What is Pre-Authorisation and Why Is It Important?

Pre-authorisation is the formal process where members notify Affinity Health in advance before undergoing certain planned hospital admissions or medical procedures. This process is essential because it allows Affinity Health to confirm benefit eligibility before treatment begins, ensuring members avoid delays or out-of-pocket costs on the day of admission. Most hospital-based treatments, surgeries and some specialised diagnostic procedures require pre-authorisation to be covered under your hospital or combined plan.

Key Steps in the Pre-Authorisation Process

1. Consult your healthcare practitioner and receive recommendation for a procedure or admission.
2. Contact Affinity Health’s pre-authorisation team (via phone or their designated contact channels) as soon as a procedure date is set-ideally at least 72 hours in advance.
3. Submit required documentation, such as your Health Insurance membership number, details of the planned procedure, and the admitting doctor's information.
4. Wait for confirmation: Affinity Health assesses your benefits, checks policy coverage, and approves or provides feedback on your request.
5. Receive pre-authorisation reference-this unique code must be presented at the admitting hospital or clinic.

When Do You Need Pre-Authorisation with Affinity Health?

• Planned admissions to hospital (for surgery, maternity, medical observation, etc.)
• Certain specialised diagnostic procedures (for example, MRI or CT scans requiring hospital resources)
• All non-emergency ambulance transfers

Routine day-to-day benefits-like standard GP visits or basic dentistry-do not require pre-authorisation for Day-to-Day Plan clients. However, any event requiring hospitalisation or advanced treatment should be vetted in advance for uninterrupted service.

How is Your Request Assessed?

Each application is reviewed by Affinity Health’s medical team, referencing your policy details, waiting periods, and benefit inclusions. Members receive clear feedback: approval, required additional information, or alternative covered procedures. This helps safeguard members from unexpected exclusions at the point of care.