Going to hospital
Hospital admission and treatment whilst in hospital
The details of the authorisation, including possible exclusions, will be emailed to you (if we have your email address and you are requesting the authorisation), your treating healthcare professional and the hospital.
Make sure to clarify any uncertainty you may have with your treating practitioner or the Fund prior to your admission as some procedures, items and medication may not be covered or you may have to pay some of the costs. Should the treating practitioner disregard the terms and conditions of the authorisation, you will remain responsible for the costs incurred.
Where possible, make use of a hospital in the KeyCare Network, specialists and other medical service providers on the Fund’s Network lists to optimise benefits and minimise co-payments for treatment while in hospital. Please visit the Fund’s website at www.engenmed.co.za to find the nearest Network GP or Specialist to you.
When you need to go to hospital for a planned PMB procedure or treatment, and want the Fund to pay all costs related to the care in full, your admitting doctor must be a DSP GP or Specialist and you must go to a hospital in the KeyCare Hospital Network.
Funding of accommodation in a private ward is subject to a motivation from the attending practitioner and authorisation.
A co-payment applies in the case of elective investigative endoscopies, if these procedures are performed in hospital (Colonoscopy, Sigmoidoscopy, Proctoscopy, Gastroscopy, Cystoscopy, Arthroscopy, Laparoscopy and Hysteroscopy).