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 care coach will liaise with the hospital staff and/or treating doctor to ensure the appropriate treatment is received

Hospital pre-authorisation Reference Guide

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Imperialmed Dental Benefits

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