Cover for planned hospital admissions

We cover you in hospital for emergency and planned hospital admissions. In an emergency, go straight to hospital but call us or get someone to call us within 12 hours. For planned hospital admissions, please call us 48 hours before you go to hospital to confirm your admission. 

Before you go to hospital for any planned procedure, you must:

  • See your doctor
  • Call us on 0860 100 693 to confirm your hospital admission at least 48 hours before you go to hospital. If you do not confirm your admission, we will only pay 70% of the costs that we would normally cover.

When you contact us, give us the following details:

  1. Your membership number
  2. When you will be admitted to hospital and how long you will stay
  3. The date of the procedure
  4. The name of the hospital or clinic
  5. Your treating doctor’s name, practice number and phone number
  6. Your diagnosis (ask your doctor for the ICD-10 diagnosis code)
  7. The procedure name
  • If one of your dependants is admitted, give us their details.
  • There is no overall hospital limit on the Anglovaal Plan.
  • Limits apply to some healthcare services and procedures.

Cover is subject to our rules

We pay medically appropriate claims. Your cover is subject to our Scheme rules, funding guidelines and clinical rules. There are some expenses that you may incur while you are in hospital that your benefit does not cover, for example private ward costs. Certain procedures, medicines or new technologies need separate confirmation while you are in hospital.

Cover for Prescribed Minimum Benefits

For Prescribed Minimum Benefits, we pay hospital admissions for 270 defined conditions in full at our designated service providers our choice of healthcare professionals.

How we cover your childbirth

We cover childbirth from your Hospital Benefit, including home births done by midwives with valid practice numbers and who are appropriately registered with the Board of Healthcare Funders. You must authorise the childbirth admission to hospital or home birth with us before you go to hospital. Remember to register your baby with us as soon as possible so we can cover the baby.

There are certain limits for childbirth benefits:

Childbirth serviceLimit
Pregnancy scansTwo 2D scans for each pregnancy, which we pay from the available money in your Medical Savings Account
Normal vaginal deliveriesA stay of three days and two nights in hospital
Caesarian sectionsA stay of four days and three nights in hospital

How we cover your healthcare professionals

Your healthcare professionals’ accounts are separate from the hospital account. Healthcare professional accounts may include specialist accounts and other related accounts, for example accounts from a surgeon, anaesthetist, pathologist or radiologist.

Healthcare professionals are free to set their own rates.

If your healthcare professional charges the Scheme Rate, we will pay him or her directly. If your healthcare professional charges more than the Scheme Rate, we will pay you. You will have to make sure you pay your healthcare professionals the full amount.

If your healthcare provider is a provider participating in the Discovery Health network, he or she will be covered in full. You can access the MaPS tool to search for the healthcare professionals who participate in the Discovery payment arrangements.

Your benefits for 2019

All admissions are subject to prior authorisation

Note: Discovery and the Scheme’s in-hospital clinical protocols will be applied

Hospital BenefitThe limit on this benefit
Admission for a Non-Prescribed Minimum Benefit (Non-PMB)
  • Unlimited
  • General ward at a private or state facility or day clinic
  • Scheme Rate
Admission for a Prescribed Minimum Benefit (PMB)
  • Unlimited in terms of the Medical Schemes Act
  • General ward at a designated service provider
  • 100% of PMB tariff
Emergency evacuation (road or air)
(Note: this excludes planned transfers)
  • Subject to authorisation by ISOS
  • Subject to the annual limit.